Electronic Medical Records

Background - The Truth About EMRs

The following information is useful for executives prior to selecting and implementing an electronic medical record (EMR). There are obvious distinctions between hospitals and medical groups/practices regarding EMR functionality and usage and more subtle differences in functionality and usage between small and large practices.

Hospitals

Many hospital EMRs are not advanced enough to embrace the demands of ICD-10. For hospitals that have delayed selection of an EMR, the position is slightly improved because they are in a better position to acquire a third generation (or higher) EMR which would be based on a more modern architecture, have performance issues resolved, and be further along from an interoperability standpoint. However, given the short timeframe between now and the ICD-10 effective date, any delay increases the chance that the Certified vendors may be unavailable for implementing their products in time for testing and meeting compliance deadlines.

Because ICD-10-PCS initially affects hospitals, the importance of implementing an EMR well in advance of the deadline becomes critical.

Medical Groups and Practices

Historically, fewer than 10 percent of the 750,000 US physicians use an EMR. However, ICD-10 changes the necessity and increases the benefits of using an EMR. Among other benefits, an EMR:

• Enables interoperability among caregivers
  
• Improves reimbursement turnaround times because of fewer required exchanges between providers and payers
• Increases reimbursements because of the added specificity
• Provides access to incentives from CMS for electronic prescribing
  
• Provides access to potential incentives for EMR adoption from CMS
• Reduces transcription costs
• Reduces labor costs for filing and pulling paper records
• Reduces or eliminates storage requirements and costs for paper records
• Increases portability and legibility of medical records
• Improves outcomes because of better record management
• Facilitates evaluation and management (E&M) coding
  

In addition to the incentives from CMS listed above, hospitals and payers have increased financial support offered to encourage EMR adoption. With the transition to ICD-10, justifications and incentives for implementing an EMR are dramatically increased. ICD-10 presents a window of opportunity to take advantage of financial incentives from CMS, payers, and potentially hospitals.

Certification Commission for Healthcare Information Technology (CCHIT)

When selecting an EMR, hospitals and medical groups/practices should determine whether or not a vendor's system has achieved "Certified" status from CCHIT, an organization that certifies electronic health records products. CCHIT evaluates products for functionality and interoperability. According to CCHIT's web site, certification is also important because, "[I]n August 2006, the Department of Health and Human Services (HHS) published rules that provide an exception under the physician self-referral prohibition law (Stark), as well as safe harbor under the anti-kickback act (AKA), for the donation of interoperable EHR technology to physicians and other health care practitioners or entities."

For information on CCHIT, certification criteria, Certified systems, and the Stark and AKA legislation, please go to CCHIT.org. TM Floyd & Company can guide organizations through the system selection and evaluation process.

Peripheral Applications and Tools

In order to increase physician productivity, hospitals and physician practices should select an EMR that integrates or is compatible with continuous speech recognition (CSR) software, customized templates, and mobile computing, including tablet PCs. Doing so will:

• Offset declines in physician productivity and ultimately increase productivity
• Reduce or eliminate transcription expenses (in certain cases, this pays for the cost of the EMR)
• Increase physician acceptance