Understanding
the Paperless Medical Office
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Before deciding to purchase
any medical record management system,
I believe it is incumbent upon physicians
to thoroughly understand the underpinnings
of electronic medical record(EMR)
management fundamentals. The first thing
a medical office administrator needs to
understand is the three basic elements
which constitute a paperless medical office.
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1.
Clinical Electronic Medical Record System(CEMR)
The clinical EMR is basically
a computer-based solution to assist physicians
with medical coding issues such as ICD-9,
CPT coding and super bill generation.
The CEMR(clinical EMR system) has built-in
logic and programming functionality which
is specific to your medical specialty.
Generally, these systems enable physicians
to customize their coding practice, assist
with ICD-9 to CPT coding relationships,
provide edits, electronically manage clinical
and prescription records ,etc. I think
it's fair to say that a clinical EMR is
like a super bill on steroids.
2.
Standard Medical Record EMR
This is a system which
generally keeps track of medical reports
such as x-ray reports, operative reports
and other general paperwork pertaining
to the functionality of your medical practice.
This type of software is generally database
driven. Super bills, patient demographic
information, insurance ID cards, medical
reports and can be scanned into computer
systems and retrieved later. Information
properly read through your digital scanner
is converted through a process called
optical character recognition(OCR) into
text which is easily stored within a database.
Later, your office staff "should
easily" be able to retrieve paperwork
which was previously scanned. This type
of system will save your staff a great
deal of time because it avoids your billing
office, nursing staff, or other physicians
from having to physically go to the paper-based
filing system which is always a drudgery.
3.
Practice management system
The third element of
this equation is your practice management
system which handles your billing and
scheduling information.
I go into great detail about points 1.,
2.,and 3 later later in this article if
you're interested.
At this point I'd like
to offer my professional opinion after
nearly 20 years experience as the owner/operator
of a medical billing service. My entire
business hinges on the ability to keep
track of medical, billing and clinical
records. Currently, Medi Bill Inc. has
millions of digital records which have
been stored over the past eight years.
A.
Unless you're willing to spend $100,000
on a system capable of managing all three
elements of the billing, clinical and
medical record aspects of your practice,
You should keep three distinct EMR systems.
Initially this may sound complicated but
in reality it actually simplifies matters.
Medi- Bill Inc. processes large volumes
of medical records, much more than a typical
physician group. Currently, we find keeping
three separate subsystems for handling
our medical record needs to be less complicated
and much less risky than one single comprehensive
database.
B. There
are very few, if any systems on the market
today capable of handling all three elements
in tandem.
C.
Unless your practice can
afford a full-time IT personnel or have
no other options available, I'm strongly
in favor of keeping all three EMR systems
completely separate.
The Paperless
Medical Office in Today's Digital Environment.
Recent reports show that
while only 5% to 9% of American physicians
use electronic health record systems on
a regular basis. The core of the paperless
medical office is a system that integrates
electronic medical records with physician
practice management and patient scheduling
software. Such software has the ability
to facilitate many critical practice functions,
including patient record-keeping, scheduling
and communication, insurance bills and
tracking of claims, ordering the receipt
of diagnostic test information, generation
and tracking of physician referrals, measurement
of physician and staff productivity and
performance, and internal administrative
workload and budget control. In its fully
realized form, the paperless office can
increase quality of care, decrease costs
while simultaneously offering an array
of other benefits. Some of these benefits
include;
- Instant access to patient health
data from any location with a computer
and Internet access;
- Real-time medical decision support:
- Updating of the electronic medical record while the patient is being seen
- Digital transmission and receipt of all patient laboratory and results, physician
consult reports and patient prescriptions;
- Medication and formulation information and advice, aimed at avoiding errors
in drug interactions and keeping drug
costs as low as possible;
- Coding advice to physicians to assure accurate documentation of a visits
level of complexity;
- generation of patient bill and patient take-home medical summaries, condition-specific
report information, and treatment instructions
for patients before leaving the office;
- kept scheduling patient appointments and sending reminders to patients about
important treatment items and upcoming
tests and appointments;
- Digital transmission and tracking of claims sent to insurers;
- Physician performance measurement and
healthcare outcomes research:
The technology and software are currently
in existence which would allow physicians
to spend much more time treating patients
and less time on awkward paperwork; however
typical physicians in the United States
have been very slow to embrace the new
technology. Eventually the US healthcare
system will be wired to send and receive
all patient information in a digital format
and will be required to do so in a common
and accepted language by all health care
providers. Part of the apprehension on
physicians to purchase electronic medical
record systems stems from horror stories
by colleagues who've been ripped off in
the past by shaky vendors and serious
technology implications. Medi Bill inc.
fully understands this apprehension because
we face the same problems.
I believe it is possible
to avoid pitfalls that can undermine successful
conversion to a paperless system by learning
from the mistakes of offices who have
unfortunately already failed. The goal
of this article is to help physicians
ask the right questions about whether
or not investing in a paperless office
is a worthwhile endeavor.
1.
What are the central issues, costs and
obstacles physicians must address before
going paperless?
The software/hardware
costs for an electronic filing system
depend on a wide array of factors. These
factors include the number of physicians,
and overall size of the practice and deciding
whether to purchase EMR/practice management
software and install new servers and workstations
or to lease software and or servers from
an application service provider or to
maintain separate subsystems for accomplishing
this task.
I.
What are the key obstacles physicians
will experience when setting up a paperless
medical office.
- The time and cost of system testing
and customization before implementation
of your new electronic filing system
and practice management software.
- The cost of designing and building
or redesigning the office's physical
layout to accommodate a paperless office
- the cost and time of training staff
to use the new electronic filing system
and practice management software and
related updated office protocols.
- The time and cost for existing practices
to upload paper medical records in to
the electronic filing health record
format.
- Short-term loss of productivity and
practice revenue while the new system
is being implemented and debugged.
- The ongoing costs of system maintenance,
upgrading technical support and staffing.
- The temporary loss of system due
to computer crashes or power failures
is possible and should be noted.
II. potential benefits of the paperless
office.
- Improving quality of care
- Improving the time spent with patients
- Improved practice profitability
- Eliminating the need for paper lab
orders, paper physician referrals, and
paper medication prescriptions and speed
results back to the referring physician
- Improving practice revenue through
more accurate software assisted coding
- Decreasing risk of medical errors
- Increasing patient satisfaction,
education and public compliance
- Ensuring compliance with security
and transaction provisions of HIPPA
- Electronic billing is faster and can
result in less rejected claims, higher
revenue and faster payment turnaround patients
can communicate with physicians by secure
e-mail, a limiting phone calls and assuring
that patient visits are appropriate
and necessary while more minor problems
can be handled remotely.
- Physician performance measurement
and healthcare outcomes research
- Electronic health records may help
lower liability insurance costs
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