Alerts Alerts -- Alerts are most important for specialists who deal with urgent or critical issues, (e.g. Cardiologists).
Notification of required annual or follow-up testing.
Notification of required medication renewal.
Notification of prescription refills requested by the patient.
Notification of drug interactions.
Notification of possible reactions due to allergies.
Notification of abnormal laboratory results.
Appointments/Billing (PM) Appointments/Billing (PM) -- The Practice Management system can be integrated with the EHR, or can be a separate component. If you plan on purchasing ONLY an EHR, do not check this feature, which can include each of the following:
Creation of the SuperBill within the EMR that is automatically sent to the billing software via Electronic Data Interchange (EDI).
Creation of the SuperBill within the EMR that is manually entered into the billing software.
Ability to identify the status of all SuperBills.
Ability to interface to the Clearinghouse used for billing.
Ability to interface to insurance companies for submission of a bill.
Ability for a coding tool to suggest ways to correct up-code encounter documentation to receive a higher level of reimbursement.
Tools to create, change, confirm or cancel an appointment.
Tools to send a reminder to the patient via email.
Tools to handle the scheduling for individual healthcare providers.
Tools to schedule specific rooms in the practice for specific purposes.
Customized Templates Customized Templates -- For many physicians, implementing an EHR will be easier if you utilize templates judiciously. Two concepts to keep in mind are that some EHRs will come with a wide variety of pre-loaded templates, and other systems will allow you to easily incorporate your own templates into their structure.
Decision Support Decision Support -- Decision Support is one of the critical features required by the Federal Government in order to take advantage of the HITECH Act's stimulus funding. Features included within decision support can include each of the following:
Standards of Care support tools within the EHR customized to the practice.
Customized order sets based on a patient's diagnosis.
Quality measures linked to an order set.
Treatment protocols using pre-defined order sets.
The ability to prompt the physician for PQRI-related coding, when applicable to the patient's diagnosis or procedure.
Access to the internet and favorite sites to review the newest information on standards of care.
Document Management Document Management -- The ability to scan multiple documents belonging to one patient and automatically assign them to the patient's EMR.
Additional features that relate to document management include:
The ability to receive a fax via the computer and assign it to the appropriate reviewer.
The ability to send a fax of patient information via the computer to a requestor.
The ability to automatically date stamp a document at time of receipt and at time of viewing to create an audit trail.
The ability to upload a document directly from the internet and assign it to the appropriate reviewer or place it in the patient's EMR.
The ability to prioritize documents so the most important are handled first.
The ability to respond to a subpoena and/or a patient request with a specific set of documents.
The ability to view all faxed or uploaded documents in one location relating to an individual patient.
Documentation Ease Documentation Ease -- Some of the more sophisticated programs use algorithms which allow future reports to be modeled after past reports, while others utilize rather rigid templates.
There are advantages to each methodology, and some of the more rigid templates allow for more structured reporting and E&M coding capabilities. However, reports produced by programs of this nature may appear rather stilted and "cookie cutter."
The EHR Companies will tell you that they can help you produce medical reports quickly. We recommend testing this feature on some sample patients, to determine which style is most suitable to you.
Methods that are utilized to help ease the documentation burden include:
Voice Recognition such as Dragon Medical
Handwriting Recognition Tools
Use of "QuickNotes" or "normal" encounter documentation that automatically populates the fields.
Photos/Drawings
The ability to create a "sticky" or "post-it" note on a document.
Automatic generation of a consultation or progress note with the practice information on it.
Dragon Medical Dragon Medical -- The world's leading speech recognition solution series designed specifically for physicians. By eliminating physicians' sole reliance on typing, clicking and scrolling, something that 67 percent of doctors surveyed cited as a concern ("time associated with reliance on keyboard and mouse to document within an EHR"), healthcare providers can allocate more time toward patient care instead of reporting. Because most doctors speak at least three times faster than they type, speech recognition software can improve physician productivity by up to 25 percent, as compared to a non-speech-enabled system.
e-Prescribing e-Prescribing -- e-Prescribing is one of the most basic features of a modern Electronic Health Record, and unless you do not anticipate writing prescriptions (such as will be the case for Physical Therapists and Chiropractors), we strongly recommend purchasing a software program that has robust e-Prescribing features.
E&M Coding E&M Coding -- Most modern EHRs provide sophisticated algorithms to ensure that you are coding at the proper level, based upon the documentation that you have provided for each encounter. In many systems recommendations are further provided to suggest additional documentation which could be undertaken to allow you to code at the next higher level.
Health Maintenance Health Maintenance -- Health Maintenance Guidelines are available from birth to death for healthy individuals as well as for a large number of disease states.
These can be particularly helpful for physicians who may be incentivized by various third parties to provide, and prove that they are providing high quality care, as well as for those physicians who truly wish to follow the guidelines provided by various organizations.
Issues that may be addressed in the Health Maintenance Guidelines include:
Immunizations / Vaccinations
Cholesterol levels
Glucose levels / A1C
Blood Pressure
Colorectal cancer screening
Bone mineral density>
PAP Smear
Mammograms
Prostate Cancer Screening
Internal Messaging Internal Messaging -- Tremendous increases in efficiency can be obtained by utilizing an internal and/or external messaging system effectively.
Interfaces Interfaces -- A modern EHR can interface with a bewildering assortment of other organizations and pieces of equipment.
Mobility Mobility -- A modern physician does not need to be in their office in order to "see" patients. Using an iPhone, for instance, you can view your schedule, see the laboratory results on your patients, see a summary of their patient record or just about any other information you may need.
Outsourced Billing Outsourced Billing -- Many offices realize that they are most efficient when they do what they were trained best to do, and that is to provide medical care. Medical billing is a specialty all by itself, and physicians can be more productive and earn a higher net income by outsourcing this task to an expert in the field.
Indications that you should strongly consider an outsourced billing solution include:
You see patients covered by a wide variety of insurance types
You have a small multi-specialty group
You practice in a high rent district
You have difficulty hiring qualified employees
Salaries are high in your geographic area
Your collection ratio is below industry average
You are a new practice and want to concentrate on other issues
You do not have enough space in your office
An outsourced billing service should provide the following:
Integration with an EMR
Generation and submission of electronic and paper claims
Confirmation of receipt of claims and resubmission of lost claims
Posting payments and remittance advice received from payers, including scanning paper remittance advice into a practice management application for online reference
Following up on unpaid claims and denied claims and working to secure payment for them
Access to the latest coding and insurance rules to help prevent denial recurrences
A comprehensive reporting solution that at a minimum provides monthly reports, but ideally real-time reports as needed of patient panel size, A/R, claim status, collections and key performance metrics
Reviewing key performance metrics and notifying you proactively if performance is not consistent with targets/benchmarks
Committed billing and collections experts that work in partnership with you to maximize revenue
Specially trained staff that can proactively seek opportunities to help you improve practice performance
Patient Portal Patient Portal -- Patient Portals allow patients to access your EHR from outside of the office. This can have tremendous advantages, both in terms of efficiency as well as in terms of quality of care.
Revenue Cycle Management Revenue Cycle Management -- Revenue Cycle Management (RCM) is an all inclusive outsourced billing management service not to be confused with Billing. RCM is seamlessly integrated throughout a physicians practice and is implemented at the onset of the practitioner/patient relationship starting when the first appointment is made and concluding after payments and adjustments are made to zero a patient's account. Groups who have an efficient RCM usually have a higher percentage of increased yearly profit.
Robust Workflow Robust Workflow -- Workflow is one of the most difficult, and unfortunately, one of the most important concepts to understand when shopping for an EHR. We will start by providing a dictionary definition, but that probably will not be sufficient. "Workflow - The flow or progress of work..."
A few examples should assist. As an Allergist, it may be important for you to have a timer included within your patient flow in order to allow patients to leave the waiting room 20 minutes after their injection. As a Cardiologist, you will need to have the ability to move patients from the examining room to the stress test lab, and back. Dermatologists need to be able to bill for a large number of simultaneous procedures. Endocrinologists frequently require home glucose monitoring capability. An Infection Disease Specialist should have access to updated world literature from within the EHR. A multi-specialty office must have the ability to offer customizable workflow capabilities to each of the various specialties within the office. Many lower end products have a hard-wired workflow which may be suitable for a specific specialty, but may not be modifiable for others.
We strongly recommend that you very carefully visualize having patients walk through your office, envisioning the various activities they will perform, and the various locations they will visit. Make sure that the programs you consider are capable of handling each of the diverse actions.
Some specific capabilities of a robust workflow include:
The ability to create an assignment for each staff member and track it to completion.
The ability to create practice specific letters, forms and reports.
The ability to view all incoming faxes and other uploaded documents in one location, or to be able to segregate them so that only certain subsets are available for viewing by various staff members.
Role-based Security Role-based Security -- There are different security requirements for Software as a Service (SaaS) installations in comparison to Client/Servers. You must ensure that you remain HIPAA compliant at all times. Interfaces with outside entities must be taken into consideration.
