Government // Leadership
Commentary
8/28/2009
12:50 PM
Michael Mirro
Michael Mirro
Commentary
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Minimally Invasive, Incremental Approach To EMRs

With the stimulus incentive deadline for adoption of e-healthcare records quickly approaching, rising healthcare costs, and the increasing need to access patient data at multiple locations, there's no doubt that most healthcare IT professionals and physicians are planning to quickly and cost effectively embrace EHR technology in their organizations.

With the stimulus incentive deadline for adoption of e-healthcare records quickly approaching, rising healthcare costs, and the increasing need to access patient data at multiple locations, there's no doubt that most healthcare IT professionals and physicians are planning to quickly and cost effectively embrace EHR technology in their organizations.Before diving into the implementation process, careful planning is imperative. Based on what I've seen from other practices, if you don't analyze your options in detail, your greatest fears of practice workflow upheaval will likely come to fruition. I suggest that beginning with an honest assessment of your practice:

  • Evaluate individual practitioners' comfort levels and tolerance for change, as well as their thoughts on investment levels and technology use
  • Assess your objectives. Are you interested in reducing staff? Improving reporting capabilities? Reducing errors? Eliminating duplication? Qualifying for stimulus money? All of the above?
  • Look at practice workflow. How does work get done in your office? Does it vary by location? Is it different for each practitioner, or does your office employ a uniform approach?
  • Determine who will use the technology. Plan on forming a cross-functional IT team. Clinicians need to be part of the selection and implementation process, as well as nurses and administrators.

    This assessment will help you determine whether your office is ready for an EMR, what kind of EMR you should look for, and how to best implement one in your practice.

    Incremental Adoption Based on the assessment in our offices, we chose to adopt a software-as-a-service EMR from Medical Informatics Engineering in an incremental, minimally invasive fashion. My practice has nearly 200 staff members ranging in age from near retirement to young physicians early in their career. Each of us was at a different stage in our willingness to embrace technology. Therefore, we started with a very simple approach.

    Since most of us receive those 2 a.m. phone calls that require access to patient records, we found a way to start with a simple benefit that required little or no change. We made it possible to use a browser from home to review medication lists, problems, and other critical patient data; make a decision; and avoid driving into the office.

    After the initial success with online access, we went back to our physicians and said, "You know how much you like being able to pull up patient charts from home at 2 a.m.? Well, how would you like to add document management and e-prescribing?" That would let us build the EMR from within as the practice is ready. Over a short amount of time, we've added document management, point and click exam templates, and the ability to read and interpret imaging studies.

    Cost Control Not only did this approach improve our workflow, it helped us manage costs. It let us pay for the EMR functionality we needed, when we needed it, and we avoided paying for dormant and unused functionality.

    We made an affordable and incremental initial investment to deploy the software and, to date, we've save approximately $100,000 annually just on reduced transcription and chart pulls.

    Medical Informatics Engineering's EMR also enabled us to track quality metrics that we use to participate in Medicare's Physician Quality Reporting Incentive program, which offers financial bonuses to physicians who uphold certain quality measures. Only 16% of physicians nationally participated in this program in 2009 and among them, only 2% received the maximum reimbursement.

    Because of our electronic technology, we were able to provide data on three performance measures and received the maximum reimbursement of $3,800 for each of our physicians for the first six months of the program. Our EMR also collects and reports data for IC3, an American College of Cardiology quality reporting initiative.

    Transitioning to an EMR doesn't require a revolutionary approach. Our evolutionary, minimally invasive approach resulted in less expense, discomfort, and upheaval, as well as improved patient care. Our EMR not only helps us qualify for current and upcoming incentive payments, it has enabled us to demonstrate meaningful use and realize meaningful benefits.

    Dr. Michael Mirro is a practicing cardiologist at Fort Wayne Cardiology, a 21-physician practice in Northeast Indiana. He's active in the American College of Cardiology and has served as a trustee and the chair of the organization's health IT committee. He's also the medical director at Parkview Research and a clinical professor at the Indiana University School of Medicine.

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