EHR Implementation Questions and Answers from TMPros

Q: Which EHR software is the best?

A: It really depends on your practice and what your priorities are. Some EHR’s were originally designed for hospitals but work with ambulatory practices and some are better suited to small practices. Just like choosing a car, everyone has different opinions. After you clearly understand what your priorities are, the right EMR for you is the one that best fits your budget, you deem is most user friendly, best interacts with any legacy systems you want to keep, and the one that best fits any other criteria that you determine important. Choosing an EHR system is a very complicated process that takes time and study. You may not get the best, but as long as you do your homework your chances of getting the “right” EHR are much more likely.

Q: What is the difference between EMR and EHR?

A: The traditional answer has been that an EMR is an electronic medical record generated by a single organization. Whereas an EHR is an electronic medical record that has aggregate information from more than one organization. An EMR turns into an EHR once its information no longer comes from a single source. EMR software packages that do not have interoperability are becoming more scarce as vendors clamor to meet “meaningful use” standards to qualify for stimulus funding. In looking at numerous software vendors, I’ve seen the term EMR and EHR frequently interchanged. Some use EHR while others use EMR, but EHR is definitely overtaking EMR as the proper term for an “Interoperable” electronic health record solution. I’ve also seen the word EMR used specifically for the software component of a bigger package that deals specifically with a single entity’s documentation of patient information. As we go forward, using the term EHR is probably more appropriate.

Q: What type of stimulus funding is available today?

A: See our Stimulus Incentive Information white paper for specific information. What you need to know is practices can receive up to $44,000 per eligible physician (EP) from Medicare and up to $63,000 from Medicaid. Most practices don’t see enough Medicaid patients to qualify, so the $44K Medicare per EP starting is 2011 is what is driving most offices toward an EHR system.

Q: How do I meet the “meaningful use” requirements so I get reimbursed?

A: This is probably the most elusive question in the industry today because standards have been changing. The Certification Commission for Health Information Technology (CCHIT) has been updating its criteria for certification since 2006. What constituted a certified EHR system in 2008 is not the same as it is today. If you look at our synopsis on Meaningful use, we have broken down the 2011 requirements into a very readable format. Many software vendors are working diligently to update their software to meet the requirements. The key for your practice is to find a vendor that is in the process of certification. There are many fine products out on the market that meet some of the requirements. However, they must be packaged with third party software to meet all of the requirements, so if you plan on putting modules together, your odds of being a “meaningful user” go up drastically. Your best bet is to find a vendor who has a previous certification from CCHIT and is working on a current certification. One of the most important things to understand about meeting “meaningful use” requirements is the difference between yours and the vendor’s responsibilities.

Q: When is the right time to implement an EHR?

A: Because the stimulus money starts shrinking at the end of 2012 compounded by increased “meaningful use” criteria, it is best to start moving toward it right now. Another factor that you should consider is although there are numerous EHR vendors vying for your business today, as more and more practices start to convert in order to take advantage of stimulus funding, the waiting line for implementation will begin to lengthen. This could put you in a situation where you are late to implement and do not qualify in time to receive the maximum funding. Additionally, there is going to be a shortage of qualified Health IT professionals in the field as the demand for IT consultants rises sharply over the next year.

Q: Can I convert to EHR in phases?

A: Yes. There are two basic approaches to implementing EHR. The phase approach has the least impact on workflow and the bottom line. Some practices start with LAB and ePrescribing then eventually implement the electronic health record portion. With this type of approach, productivity suffers a little less than if you use the complete Implementation approach, but the productivity hit lasts much, much longer. There are advantages and disadvantages to each method, and it really is a management decision as to which one you would prefer. However, because time is a factor in getting reimbursement from the government, a phase approach needs to have a very aggressive timeline.

Q: How many different EHR companies are there?

A: My understanding is there are around 200 in the market right now. We are only dealing with approximately 85. The reason for this is the rest of them are either specialty EMR’s that don’t have interoperability built-in, or they are free-ware companies who are probably not currently capable of getting their users to meaningful use. Our focus is on finding our clients the best possible solution that meets all of their needs. Getting reimbursed is a high priority.

Q: Should I look for a vendor with a guarantee?

A: Absolutely. But, please understand that all guarantees are not created equal. Find out exactly what the vendor is guaranteeing and exactly what will happen if you don’t get reimbursed. Some vendor sales reps. will talk about guarantees but won’t tell you that they will only reimburse you a limited amount of money. It’s like an insurance policy. There are limits. Find out what those limits are.

Q: How do I get financing for an EHR?

A: Fortunately, many vendors already have financing in place. Many of them have deferred payment plans, so one of the biggest reasons for waiting has been cleared. You can implement now and pay later. What you should keep in mind is whether you meet meaningful use or not, they will expect you to start repaying the money on a specific date. Before you sign any paperwork, you should have an expert look at it and give you objective advice as to whether you will be fully implemented by that date. You need to be realistic in your timeline. If you skimp on training, you may find yourself in a situation where you need to go back to the drawing board after your “Go Live” day. Remember, there are two parties involved in implementation. There’s you and the vendor. What the vendor is guaranteeing is their product’s ability to meet meaningful use. The rest is up to you. So, take advantage of the financing available, but make sure you have a thought out plan in place before you commit to a timeframe.

Q: What’s better, a client/Server model or a Web Based ASP or Software as a Service (SaaS) model?

A: It really depends on the size and financial position of the organization. Larger organizations that already have servers in place that host their practice management system locally are better equipped to handle the client/server model than smaller practices. A practice with a dedicated IT staff is also in a better position to utilize the client/server model. The advantage of this model is that your data is stored locally. Historically, your local area network has been much faster than an internet based application. However, the internet speed available today in many places has closed that gap considerably. Another advantage of the client/server model is you are not relying on your internet connection for your PM and EHR to be up and running. This can be a scary situation. To make this a nearly non-existent issue, you need to set-up a dedicated internet connection if you are using the SaaS model. You do not want to trust the system to a basic ADSL or residential cable connection.

The downside of the client/server model is you are required to buy licenses for each provider. You are also on the hook for equipment if you do not already have a capable server in place. You also need storage equipment. There may also be numerous connectivity fees and setup costs. All of these expenses can add up. With the SaaS model, many of these fees are not applicable. Small practices can have their system up in a very short time by using this model. So, saving upfront costs is the main reason smaller practices choose the SaaS model, but there is still a price.

The practice will pay an ongoing monthly fee for licensing/service with the SaaS model while the practice who opted for the client/server model will only pay maintenance fees. You need to look at the overall cost of ownership prior to making your decision. You also need to look at the total amount of stimulus funds you expect to qualify for. You should also look at the expected ongoing IT costs. If you host your own server, you will have in-house IT costs. The good news is these costs can be mitigated by utilizing an outsourced IT company who will monitor your software and servers 24/7 without having to pay a full-time employee to be there on site. This is another situation where you need to gather as much information as possible and make the best decision for you.

For more information on Electronic Health Records, go to our website.  www.technologymanagementpros.com