How are EHR Contracts Getting More Difficult?

EHR contracts contain an increasing array of complicating structures and dense terms that offer fewer and fewer commitments to your practice.  The problematic terms include:

Should ICD10s Affect Your EHR Strategy?

On October 1, 2014, practices will start submitting claims using the ICD10 coding system.  Any practice planning on using EHR systems to facilitate the transition to ICD10 needs to take a close look at the practicality of implementing an EHR in time to support ICD10 coding.

Will ICD10s be an EHR Challenge?

In theory, EHR systems will make ICD10 coding tolerable.  However, ICD10 coding presents a wide range of challenges to EHR vendors and users. 

Does Your EHR Present What Your Recorded?

With paper exam notes, the doctor and staff record information and the note reflects what they recorded.  Unfortunately, EHR based notes may not be as direct.

Why Are Patient Portals More Important Than You Think?

Patient portals facilitate the exchange of information between patients and physician practices.  What was once considered a nice option for your EHR is becoming a necessity.  Unfortunately, not all patient portals offer the same features.  Failure to acquire an adequate patient portal could limit your EHR benefits and increase your costs.

What ACO Features Are Needed in an EHR?

Most EHR systems are based on strategies that predate accountable care organizations (ACO) and Certified EHR standards.  The key EHR requirements for ACOs are the ability to electronically exchange patient information, support provider collaboration, and monitor patient care.  The EHR focus to date has been on creating patient exam notes and specifically meeting the Evaluation and Management documentation standards.  Most EHR products do not adequately accommodate the operational or management needs of the ACO structure.

Why You Need a Clinical End of Day Procedure?

At the end of the working day, every healthcare organization performs a reconciliation of fee tickets and receipts to assure that all charges and payments were properly posted and applied.  This effort assures the integrity and accuracy of the financial records.  A similar process is needed to maintain and assure the integrity of your EHR based patient information.

Do You Know The Paper Chart to EHR Transition Risks?

I co-authored a case study on Medical Professional Liability (MPL) Risk with Susan Lieberman, Vice President of Risk Management for Conventus Inter-Insurance Exchange.  This case study highlights the importance of making good transition decisions as well as the substantial number of MPL Risks and, more importantly, risk reduction strategies you need to use to avoid serious problems in the future.

Can Your Practice Afford Vendor Best Practices?

In addition to the pressure on practices to implement EHRs, EHR vendors have seen a surge in activity that is stretching, if not breaking, their ability to implement and/or support their products.  In order to deal with the accelerated adoption of EHRs, a number of vendors have developed “best practice” guides.

This cook book approach to EHR implementation helps the vendors standardize use and, in some cases, use less experienced people to put in an EHR.  Such “best practices” may implement your EHR in a way that may not be most effective for your organization.

Why Should Your EHR Be “In Service” by December 31, 2011?

As we move further along on 2011, you should seriously consider your plans for the year and the most advantageous (and soon to be extinct) tax benefits of an EHR investment in 2011 or 2012.

What are the Critical EHR Technology Infrastructure Issues?

The loss of access to you PMS may be disruptive, but your will still be able to practice medicine.  However, the loss of your EHR will stymie you clinical operation and pose serious challenges to continue serving patients.  Preventing the loss of your EHR requires appropriate hardware design and management commitment to invest monies to mitigate the chance of an EHR failure.

What are the Issues with Clinical Content?

Clinical content refers to the various checklists, documents, and forms that address an area of medicine when using an EHR.  For example, a pediatric practice would be interested in documentation tools for a newborn visit. Not all EHRs have clinical content for all areas of medicine.  For example, some EHRs have clinical content for internal medicine, but lack the details needed for dermatology or cardiology.

A disturbing number of practices have failed to analyze the clinical content of their EHR and are distributing exam documents and other information that do not adequately or accurately document patient care.  In the more serious situations, EHR clinical documents misrepresent the care provided and the patient’s condition.  For example, one practice was distributing exam notes that had inappropriate gender information for all patients.  In another situation, a specialist included extensive ROS information on the patient’s cardiovascular system which was not performed and not the specialist’s area of expertise.  Such problems could precipitate a wide array of care, insurance, and medical professional liability issues.

How Do You Provide Technical Support for an EHR?

Any EHR effort requires a plan to support the EHR technology.   Some practices have created an information technology (IT) position or even a department.  Unfortunately, many practices overspend on IT support that is more than they need technically, but less than they need operationally. 

What Are the Old EHR to New EHR Conversion Issues?

Data conversion from an old EHR to a new EHR is challenging and problematic.  In most cases, old contracts (and unfortunately many new contracts) do not obligate the current EHR vendor to provide the patient’s data or support the conversion.  Indeed, many practices are left to deal with the data that the current vendor “can” provide and the loading of data that the new vendor is ”willing”  to support. 

The gap between the old EHR information and the new system could pose a variety of operational issues and call into question continuity of patient care and even your stewardship of the patient medical record.  Indeed, contextual issues due to missing information and placement in the new EHR may complicate clinical decision making.

What Should You Worry About on Transitioning from Paper Charts to an EHR?

The transition from paper to EHR is a major policy decision that can have repercussions on patient service, your operations and even your medical professional liability (MPL.)  Unfortunately, many practices are not taking the time to analyze their options and responsibilities from a patient care and compliance standpoint.  In order to set the correct framework for your effort, you should think about how you would answer questions about your paper chart transition strategy in order to prove due diligence in maintaining the patient record and/or in the transition from the paper chart to your EHR.

ISSUE:  Disposition of the Paper Chart in the Move to EHR -

What MPL Issues are Associated with Meaningful Use (MU)?

Any transition of patient clinical records presents potential problems and issues that could affect medical professional liability (MPL).  Attainment of Meaningful Use is no different.

The Meaningful Use (MU) Criteria frames the use of a Certified EHR that enables a practice to qualify for the Medicare and Medicaid incentive payments.  Eligible Providers must fulfill 15 Core Measures and 5 of 10 Menu Set Measures to attain MU (For a complete list, go to https://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC-Core-and-MenuSet-Objectives.pdf ).  Many measures are associated with level of use based on a defined way of counting eligibility and usage.  For example, clinical summaries are to be provided for 50% of all office visits within 3 days of the visit to meet the clinical summary measure.

Your MU strategy should consider several MPL issues:

How Can You Attain Meaningful Use?

Attaining Meaningful Use (MU) is not an event, but a process.  As a practical matter, MU should be organized around packages of MU criteria in a sequence that leads to achieving Meaningful Use.  For example, it would not be practical to provide patients with electronic access to their patient records (MU Menu Set 5), until you maintain an electronic copy of patient health information (MU Core Measure 12). 

Meaningful Use can be divided into three stages:

Why Should You Worry About Your Next EHR Now?

While you are looking for a new EHR to qualify for Meaningful Use, it is not too early to think about what you are going to do when you stop using this new EHR and move to the next generation of EHR products in (hopefully) a number of years down the road.

The significant and troublesome barriers to moving from one EHR to another and the vendor issues that impede such moves are a strategic concern for anyone buying an EHR.

Is Your Practice Ready for an EHR?

From Medicare/Medicaid incentives to EHR industry ads, it is hard to cut through the hype and determine if your practice is even ready to try to select and implement an EHR.

Implementing an EHR is a transformational exercise for any practice that requires redesigning every aspect of charting, clinical workflow and interaction with patients.  However, in too many cases, practices approach EHR projects without considering the organizational commitment needed to succeed.

Governance and Management –

What is a Certified EHR?

In order to receive the Medicare or Medicaid stimulus monies, you have to attain Meaningful Use using a Certified EHR.  One would think that all Certified EHRs offer a high level of capability and functionality.  Unfortunately, you would be wrong.

How Do You Organize EHR Transitions?

EHR implementation is not an event as much as a process.  The key to implementation is managing a variety of transitions from the paper chart to the electronic chart.  Your transition strategies and decisions could have repercussions on patient care and malpractice risk.

EHR transition must be based on sound clinical decision making and coordination of dramatic changes to clinical operations.  In too many cases, practices let the technological issues dominate EHR deployment and relegate clinical issues to an afterthought.

How Can You Plan and Design Your EHR Effort?

Any EHR project must be based a clear commitment in time and resources by management and doctors.  In too many cases, EHR projects focus on the technical project aspects rather than the transformational strategies and commitment needed to succeed.  In the final analysis, the project must be supported by effective empowerment and governance.

Planning, analysis and design is woefully inadequate for most EHR projects.  As a practical matter, practices need to create a clear and complete plan backed by good project and implementation design efforts to succeed.  The components that you need to address include:

What is an Additional Financial Consideration for EHR Adoption in 2011?

Until December 31, 2011, EHR investments are eligible for 100% Bonus depreciation.  100 % Bonus Depreciation allows a practice to completely write off their hardware and software EHR expense without limit in 2011.  (Bonus Depreciation drops to 50% in 2012 and reverts to regular depreciation in 2013.)  Another interesting aspect to Bonus Depreciation is that Bonus Depreciation is not limited to an offsetting profit.  Without getting into too much number crunching, that means that you may be able to generate positive cash flow depending on financing etc.

What EHR Contract Issues are Important?

EHR contract negotiations should based on the fact that your practice, and not the vendor, is responsible for maintaining your patient records.  Anything that could inhibit your access or use of patient information will cause you problems and may compromise patient health.  Unfortunately, most EHR contracts do not recognize your obligations or accommodate your situation.

What are the Key Issues in Selecting an EHR?

The key difficulty in selecting an electronic healthcare record (EHR) is that few practices have a clear vision of what the EHR should have and what constitutes an effective EHR.  With several hundred potential EHR options, the average practice is faced with a dizzying array of options and products.

Surprisingly, the EHR product selected can affect medical professional liability (MPL.)  Not all EHR products are the same or have the same capabilities.  If you buy an inappropriate product, you may have to make operational and management compromises that affect how well you track and administer patient care.  In order to avoid such risks, you need to purchase a product that effectively handles three key needs:

Why are $640 Million in Federal Funds Aimed at Encouraging EHR Success Anti-Competitive?

Over half of the healthcare information technology regional extension centers (HITREC) are undertaking activities and establishing relationships that don’t appear to support the notion of unbiased advice and avoiding a conflict of interest.  Federal funding of over $640 million to encourage the deployment of electronic health records (EHR) by primary physicians is being used by many HITRECs in ways that will stifle innovation and bar new companies and innovative products from the exposure needed to improve health care.