Description
Write an article (3–5 pages) for submission to the Journal of AHIMA on EHR standards. Incorporate information on data standard integration strategies and the importance of data modeling and data dictionaries.
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Introduction
What would happen if you were visiting another state or country and suddenly became ill? What if you had an accident, became unresponsive, and could not share your medical history with those treating you? How would the care provider obtain your medical history, such as allergies, current medications, or chronic illnesses?
One of the EHR’s goals is interoperability, which allows various EHR systems to communicate with each other. With interoperability, no matter where you are, care providers will be able to obtain essential medical information about you. To make this a reality, standards must be in place. Standards are the rules, or guidelines, that direct the EHR’s structure and specify the terminology used in the EHR system.
With interoperability comes one of the biggest concerns with the EHR: privacy and security. Privacy is an individual’s right to control the use of and access to his/her protected health information. Security refers to the measures used to ensure privacy. Security also ensures confidentiality, integrity, and availability.
In this third course assessment, you will have the opportunity to demonstrate your knowledge and skills related to EHR standards. As an HIM manager at Vila Health, one of the requirements of your yearly evaluation is to submit an article for publication to the Journal of AHIMA. This year you have selected EHR standards as your topic. In addition, you will be including in your article information on data standard integration strategies and the importance of data modeling and data dictionaries.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
Competency 3: Evaluate the role that data and technology standards play in implementation and maintenance of an electronic health record (EHR) system.
Identify the standards that govern EHR systems and the organizations that set them.
Distinguish among types of data, data formats, and data reporting requirements.
Describe the purpose of data modeling and data dictionaries.
Determine integration standards among applications.
Competency 5: Communicate in a professional manner to support health data management.
Create a clearly written, well-organized, compelling, professional article that is generally free of errors in grammar, punctuation, and spelling.
Follow APA style and formatting guidelines for citations and references.
Preparation
EHR Go
Complete these specific EHR Go activities before beginning Assessment 3. You will be incorporating information from these activities into your assessment:
Many different types of EHR standards exist, including those related to technology, documentation, and content, as well as privacy and security. This activity focuses on documentationstandards in an EHR.
EHR Go: EHR Documentation Standards.
This activity is an introduction to privacy, security, and confidentiality in the EHR.
EHR Go: Introduction to Privacy and Security.
Case Studies
For Assessment 3, select a different case study than you selected for Assessments 1 and 2. This time, choose a case study that allows you to focus on standards for EHR data and technology along with the organizations that set these standards. Analyze your selected case study and then incorporate appropriate elements into your assessment. Remember: Choosing a case study that allows you to meet the assessment’s scoring guide criteria is your responsibility.
HealthIT.gov. (n.d.). Case studies. https://www.healthit.gov/case-studies
At this link, you will find EHR implementation stories from providers around the country. In addition, case studies from specific categories, such as meaningful use and health information exchange, are provided. On the left-hand side of the screen, be sure to click the + sign to open the list of case studies.
Michigan State Medical Society. (n.d.). EMR in physician practices: A summary of 14 case studies to guide Michigan physicians [PDF]. https://www.msms.org/Portals/0/Documents/MSMS/Reso…
These studies fill a gap in research by providing physicians with examples of adoption by practices of various sizes and settings.
Capella Library Databases.
This link takes you to a list of all Capella library databases. Within this list, PubMed Central is a good resource for case studies. Search electronic health records to get started.
Independent Research
If you are less familiar with EHRs, you may wish to conduct additional independent research. The suggested resources provide a good starting point. You may also wish to consult the Health Care Administration Undergraduate Library Research Guide for research tips and help in identifying current, scholarly, and/or authoritative sources.
Instructions
As a HIM manager at Vila Health, one requirement for your yearly evaluation is to submit an article to the Journal of AHIMA for publication. This year, you have decided to write your article on EHR standards. From past experience, you have learned that the editors of the Journal like writers to incorporate a case study and examples from their professional experience into their articles. If you are not currently working in the HIM field, you will need to rely on your experience with the EHR Go activities you have completed so far in this course.
As you write your article for the Journal of AHIMA, consider all of the following:
The case study you selected for this assessment.
Your experience using an EHR in the workplace and/or in this course.
The independent research you conducted on EHRs and the standards that govern them.
Be sure to address all of the following headings and the questions underneath each heading in your article:
Introduction (1–2 paragraphs)
How will you capture your reader’s attention so that they read your entire article to the end?
Consider a compelling scenario or problem, such as the one that appears in the introduction to this assessment. Other possibilities include startling statistics, a thought-provoking question, et cetera. Use your imagination.
Be sure to tailor the title of your introduction for your specific article.
EHR Standards and Standards Development Organizations (1/2 page)
What are the some of the standards governing EHR systems?
Which standards development organizations (SDOs) set these standards?
What is one specific vocabulary standard addressed in the case study you selected?
What issues, if any, arose related to implementing the vocabulary standard you selected?
What improvements would you recommend to resolve any issues that arose?
What is one specific classification standard addressed in the case study you selected?
What issues, if any, arose related to implementing the classification standard you selected?
What improvements would you recommend to resolve any issues that arose?
Types of Data versus Data Formats versus Data Reporting Requirements (1/2 page)
How would you define types of data, data formats, and data requirements?
How are these similar to each other?
How are they different?
Note: Be sure to use examples from your case study, your experience in the workplace or in this course, or from your research to illustrate these similarities and differences.
Purpose of Data Modeling and Data Dictionaries (1–1 1/2 pages)
What is the purpose of data modeling and data dictionaries?
How did the case study you selected address: data architecture, databases, data warehouses, data modeling, data dictionaries, and metadata?
Why are data usability and quality important?
What are the consequences of data that can’t be used and poor quality data?
Include examples from your case study, your experience in the workplace or in this course, and from your independent research.
Why are consistency and design important?
What are the ramifications of inconsistency and poor design?
As before, use examples to illustrate your points.
Data Standard Integration Strategies Among Applications (1/2–1 page)
Which data standard integration strategies were employed in your case study, in your experience in this course or in the workplace, or in your independent research?
Which strategies were most effective? Why were they effective?
Which strategies were not as effective? Why weren’t they effective?
What are the two or three most effective data standard integration strategies you would recommend based on your experience and research?
Conclusion (One paragraph)
What are the two or three most important takeaways that you want readers to have as a result of reading your article?
What do health care organizations need to be thinking about in the future in terms of EHR data standards?
Additional Requirements
Length: 3–5 double-spaced pages.
Font and font size: Times New Roman, 12 point.
APA: Provide citations and references in current APA style and format. This guide is a good refresher on APA style and formatting guidelines: Evidence and APA.
Writing: Create a clear, well-organized, compelling, professional article that is generally free of errors in grammar, punctuation, and spelling.
Scoring Guide
EHR Standards Scoring Guide
CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Identify the standards that govern EHR systems and the organizations that set them. Does not Identify the standards that govern EHR systems and the organizations that set them. Attempts to Identify the standards that govern EHR systems and the organizations that set them; however, omissions and/or errors exist. Identifies the standards that govern EHR systems and the organizations that set them. Identifies the standards that govern EHR systems and the organizations that set them. Includes multiple examples and references to current, scholarly and/or authoritative sources.
Distinguish among types of data, data formats, and data reporting requirements. Does not distinguish among types of data, data formats, and data reporting requirements. Attempts to distinguish among types of data, data formats, and data reporting requirements; however, omissions and/or errors exist. Distinguishes among types of data, data formats, and data reporting requirements. Distinguishes among types of data, data formats, and data reporting requirements. Includes multiple examples and references to current, scholarly and/or authoritative sources.
Describe the purpose of data modeling and data dictionaries. Does not describe the purpose of data modeling and data dictionaries. Describes the purpose of data modeling and data dictionaries in minimal depth and detail. Describes the purpose of data modeling and data dictionaries. Describes the purpose of data modeling and data dictionaries. Includes multiple examples and references to current, scholarly and/or authoritative sources.
Determine integration standards among applications. Does not determine integration standards among applications. Attempts to determine integration standards among applications; however, omissions and/or errors exist. Determines integration standards among applications. Determines integration standards among applications. Defines criteria for choosing standards.
Create a clearly written, well organized, compelling, professional article that is generally free of errors in grammar, punctuation, and spelling. Does not create a clearly written, well organized, compelling, professional article that is generally free of errors in grammar, punctuation, and spelling. Attempts to create a clearly written, well organized, compelling, professional article that is generally free of errors in grammar, punctuation, and spelling. However, lapses, omissions, and/or errors exist. Creates a clearly written, well organized, compelling, professional article that is generally free of errors in grammar, punctuation, and spelling. Creates a clearly written, well organized, compelling, professional, error-free article that is generally free of errors in grammar, punctuation, and spelling. Article contains multiple examples and references to current, scholarly and/or authoritative sources.
Follow APA style and formatting guidelines for citations and references. Does not follow APA style and formatting guidelines for citations and references. Attempts to follow APA style and formatting guidelines for citations and references; however, omissions and/or errors exist. Follows APA style and formatting guidelines for citations and references. Follows APA style and formatting guidelines for citations and references without errors or omissions.
Unformatted Attachment Preview
•
One purpose of these studies is
to offer physicians a menu of
possibilities from which they can
choose the best for their practices.
Information Technology
• Have the right IT person. The day-to-day
management of the system required our outside
Assessing Vendors
•
•
•
•
Try hard to talk with physician colleagues who have
used the systems you are considering before buying.
They will tell you about the quirks of each.
When you are testing different EMR systems, choose
a hard-to-diagnose condition and look at what the
software does with it.
Have an outside hacker try to break into your system.
Vendors are fond of saying that their system can do
whatever you ask them. Insist that the vendor show
you that its system has already done it.
Champions
• Physician champions should be ready and willing
to handle criticism from colleagues when the system
•
isn’t performing as they hoped.
Much is rightly made of the importance of having a
“physician champion” if a practice is to implement
EMR. It is equally important that the practice have a
nonphysician champion. The office administrator or
manager must spearhead efforts because, obviously,
doctors must continue to see patients and generate
revenues. This is especially true with implementation.
Training
•
•
Don’t cut short the training. Try to find a system with a
training module so new staff and providers can practice
doing everything they will do with real patients.
Physicians need protected time to be trained on EMR.
They should not have access to pagers and cell phones.
And the training must be hands on.
Ongoing Support
•
•
Establish a regular (weekly or biweekly) call with the
vendor’s project manager to go over the practice’s
problem list.
Ask if the training and support team includes people
who have run physician practices. They are best
equipped to understand and address the issues you will
face.
Make certain that the phone support team from your
vendor can pull up the same patient screen that you
are viewing. Problems can be solved much quicker,
and this is important when you are with a patient.
•
consultant to work many hours. This person, whether
it be an employee or a contracted consultant, must be
able to manage the technical aspects of the EMR and
speak to laypersons about it.
You will need local IT support. If you live in a
metropolitan area, ask fellow physicians which system
they use and, if it is the same as yours, whom they use
as a local IT consultant. You may be able to find local
support familiar with your system.
A Summary of 14 Case Studies
to Guide Michigan Physicians
Making the Most of the New Technology
•
•
•
Do not pave the cow paths. You are spending all this
money for an electronic system. It is a new paradigm.
Think about how you can leverage this technology to
do a better job than you are currently doing.
In some practices, early customization may actually
slow down physicians’ EMR adoption, as it can focus
practitioners too much on the way they used to do
things rather than how EMR can help them do things
differently—and better.
Create opportunities for the entire staff to meet to
talk about EMR. It is important to debrief on how
the system is working for everyone. People yearn to
learn from each other. These meetings can also be
used to develop the next set of EMR priorities and
functionality for the practice.
As one physician sums up well, “EMR is a huge change
process. It’s not the software, it’s the process. It’s a very
complicated corporate process change. Consider that very
carefully. Consider what you can do to get people on board
in a positive way.”
The 14 case studies of Michigan physicians’
experience with EMRs are available to MSMS
members online at www.msms.org/emr
www.msms.org/emr. The
studies also will be serialized in Michigan
Medicine magazine. For further information
and resources, contact Rebecca Blake at
[email protected] or 517-336-5729.
Michigan State Medical Society • 120 W. Saginaw • East Lansing, MI 48826-0950
517-337-1351 • www.msms.org/emr
www.msms.org/emr
Electronic Medical Records: Case Studies Summary
T
he Michigan State Medical Society offers this series of
case studies of diverse physician practices to capture
the actual experience of Michigan physicians as they
made the decision to use an electronic medical record (EMR)
system and then implemented it.
These case studies aim to address a gap in the EMR research:
there are definitive general studies of adoption and there are
consultants and vendors well qualified to assist physicians with
the technical and operational details of selecting, installing,
and maintaining an EMR, but there are no stories of diverse
physician practices in Michigan that give physicians a vivid
sense of the decisions, changes in operations, benefits, and
drawbacks to adopting an EMR system.
We hope that these case studies are rich and varied
enough for a physician to say of at least one, “Yes, that’s
like my practice and that’s where I am right now in my
thinking about EMR.”
These case studies vary by practice size, practice location,
specialty, EMR vendor, and length of time using EMR. One
practice is still evaluating vendors for its system, while others
have had EMR for several years. All of the people interviewed—
physicians and nonphysicians alike—have struggled with some
aspect of EMR. With few, if any, exceptions, they believe that
the benefits outweigh the drawbacks.
Each case study describes:
• The nuts and bolts of the practice—its specialty,
location, number of physicians and staff—so that
readers can quickly identify which physician groups
are of most interest to them
• The practice’s decision to use EMR and its
evaluation of vendors
• The training and transition from paper to EMR
• The assessment of physicians and colleagues of the
benefits and detriments of EMR
• Patients’ response to the new system
To prepare the case studies, MSMS commissioned Public
Sector Consultants, a Lansing public policy research firm that
has worked with the medical society on numerous projects,
including the Future of Medicine report. Senior Vice President
for Health Policy Peter Pratt and Senior Consultant for Health
Policy Amanda Menzies visited practices and spoke with
physicians and nonphysicians to hear their perspectives on
EMR.
Although the purpose of the report is to convey the
valuable details of physicians’ experiences with EMR, this
introduction highlights comments that came up frequently
during the case study site visits or seem particularly useful
for physicians considering EMR. It is important to note,
however, that this is not a statistically significant research
study. While we have attempted to present varied practices
that reflect the physician practice environment in Michigan,
the 14 case studies are not a representative sample of physician
practices in our state.
T
o one degree or another, these are success stories—or,
at the very least, stories of promise. Almost all the
physicians we talked with think EMR improves the
quality of care. Many believe they have seen or will see a return
on their sizable investment in the technology, even when they
consider the time spent evaluating vendors and readying their
practices for change, and losses in productivity in the first
months of adoption. In other words, success does not arrive
without much hard work, perseverance, and adaptability.
Almost every practice said it took more time than expected to
identify a vendor, train the staff, and go live.
One measure of EMR’s promise is the frustration and impatience
that physicians and office staff feel once they have adopted
it. Many physicians see the enormous and, as yet, unrealized
potential that EMR brings. Many said that they cannot wait to
find time to do more with EMR than it does for them and their
patients now. For some, interconnectivity—and with it access
to all a patient’s health and health care information—will
usher in a new era of medicine. EMR just whets their appetite
for that day.
• The effect of EMR on liability
• The financial implications (including return on
investment) of EMR
These case studies vary by
• The promises and challenges that await physicians
using EMR
practice size, practice location,
• Words of wisdom that those interviewed can offer
to practices considering EMR
specialty, EMR vendor, and length
of time using EMR.
Read the case studies at www.msms.org/emr
EMR can also be daunting. Access to so much new
information about a patient, or a population of patients,
means that physicians must meet the challenge of organizing
and assimilating that information in a way that improves
patient care. As with so much in our daily lives, EMR can
bring information overload.
T
he 14 case studies offer variety in approaches to the
EMR. Physicians told us of several ways they use the
EMR when they are with patients: some have a tablet
or laptop in the room and show patients the screen, some
have a scribe in the room with them to enter information into
the EMR while they talk to the patients, some wait until the
patient leaves to enter information themselves into the EMR.
We also saw variation in the extent to which practices phased
out paper charts when they went live with EMR. Some went
cold turkey—no paper charts after they had been preloaded
into the EMR. Some transitioned over time from paper to
EMR, using both for several months. And some, many months
in, still use some paper charts. One purpose of these studies
is to offer physicians a menu of possibilities from which
they can choose the best for their practices.
Many physicians see the enormous
and, as yet, unrealized potential
that EMR brings.
Here’s what the case studies revealed:
Getting Ready
•
It is really up to physicians to build the systems to
meet the goals they set.
•
Practice knowledge and assessment are essential.
The better you know your practice in all its details,
the better you will be able to pick the best system
and insist on proper implementation.
•
Think of how you want to change your practice
before you buy a system. That will drive your
decision and make EMR more advantageous to you
and your patients.
•
Expect it to be two years from the day you
decide to implement an EMR until everyone is
comfortable with the system. Let everyone in your
practice know you expect it to take this long. If
you give yourself two years you will begin to see
some return on investment, which will bolster your
confidence in the decision.
The case studies also show the diverse experiences of
physicians. For example, some say that the EMR speeds
up documentation, some say it slows them down. Almost
everyone agrees, however, that EMR fosters more thorough
documentation, which is always a positive.
M
any practices are excited by the payoff—in improved
patient care at the very least—from their investment
and hard work. But even those who are struggling
acknowledge two facts: They cannot go back to paper now
and payers will require that physicians have EMR to document
aggregated patient information in the near future. In fact,
several practices lauded EMR because it gives them a ready
means of presenting such information for payers so that they
qualify for quality bonuses.
While this is not, strictly speaking, a study of best practices—
case studies, after all, must also catalogue frustrating practices,
if only to help others see what not to do—each practice did
offer words of wisdom to their colleagues who are considering
EMR. This summary concludes with a selection of these, a few
of which (see “physician buy-in”) contradict each other.
Physician Buy-in
•
Don’t wait for everyone in the practice to agree to
implementing an EMR. If you want to implement an
EMR, one or two doctors or nurses have to push for it,
but don’t expect everyone to be on board.
•
Obtain strong backing of as many providers in the
practice as possible to ensure the EMR’s success. If the
providers don’t understand the system and provide
their input, it won’t work.
•
Doctors have to be on board in a way that they have
no choice. You can’t have people silently sulking.
Before you spend any money, have a meeting where
everyone signs on. If you can’t achieve that kind of
consensus, you have to get rid of the naysayers or
decide not to implement the EMR.
Read the case studies at www.msms.org/emr
•
One purpose of these studies is
to offer physicians a menu of
possibilities from which they can
choose the best for their practices.
Information Technology
• Have the right IT person. The day-to-day
management of the system required our outside
Assessing Vendors
•
•
•
•
Try hard to talk with physician colleagues who have
used the systems you are considering before buying.
They will tell you about the quirks of each.
When you are testing different EMR systems, choose
a hard-to-diagnose condition and look at what the
software does with it.
Have an outside hacker try to break into your system.
Vendors are fond of saying that their system can do
whatever you ask them. Insist that the vendor show
you that its system has already done it.
Champions
• Physician champions should be ready and willing
to handle criticism from colleagues when the system
•
isn’t performing as they hoped.
Much is rightly made of the importance of having a
“physician champion” if a practice is to implement
EMR. It is equally important that the practice have a
nonphysician champion. The office administrator or
manager must spearhead efforts because, obviously,
doctors must continue to see patients and generate
revenues. This is especially true with implementation.
Training
•
•
Don’t cut short the training. Try to find a system with a
training module so new staff and providers can practice
doing everything they will do with real patients.
Physicians need protected time to be trained on EMR.
They should not have access to pagers and cell phones.
And the training must be hands on.
Ongoing Support
•
•
Establish a regular (weekly or biweekly) call with the
vendor’s project manager to go over the practice’s
problem list.
Ask if the training and support team includes people
who have run physician practices. They are best
equipped to understand and address the issues you will
face.
Make certain that the phone support team from your
vendor can pull up the same patient screen that you
are viewing. Problems can be solved much quicker,
and this is important when you are with a patient.
•
consultant to work many hours. This person, whether
it be an employee or a contracted consultant, must be
able to manage the technical aspects of the EMR and
speak to laypersons about it.
You will need local IT support. If you live in a
metropolitan area, ask fellow physicians which system
they use and, if it is the same as yours, whom they use
as a local IT consultant. You may be able to find local
support familiar with your system.
A Summary of 14 Case Studies
to Guide Michigan Physicians
Making the Most of the New Technology
•
•
•
Do not pave the cow paths. You are spending all this
money for an electronic system. It is a new paradigm.
Think about how you can leverage this technology to
do a better job than you are currently doing.
In some practices, early customization may actually
slow down physicians’ EMR adoption, as it can focus
practitioners too much on the way they used to do
things rather than how EMR can help them do things
differently—and better.
Create opportunities for the entire staff to meet to
talk about EMR. It is important to debrief on how
the system is working for everyone. People yearn to
learn from each other. These meetings can also be
used to develop the next set of EMR priorities and
functionality for the practice.
As one physician sums up well, “EMR is a huge change
process. It’s not the software, it’s the process. It’s a very
complicated corporate process change. Consider that very
carefully. Consider what you can do to get people on board
in a positive way.”
The 14 case studies of Michigan physicians’
experience with EMRs are available to MSMS
members online at www.msms.org/emr
www.msms.org/emr. The
studies also will be serialized in Michigan
Medicine magazine. For further information
and resources, contact Rebecca Blake at
[email protected] or 517-336-5729.
Michigan State Medical Society • 120 W. Saginaw • East Lansing, MI 48826-0950
517-337-1351 • www.msms.org/emr
www.msms.org/emr
Electronic Medical Records: Case Studies Summary
T
he Michigan State Medical Society offers this series of
case studies of diverse physician practices to capture
the actual experience of Michigan physicians as they
made the decision to use an electronic medical record (EMR)
system and then implemented it.
These case studies aim to address a gap in the EMR research:
there are definitive general studies of adoption and there are
consultants and vendors well qualified to assist physicians with
the technical and operational details of selecting, installing,
and maintaining an EMR, but there are no stories of diverse
physician practices in Michigan that give physicians a vivid
sense of the decisions, changes in operations, benefits, and
drawbacks to adopting an EMR system.
We hope that these case studies are rich and varied
enough for a physician to say of at least one, “Yes, that’s
like my practice and that’s where I am right now in my
thinking about EMR.”
These case studies vary by practice size, practice location,
specialty, EMR vendor, and length of time using EMR. One
practice is still evaluating vendors for its system, while others
have had EMR for several years. All of the people interviewed—
physicians and nonphysicians alike—have struggled with some
aspect of EMR. With few, if any, exceptions, they believe that
the benefits outweigh the drawbacks.
Each case study describes:
• The nuts and bolts of the practice—its specialty,
location, number of physicians and staff—so that
readers can quickly identify which physician groups
are of most interest to them
• The practice’s decision to use EMR and its
evaluation of vendors
• The training and transition from paper to EMR
• The assessment of physicians and colleagues of the
benefits and detriments of EMR
• Patients’ response to the new system
To prepare the case studies, MSMS commissioned Public
Sector Consultants, a Lansing public policy research firm that
has worked with the medical society on numerous projects,
including the Future of Medicine report. Senior Vice President
for Health Policy Peter Pratt and Senior Consultant for Health
Policy Amanda Menzies visited practices and spoke with
physicians and nonphysicians to hear their perspectives on
EMR.
Although the purpose of the report is to convey the
valuable details of physicians’ experiences with EMR, this
introduction highlights comments that came up frequently
during the case study site visits or seem particularly useful
for physicians considering EMR. It is important to note,
however, that this is not a statistically significant research
study. While we have attempted to present varied practices
that reflect the physician practice environment in Michigan,
the 14 case studies are not a representative sample of physician
practices in our state.
T
o one degree or another, these are success stories—or,
at the very least, stories of promise. Almost all the
physicians we talked with think EMR improves the
quality of care. Many believe they have seen or will see a return
on their sizable investment in the technology, even when they
consider the time spent evaluating vendors and readying their
practices for change, and losses in productivity in the first
months of adoption. In other words, success does not arrive
without much hard work, perseverance, and adaptability.
Almost every practice said it took more time than expected to
identify a vendor, train the staff, and go live.
One measure of EMR’s promise is the frustration and impatience
that physicians and office staff feel once they have adopted
it. Many physicians see the enormous and, as yet, unrealized
potential that EMR brings. Many said that they cannot wait to
find time to do more with EMR than it does for them and their
patients now. For some, interconnectivity—and with it access
to all a patient’s health and health care information—will
usher in a new era of medicine. EMR just whets their appetite
for that day.
• The effect of EMR on liability
• The financial implications (including return on
investment) of EMR
These case studies vary by
• The promises and challenges that await physicians
using EMR
practice size, practice location,
• Words of wisdom that those interviewed can offer
to practices considering EMR
specialty, EMR vendor, and length
of time using EMR.
Read the case studies at www.msms.org/emr
EMR can also be daunting. Access to so much new
information about a patient, or a population of patients,
means that physicians must meet the challenge of organizing
and assimilating that information in a way that improves
patient care. As with so much in our daily lives, EMR can
bring information overload.
T
he 14 case studies offer variety in approaches to the
EMR. Physicians told us of several ways they use the
EMR when they are with patients: some have a tablet
or laptop in the room and show patients the screen, some
have a scribe in the room with them to enter information into
the EMR while they talk to the patients, some wait until the
patient leaves to enter information themselves into the EMR.
We also saw variation in the extent to which practices phased
out paper charts when they went live with EMR. Some went
cold turkey—no paper charts after they had been preloaded
into the EMR. Some transitioned over time from paper to
EMR, using both for several months. And some, many months
in, still use some paper charts. One purpose of these studies
is to offer physicians a menu of possibilities from which
they can choose the best for their practices.
Many physicians see the enormous
and, as yet, unrealized potential
that EMR brings.
Here’s what the case studies revealed:
Getting Ready
•
It is really up to physicians to build the systems to
meet the goals they set.
•
Practice knowledge and assessment are essential.
The better you know your practice in all its details,
the better you will be able to pick the best system
and insist on proper implementation.
•
Think of how you want to change your practice
before you buy a system. That will drive your
decision and make EMR more advantageous to you
and your patients.
•
Expect it to be two years from the day you
decide to implement an EMR until everyone is
comfortable with the system. Let everyone in your
practice know you expect it to take this long. If
you give yourself two years you will begin to see
some return on investment, which will bolster your
confidence in the decision.
The case studies also show the diverse experiences of
physicians. For example, some say that the EMR speeds
up documentation, some say it slows them down. Almost
everyone agrees, however, that EMR fosters more thorough
documentation, which is always a positive.
M
any practices are excited by the payoff—in improved
patient care at the very least—from their investment
and hard work. But even those who are struggling
acknowledge two facts: They cannot go back to paper now
and payers will require that physicians have EMR to document
aggregated patient information in the near future. In fact,
several practices lauded EMR because it gives them a ready
means of presenting such information for payers so that they
qualify for quality bonuses.
While this is not, strictly speaking, a study of best practices—
case studies, after all, must also catalogue frustrating practices,
if only to help others see what not to do—each practice did
offer words of wisdom to their colleagues who are considering
EMR. This summary concludes with a selection of these, a few
of which (see “physician buy-in”) contradict each other.
Physician Buy-in
•
Don’t wait for everyone in the practice to agree to
implementing an EMR. If you want to implement an
EMR, one or two doctors or nurses have to push for it,
but don’t expect everyone to be on board.
•
Obtain strong backing of as many providers in the
practice as possible to ensure the EMR’s success. If the
providers don’t understand the system and provide
their input, it won’t work.
•
Doctors have to be on board in a way that they have
no choice. You can’t have people silently sulking.
Before you spend any money, have a meeting where
everyone signs on. If you can’t achieve that kind of
consensus, you have to get rid of the naysayers or
decide not to implement the EMR.
Read the case studies at www.msms.org/emr
Contents
INTRODUCTION …………………………………………………………………………………………………………. 1
FAMILY EAR, NOSE, THROAT, AND ALLERGY………………………………………………………. 6
An experienced physician starts from scratch with EMR
JOHN VASSALLO MD……………………………………………………………………………………………….. 10
New primary care physician starts out with EMR
MICHIGAN MEDICAL PC…………………………………………………………………………………………. 14
A two-physician primary care practice switches from one EMR to a better one
FAMILY TREE MEDICAL ASSOCIATES …………………………………………………………………. 19
A rural family practice thoroughly plans and implements EMR
MANSION STREET OB/GYN …………………………………………………………………………………….. 25
OB/GYN practice using EMR for ten years and still going strong
WOMEN’S HEALTH CENTER OF ALPENA …………………………………………………………….. 30
Ready to implement EMR, but waiting for the local hospital
MEDICAL ARTS HEALTH CARE……………………………………………………………………………… 32
A rural health clinic finds an enjoyable challenge in EMR
EYE AND E.N.T. SPECIALISTS PLC …………………………………………………………………………. 37
A small, growing multispecialty practice asks a lot from EMR
PREFERRED MEDICAL GROUP ………………………………………………………………………………. 43
Primary care practice increases efficiency with EMR while building EMR physician network
ASTHMA ALLERGY CENTERS OF SOUTHWEST MICHIGAN ……………………………… 49
A single-specialty group practice develops its own EMR
WAYNE STATE UNIVERSITY PHYSICIAN GROUP—DEPARTMENT OF
INTERNAL MEDICINE ……………………………………………………………………………………………… 57
An academic practice tests EMR
WESTERN WAYNE PHYSICIANS …………………………………………………………………………….. 60
Primary care group practice seeking benefits of EMR
MICHIGAN HEART PC……………………………………………………………………………………………… 65
Cardiology group uses EMR to increase efficiency and improve quality
MSU HEALTHTEAM …………………………………………………………………………………………………. 74
A large academic faculty group practice sees much to like—and some frustration—with EMR
Family Ear, Nose, Throat, and Allergy
An experienced physician starts from scratch with EMR
Practice Profile
Joe Gilletto MD is starting from scratch after moving to northwest Grand Rapids from the
Upper Peninsula. He brought no patients and no paper with him when he set up his
otolaryngology practice in July 2007. After
practicing for 23 years as an employed physician
• Solo practice in otolaryngology
and a partner with other doctors, Dr. Gilletto
decided that he wanted to go solo: “I’m an old
• Went live July 2007
horse-and-buggy doctor who wants to spend
• Location: Grand Rapids
more time with his patients. If I join a group,
they’ll care only about productivity.” He is
seeing 25–35 patients a day from the greater Grand Rapids area.
Why EMR?
Dr. Gilletto went live with his EMR when he opened his new practice on July 5, 2007. He
knows that physicians of his vintage—Gilletto is 60—are often resistant to change when
it comes to EMR. “The biggest stumbling block is what do you do with all of the paper?
In a group practice I used to be in, the staff came in on weekends to key in charts to the
EMR.” Nevertheless, he did not hesitate to start anew with EMR. “I didn’t bring any
paper with me. And EMR will be mandatory in five years.” He has positive reasons for
adopting EMR as well: “The promise of efficiency is attractive; the main impetus isn’t
money, but to make my life and my patients’ care simpler.”
Assessing EMR Vendors
Dr. Gilletto undertook a thorough review of EMR vendors before choosing AllMeds. He
began by watching videoconferences on three systems after hearing from a fellow ENT
physician that these three were the best for their specialty. Next, Gilletto attended
specialty society meetings and saw demonstrations of each system. His acid test is to
select a hard-to-diagnose condition—he chose burning mouth syndrome—and explore
how the software responds. “In the end,” he explains, “the system I chose was one put
together 15 years ago by an ENT doctor. It has numerous clients in my specialty. I also
liked that the vendor listened to physicians’ comments at the user conference on how to
improve the system.” Finally, Dr. Gilletto liked AllMeds because it is developing allergy
software that he can incorporate into his current system.
The Transition to EMR
Training on the EMR was five days onsite. Support, which Gilletto pays for at an hourly
rate, is necessary: “For immediate needs—when I’m with a patient—I can call the 24/7
support line. For less pressing issues, I have a running list of questions that I e-mail now
and then.” He notes that it is essential that support be able to pull up the same patient
screen as the doctor is viewing: “AllMeds gets to my patient’s record so glitches can be
6
EMR in Physician Practices: 14 Case Studies to Guide Michigan Physicians
resolved easily.” As he gets acclimated to the system, Dr. Gilletto figures that patient
visits have risen from 15–20 minutes to as much as an hour.
Current and Future Benefits
Only 40 days into practice with the EMR, Dr. Gilletto sees benefits: “Before the patient
gets to the front desk, I have sent a letter to the referring doctor and a fax of the
prescription to the pharmacy. Also, there’s no hunting for charts. Before, they could have
been anywhere—at the front desk, the to-be-filed pile, my desk. I can get to the chart
anywhere via the Internet—I can even check for allergies when I’m in the operating
room.” In addition, he likes the billing functions: “EMR allows you to bill more
completely by clarifying the distinctions between levels of visits.”
Gilletto also sees promise in improving the quality of care he delivers to patients: “I like
that I’ll have a patient with a ruptured eardrum and I can click on a number of adjectives
to describe the condition and then add my own notes. EMR leads to more thorough
documentation. It asks questions that I’ll forget—it’s a memory prompt.”
Avoiding coding errors is a huge benefit of EMR: “By the time I’d catch an error before
EMR, a lot of time had passed and I’d have to resubmit the claim.” The ability of EMR to
clean claims has real financial advantages.
Dr. Gilletto also saves time and costs on dictation and transcription, while acknowledging
that he does type slower into the EMR than he dictated. In time, he expects to address this
by having a scribe in the examination room with him and the patient. With the scribe in
place, he will have more face-to-face time with patients, which is the experience of other
ENTs he has spoken with who have had an EMR longer than he has.
Looking down the road, Dr. Gilletto sees more benefits from EMR. He hopes that EMR
and equipment manufacturers—makers of audiograms, pulse oximeters, and others—will
synchronize systems so that values will be sent straight to the EMR, without the
physician or scribe having to input them. He also hopes to access x-rays and CT scans
from local hospitals.
Patients like the EMR, he says, though some have expressed concerns about the security
of their private medical information. Both Dr. Gilletto and the patients appreciate how
EMR can help promote management of chronic conditions: “The EMR has patient
information loaded in folders,” the physician explains. “I just click on swimmer’s ear or
acid reflux and the handouts are printed right there.”
Dr. Gilletto also uses the EMR to cluster patients who have certain illnesses or
symptoms, “like cancer or headaches.” Says Gilletto: “I use this analysis for my own
researc
