An electronic medical record or EMR, also known as an EHR or electronic health record, is an IT based healthcare system designed to improve efficiency in practices of all sizes. Initially, it was widely assumed that EHRs would improve efficiency and decrease medical costs nationwide. More recently it has become rather obvious that this is not going to be true in all instances. In fact, it has been determined that the sharing of information between medical practices, a feature which is fundamental to the efficacy of this system, has not been taking place as widely as had been expected.

This makes it even more critical that each individual stakeholder in a physician’s practice or larger healthcare organization take the time needed to ascertain whether or not the selected EMR/EHR will be appropriate for their environment, and that it will both improve efficiency and lower costs.

And, of course, along with choosing an EMR/EHR, it is critical that the medical billing system be analyzed and an appropriate revenue cycle management / medical billing system be chosen as well. In most instances, EMRConsultant will recommend that a medical practice choose an integrated system, from one vendor, that accomplishes all of the features of an EMR, inclusive of medical documentation, as well as that of medical billing.

In many instances, ambulatory health care facilities will have stand-alone, independent electronic health records. However, in many others, it will be integrated with that of their local hospital, and in fact in many instances it will be paid for and/or supplied by the local hospital on which the physician(s) is on staff.

As part of a hospital’s health information system, an EMR enables users to enter, store, retrieve and manipulate records. These systems have proven to be useful and a number of hospitals in the United States are leveraging them for delivering improved healthcare. Digitizing healthcare has resulted in a more efficient paperless work environment that allows physicians to spend more time on their practice and less time on administrative tasks. Or at least so goes the theory. In practice there are a tremendous number of failures in this industry, both in ambulatory EMR selection, as well as in hospital healthcare IT, and the ramifications of a failed implementation are potentially catastrophic. Obviously there are tremendous financial risks associated with failed EMR implementations, and just as obviously, the risk to healthcare is even greater!

Low but increasing Adoption of EMR in Hospitals

EMR systems have a lot to offer and ideally they should be eagerly deployed by practices. But the truth is that EMR adoption rates were still very low at the end of the last decade.

A 2009 research by SK&A Information Services, Inc. illustrates that 67% of medical offices with four or more physicians were not using any type of EMR software. Research by the government also indicates that very few physicians have a complete EMR system. Many practices still prefer to use more traditional ways of managing medical records and are not entirely convinced about using an electronic medical record system.

Cost is one of the major barriers for EMR adoption. Market research illustrates that historically, the cost of a good EMR system was about $25,000 to $75,000. This was for a client/server system. With the advent of cloud computing, the monthly license fees for most ambulatory EMRs is drastically lower.

Practices frequently previously had to pay an upfront fee to own the system and also bear the various charges associated with the implementation. Researchers have observed that many practices are not willing to pay the recurring maintenance charges or hire additional IT staff to run these systems. Many physicians are happy with paper records systems because it doesn’t involve a lot of expenditure, and because they are used to documenting without an EMR. Security is another reason for concern and a large number of practices think an EMR system may lead to a security breach at their healthcare facilities. Recent lawsuits concerning improper speech recognition and other EMR associated liabilities increase this concern.

Hospitals have witnessed an increase in the number of computer hackers in recent years. These hackers can access patients’ medical records, get a hold of important information such as their social security numbers, and misuse the data for their benefit. This can be a nightmarish experience for both the patient and the hospital. These cases have been reported by practices using EMRs and they had a tough time dealing with angry patients. It has been reported that some hospitals don’t adopt electronic medical record systems because their patients don’t want to be treated in healthcare facilities that use these solutions. The patients are worried that their health information may be used by insurance companies and this may ultimately lead to denial of health and life insurance policies. Obviously, while these reports have occurred, it is unlikely that hospitals will be able to resist the rush to EMRs forever.

American Recovery and Reinvestment Act of 2009

The low adoption figures of EMR systems are alarming and the government is trying to encourage healthcare information technology adoption through the “American Recovery and Reinvestment Act of 2009.” The ARRA not only encourages physicians to adopt EMR systems in their healthcare facilities but also aims to give the much needed boost to a sour U.S. economy. The government hopes ARRA will drive EMR adoption and this will result in reduced medical errors. (Time has shown that at least the first of these has turned out to be true.) This in turn, in theory, will save the nation tens of billions of dollars each year. The U.S. government has set aside $19 billion for practices that will adopt electronic medical record systems. These funds will be available from 2011 and those seeking grants under ARRA 2009 can receive $44,000 to adopt and ‘meaningfully use’ an EMR. The money will be given to practices over a period of five years, with the bulk of the payments provided in the first 2 years. The maximum amount physicians that accept Medicare can receive from the EMR stimulus is $44,000 but this increases to over $60,000 for physicians who are heavily involved in treating Medicaid patients. This economic stimulus package is expected to provide significant revenue opportunities for EMR vendors and service providers, and this too has proven to be true. However, unfortunately, the rush to acquire technology has lead to an incredible number of improper selections. At EHR Scope we are increasingly seeing a tremendous number of clients who have acquired an EMR/EHR, and/or a medical billing system, and have had nothing but nightmares associated with their selection.

In the previous decade, almost all of our clients were looking for their first EMR. Now they are looking for their second, third, or sometimes even fourth program. Needless to say, the nightmares associated with an improper implementation can destroy a practice. And, the migration of data from one EMR to another EMR is not always a smooth, painless or inexpensive process.

How to Qualify for the Stimulus Package?

The U.S. government is offering huge incentives to practices willing to adopt an EMR system and this has encouraged many physicians to research how they can benefit from this opportunity. To receive the benefits of the EMR stimulus individuals have to be qualified medical professionals, not be hospital based, and must be able to demonstrate meaningful use of a certified EMR. The term ‘meaningful use’ was not originally clearly defined by the authorities but this was clarified in the spring of 2010.

In order for an EMR to be certified by the Certification Commission for Healthcare Information Technology ( CCHIT ) or any other ONC-ATCB certifying body, it must have robust features, including each of the following:

  • -e-Prescribing
  • Clinical Reporting
  • Information Exchange

In addition, the practices are also required to submit Medicare Part B claims if they want to receive EMR stimulus funding. Practices can qualify even if they were using an EMR before the ARRA 2009 was passed. They can send their applications to qualify for the early adopter incentive and if they succeed in qualifying before 2011 can receive an additional $3,000 for the first year. The EMR stimulus is calculated by adding 75% of their Medicare Part B claims, up to the maximum amount allowed, per year. Practices interested in getting the early adopter bonus of $3,000 should use the EMR at the point of care. Physicians seeking the full amount should note that they must implement an EMR system by 2012. Please note that no EMR stimulus funding will be provided after 2015.

Penalties For Not Adopting an EMR System

Practices that don’t intend to adopt an EMR in near future may face penalties. Health practitioners should make efforts to demonstrate meaningful use of electronic medical records by 2015 to avoid a reduction in their Medicare payments. These reductions will increase with time

  • 1% reduction in 2015
  • 2% in 2016
  • 3% in 2017
  • Up to 5% after this point

The EMR stimulus program can be considered to be essentially a reimbursement offer which can be utilized by the many practices that don’t have the funds to invest in an electronic medical record system. The current unfavorable economic climate has also affected the purchase decisions of practices that are struggling with cost cuts and find it difficult to take out money for an expensive solution.

Now that a large number of cloud-based EMRs and medical billing / revenue cycle management systems are available with substantially lower upfront costs, the financial burdens on a practice are materially lower than they had been. This has been among the reasons for the massive uptick in health information technology acquisitions.

Practices should do their research to purchase an EMR system that qualifies for the stimulus package if they want to receive funding through this program. There are hundreds of EMR vendors in the market, and practices may find it difficult to quickly purchase a solution that fits their needs. But EMR experts suggest practices to act fast. Practices that implement EMR technology in a meaningful fashion early on will receive the highest payouts. These experts frequently advise physicians to choose the simplest cost–effective, scalable EMR system that meets their practice needs and conforms to meaningful use requirements, and in particular, in order to minimize costs and maximize reimbursement, it is usually recommended that a cloud-based combined EMR / Medical billing system be acquired and implemented.