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Taking your practice into the digital age: Part III: Making sense of Electronic Medical Records (EMRs)

Unless you've been on a really long vacation, you know that the CMS issued the "Final Rules" clarifying meaningful use requirements and other details about qualifying for ARRA incentives for EMR implementation.  In fact, if you follow the healthcare industry at all, you've been bombarded by articles discussing the requirements from every angle (follow the link for a list, just in case).

What you don't see a lot of is anyone trying to make sense out of it (beyond figuring out how to qualify for incentives or promoting a political agenda).

What are the real incentives? 

1.  A "Practice Differentiator" -- "If you look where patients are, you see they're living online." -Dr. Jeff Livingston, OB/GYN, Dr. in a Fort Worth, TX office that implemented a Patient Portal and employs other digital media to communicate with patients.

As this series of articles explains, there's a continuum of technologies from the now archaic-sounding "telemedicine" to using secure email to communicate with patients, to the ultimate in online medical practice:  a kind of virtual Dr.'s office where, depending on the condition being treated, patients don't need to even see the Dr. face-to-face.  In today's world, businesses that use technology to make themselves more efficient and provide better services to their clientele succeed.

2. Reduced Costs of Doing Business = lower overhead = more profit -- Each of the technologies we've discussed in our series adds its own efficiencies, but none quite so much as the promise of Electronic Medical Records.  Electronic Medical Records are more likely to be complete, less likely to be lost, easier to access, review, and search, and are more portable than paper records-they can be forwarded from your Dr. to a specialist, a local hospital or even a hospital overseas if needed.  EMRs also open up the possibilities of other technologies that build significant efficiencies into the practice of medicine.

3.  Direct government financial incentives[1] -- For example, in Kansas, care providers who demonstrate "meaningful use" of electronic health records and participate in the statewide Health Information Exchange are eligible for incentive payments of $44,000 in 2011 from Medicare or $63,750 from Medicaid.  Those incentive figures are per provider, so a practice with three physicians and two other qualified medical practitioners would be eligible for up to $318,759.  Just for the privilege of implementing a system that makes your practice more efficient and helps you provide a better experience for your patients.

"Meaningful Use" under Medicare and Medicaid Defined
Qualifying for ARRA incentives is not as simple as the many software companies developing EMR techologies would have you believe.  It's multi-tiered.  First, you must use a certified technology (none are currently certified).  Second, you must meet two criteria from two separate "final rules."  The first is the Meaningful Use standard; the second, the EHR certification standard.  The Centers for Medicare and Medicaid Services (CMS) website is a good place to start and includes a regulatory implementation timeline,  a clear explanation of "Meaningful Use," Fact Sheets and other useful information. 

Okay I'm in . . . Now how far behind am I?
Considering that the Office of the National Coordinator for Health (ONC) has received just a half-dozen completed applications from certifying organizations as of the end of July, you still have time.   And in a survey conducted in 2009 by the CDC, 20.5% of U.S. physicians reported having basic EHR systems, and only 6.3% reported having a fully functional system.

Patients are also just starting to come around . . . According to a recent national medical records consumer survey conducted on behalf of the California Health Foundation, only about 7 percent of patients reported having accessed or received any type of electronic medical records (which was up from 2.7% in a similar 2008 survey), though 66% expressed at least some interest in doing so.  In the same survey, 30% reported having searched online for information about a doctor-a good reason to at least update and make sure your website information is accurate and reflects your current practice.

Some Unanswered Questions . . .

Are EMRs Secure?
The old concern about digital records being too risky or violating a patient's privacy is largely overcome nowadays by technology, but still presents a problem in that patients don't perceive EMR as a safe alternative to paper records (a very recent study revealed that almost of 80% of respondents were concerned about the security of their records).

Who "Owns" Your Medical Records?
PHR, EHR, and EMR are not exactly the same thing-but the fact that there are three names for a person's digitized health record points out another big question-Is what we're talking about a Patient record (controlled by the patient), an Electronic record (controlled by database technology) or a Medical record (controlled by the patients' doctors and other healthcare providers or insurers)?

If insurers are going to maintain our medical records, they will need to do better at accuracy than they do now-how would you like it if 20% or more of your medical record was reported inaccurately?[2]  

If patients can modify their own records, then couldn't this information also be easily falsified?  (In the previously mentioned consumer survey, a majority of respondents indicated that one of main reasons they would favor electronic records is because they could review and correct inaccuracies more easily.)

Ultimately, of course, medical records do belong to the individual patient, but as this information is more frequently shared among multiple providers and government bodies, and others questions about how the information may be used, which information belongs to the patient, which to the patient's doctors (lab results?  pricing and payment information? past medical history?  genetic profile?) and which to other entities will need to be more transparently addressed.

To find out how PBN can help your practice move into the digital age, contact . . .

PBN Business Development, 800.288.4901,

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[1] To learn more or sign up for the program, read the program invitation letter at the Kansas Foundation for Medical Care website www.kfmc.org/rec/docs/RECPCPLtr.pdf.  Similar programs are available in other Regional Extension Centers across the U.S. In Missouri, the program is administered by the University of Missouri.  Visit the program’s website to learn more.  www.assistancecenter.missouri.edu   or sign up. The chart on this page of the national Healthcare Information Technology website lists programs in other areas around the country.

[2] http://www.ama-assn.org/ama/pub/news/news/2010-report-card.shtml.  This is actually an improvement over the 2008 survey where the accuracy of claims was just 67 to 87 percent, although, according to the report, “The performance of insurers varied significantly by state, ranging from 58.6 to 96.9 percent.”

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