Palm Beach County Medical Society

Health Care IT

Health Care IT Resource Center

News Articles

"CMS and ONC Final Regulations Define Meaningful Use and Set Standards for EHR Incentive Program"

"NPRM: Modifications to the HIPAA Privacy, Security and Enforcement Rules under HITECH"

"MGMA Survey: Meaningful Use Will Slow Docs Down"
"Proposed Rule Meaningful Use"
"Synopsis of Meaningful Use Standards and Certification"
"Meaningful" Progress Toward Electronic Health Information Exchange

News Websites
http://www.himss.org
http://www.healthcareitnews.com/
http://www.healthdatamanagement.com/
http://www.drj.com/
http://www.healthcarefinancenews.com/
http://www.modernhealthcare.com/
E-Prescribing Presentation - http://aamse.execinc.com/resources/document.php?id=387
Physicians’ Electronic Health Records Readiness Survey - http://aamse.execinc.com/resources/document.php?id=388

Electronic Health Record ROI Fact or Fiction?

There has been a great deal of discussion regarding the real Return on Investment (ROI) associated with the implementation and adoption of electronic health records (EHR).  Many physicians’ practices have over the past 5 years attempted and in some cases failed to realize that elusive ROI.  In this article I share the breakdown of the most likely areas for ROI and to give you specific recommendations on how your practice can see – in some cases, dramatic ROI for going through the pain and suffering of implementing this type of technology. 

In my experience over the last 6 years of being involved in all aspects of the implementation of EHRs I can tell you unequivocally that the single biggest success factor is having a well thought out implementation plan, and then having the necessary resources to ensure that the practice maintains its focus throughout the execution of that plan.  Someone in your practice must become the “owner” of this project or it will fail under its own weight.  If you think about it, you are going to be changing some of the fundamental aspects of the way your practice operates and that cannot be done without a solid plan and a committed team of individuals.

So now you have a solid plan, a team of focused individuals and you’re wondering just what you are going to be receiving in the way of benefits when your hard work is done.  Well there are countless potential improvements across your entire practice enterprise which will likely occur with a successful EHR implementation. However, they all can be summarized into three basic categories:  Improved Patient Care, Patient Throughput, and Cost Reductions / Revenue Enhancement.

The key to improving patient care is to give the clinicians in your practice all of the available information regarding a patient and the care of their disease in a single readily accessible location.  This is an area where a good EHR can really shine.  The better products not only allow you to have a repository of all the historical clinical data on a patient but they also allow you to document your patient encounter in “real-time”.  Another factor to realizing this ROI component is to ensure that your EHR has health maintenance advice as a core part of the tool.  There are several EHRs out there that have not properly implemented this feature and therefore minimize their overall benefit to your patients and your practice.

Some folks find the notion of patient throughput to be of some concern, but what I consider as the real ROI for this area centers around the notion that your clinicians spend less time searching for the right paperwork and / or filling out paperwork and therefore spend more time with patients themselves.  This also has the added benefit of allowing your practice to see the same volume of patients in less time, which in turn could and should improve the quality of life for the clinicians.  They may also decide to use the extra time to add a few patients to the session thereby increasing revenues as well.  This ROI component does not happen overnight by any means but it does occur after successful implementation and with the individual clinicians spending the necessary time to become adept at using their new tool.

When it comes to discussing cost reductions and revenue enhancements there are a myriad of ideas that are forth.  Simply put, however, it boils down to two main things and they are reduction in hard costs and “right coding”.  There are definitely some hard costs which go away with a successfully implemented EHR.  Some of those hard costs are transcription, costs of medical records, and facilities for housing and maintaining medical records.  Depending upon the individual practice those items can add up to substantial dollars on an annual basis.  Right coding is a concept that a good EHR promotes by advising the clinician based on the documented work what the “correct” code should be.  There are many different approaches to this but the best I have seen do not take the clinician out of the decision loop but rather apply the guidelines to the encounter so that the clinician can make the best possible decision regarding level of service provided.  Too often this is done by “feel” rather than by a defined process.

In the end your practice will be able to realize real ROI instead of fictionalized ROI when it implements an EHR with a focused plan, committed individuals, and an understanding of the hard work necessary to make it through those beginning stages.  One clear way to improve the likelihood of success for an individual practice is to enlist the help of a vendor partner which can provide a more hands-on approach than the more traditional software vendors which tend to take a “fend for yourself” approach to EHR implementation.

 
Is Your Practice’s Information System Protected?

Once again, we are in the midst of hurricane season and South Floridians are concerned with their preparations for the threat of a hurricane. It is imperative that your disaster plan includes appropriate protection for your information systems. Although hurricanes seem to be the imminent threat, you need protection year round from a multitude of potential threats. 

As technology increases, more and more information has become computerized, such as billing, appointments, accounting, payroll, and medical records. It is important to have a comprehensive, update-to-date plan for protecting and recovering your practice’s information systems.  Currently, the foremost threat on people’s minds is a hurricane, but possible threats range from external threats (hackers, viruses, fire, and other disasters) to internal threats (employee sabotage, hardware breakdown, and software corruption).  Did you know that 94% of businesses that suffer a major data loss go out of business within 2 years? Today more than ever, it is necessary to utilize appropriate technological policies and have a disaster recovery plan, which are both requirements of HIPAA.

Are You Prepared?

The following questions are a basic self-audit. Do you have a recovery plan, and is it update? What issues should you address so that you will be prepared for future disasters?

• Do you have a written Disaster Recovery Plan? If yes, when was it last updated?
• Have you identified your critical and non-critical files?
• Do you regularly back-up your files, both critical and non-critical? Have you verified the backups, to ensure they are working properly and your files can be restored from those back-ups? Are back-ups taken off-site?
• Do you have a plan for emergency communications with your employees? Do you have current contact information for your employees?
• Do you have a plan for emergency communications with your patients?
• Do you have a procedure for closing the office during normal business hours?
• Does your plan include all insurance policies and contact information?
• Does your plan include contact information for vendors, in case you need to replace supplies and equipment?
• Do you have a current inventory of equipment, supplies and paper records?
• Have you discussed your plan with your staff and assigned responsibilities?
• Do you have at least one copy of the plan off-site?

While we hope to never have to employ our disaster recovery plan, it is more than likely that we will have to prepare for a hurricane.  With a properly maintained plan, the staff will have the necessary information on how to efficiently handle the office preparations. Once the office is prepared, if necessary, you can close the office early and allow your staff to prepare their personal lives. For tips on hurricane preparedness, see the Palm Beach County Medical Society’s website.

Ongoing Protection

While a disaster recovery plan prepares you to weather a storm, you need to protect your information systems on a continual basis to prevent disruption of your day-to-day operations.  Ongoing protection includes virus protection, firewalls, anti-spam programs, password maintenance, updating applications, etc.  Most practices connect to some entity (e.g. the local hospital system, a clearing house, an insurance company, regulatory body, email, etc) through the internet.  It is imperative to have anti-virus and firewall software that is updated frequently, on your computers to protect your practice’s information, just as you should with your home computer. 

Equally important to the ongoing protection of your information system is password maintenance.  Each staff member in your practice should have their own password, some practices have one password that several staff use to logon to the computer system. Also, if the security in the software always you to specify what a user can and can not do.  You should setup different rights for different users.  Finally be sure to delete the passwords of employees who have left the practice.

As more and more information is processed and stored on your computer systems, you must constantly preserve and protect your information system and data.

Prepare Your Office For A Hurricane

So far we have been lucky to this hurricane season. That does mean we should relax or get complacent in our preparation in the event we have to face a hurricane hitting Palm Beach County.  As we all learned a couple of years ago, a the aftermath of a hurricane can be a trying time, loss of electricity, not being able to get gas, staying in touch with employees and patients, not being able to see patients, not knowing when the office can open again, and losing revenue. They say the best defense is a good offense, so what is a good offense against the stress of recovering from a hurricane.

Being proactive and preparing a solid recovery plan is the best offense.  The plan does not have to be complex, but it should be in writing.  The plan should be shared with everyone in the practice, so everyone knows what they should do in the event we are hit by a hurricane.  The more your staff knows what to do the less stress they will experience and the less stress your patients will encounter. This basic checklist provides a solid starting point for your practice to build a simple recovery plan. 

Initial Preparations:

• Prepare a recovery plan notebook
• Setup a call tree list with all the employees’ numbers – to let everyone if your office is open or closed.
• Compile a list of the critical vendors’ phone numbers (such as property manager, telephone service vender, computer service vender, software vender, property insurance company, medical supply vender, answering service, etc.)
• Decide on a strategy and plan for payroll in case of a power outage.
• Document the recovery tasks and who is assigned to each task and who is their backup.
• Setup an information hot line with either your telephone company or your answering service. (If your answering service is local investigate their plan and be prepared for them to be closed if you are closed.)
• Be sure you are properly backing up your computer files. Periodically test the back-up. Finally have a plan for where to store the back-ups off-site.
• If possible identify a “partner” office in another location that we allow you to see patients if your office has to be closed.
• Purchase the necessary supplies you will need to protect your office, such as duct tape, plastic bags or covers, etc.
• Print a hard copy for the notebook of any documents you may need when your office is down, such as a telephone list of pharmacies your patients use, a list of critical patients and their medications, hospital phone numbers, referring physician numbers, insurance companies numbers, etc.

Storm Preparations:

• As the storms approaches, review your plans with employees and their tasks.
• Print flyers for the patients with your pertinent recovery information and hot line numbers so they know where to call or go if they need care or medication.
• Update information on your hotline.
• Print the appointment schedules for the five days and distribute copies to appropriate staff.
• Be sure to run at least one final pre-hurricane back-up.  Take back-up(s) off-site.
• Prepare your physical office, move equipment away from windows, file as much paperwork as possible and store the rest of the paperwork in a safe location.
• Turn off and unplug all electronic equipment including computers, monitors, copiers, etc.
• Move all electronic equipment off the floor in case the office floods.
• Cover all equipment and exposed medical records with plastic in case windows break.
• Clear desktops and countertops.
• Secure the office and go home.

Post Storm:

• Check on the condition of your office. If it is fine, update the hotline then contact employees and patients that you will be open.
• If your office is down then check with the utilities and phone companies for estimated timeframes for restoring service.
• Update the hotline and contact employees and patients to keep them informed.
• Contact your alternate location if you have one.
• Take the necessary actions until you can reopen your office.

It is important to constantly review and update your recovery plan. Let’s hope you never need to use it, but if you do, you will be relieved that you have a plan to follow.

Alan Sivek, C.P.H.I.M.S.