Last month was the first in a two-part series of questions and answers on documentation. This month, I will be expanding into the realm of electronic medical records (EMRs) with some common concerns and questions.
What does the economic stimulus package have to do with medical records?
The economic stimulus plan, as approved by the House and Senate in February, included sizable funding in several areas related to health information technology. $300 million was allocated to the National Coordinator for Health Information Technology's regional or sub-national efforts. Another $20 million was allocated for the Department of Commerce's health care information enterprise integration activities related to the Office of the National Coordinator for Health Information Technology. $50 million was indicated for the Department of Health and Human Services computer and information technology security. Obviously, with this kind of financial impact, the proliferation of electronic medical records is a major focus at the federal level.
How will this focus by the government impact my practice?
One provision of the government stimulus package would impose reduced payments from federal programs on physicians who are not "meaningfully using" information technology. Although there will be some interpretation issues related to the actual meaning of that phrase, it is absolutely clear that there is a significant push for the health industry to go electronic. Additionally, President Obama has been very vocal about the utilization of electronic medical records to modernize health care in the United States.
Are there any real financial benefits to going electronic?
Initial studies indicate that electronic health records may reduce malpractice settlements for physicians and insurance companies, which could result in lowered premiums. In a Harvard study. 6.1% of physicians with electronic records had malpractice settlements, compared to 10.8% without electronic records. The researchers believe that malpractice claims are decreased with electronic records because they offer easy access to a patient's history, which leads to fewer errors and clear documentation in case of litigation.
How would electronic records benefit my practice?
As with any topic, there are proponents and opponents to the concept. Those in favor of electronic records say that it has improved the quality of their practice in both patient care and costs. Specific benefits include better billing control, remote working capabilities, workflow advantages, better decision support, easier reporting, and more complete information relating to patient history and treatment.
What are the detriments to electronic records?
Those opposed to electronic records primarily cite loss of productivity, high maintenance requirements, and a negative impact on patient care. Practitioners at large healthcare facilities complain that it is primarily usurped by the administration as a storage device for medical records, rather than a resource for the medical and nursing staff. Others complain that more time is spent in staff meetings discussing electronic issues and problems than patient care. Many physicians also complain that the inputting of information is cumbersome and takes time away from the patient encounter.
How do I choose a system that's right for me?
Much like the concept itself, every system seems to have its fans and its detractors. The best bet would be to talk to peers with similar practices who have already gone electronic. Ask them about the good points and the bad points of their system. Arrange to see it in operation - and talk to the support staff about it as well. Once you've done your research, you are ready to begin talking with vendors, assessing financial considerations and making your choice.
Will I need to worry about security in relation to data theft?
Absolutely! Medical records are becoming a major target of identity thieves. Work with your vender and your Internet technology expert to develop a strong firewall defense to protect your data.
What about backing up the information?
There are two main ways to do this - internally or externally. If you choose to maintain your own backup on a disk, be sure that you also have a backup of the actual EMR program and that it is stored in a safe and separate location. Externally your EMR vendor may offer offsite, online backup, or you can take advantage of a myriad of online storage resources. Make sure that your contract with such vendors ensures that your data will be available to you when arranging long-term storage or transfer.
Regardless of your position on electronic records, the final outcome is inevitable. Our future is electronic and trying to stop it is akin to standing on the shore and stopping the waves from coming ashore. But whether you are operating in a paper world or the electronic realm, medical records are essential to proper patient care, financial protection of your practice, and the defense against malpractice claims.
J Michael Rosenthal, ARM - President and CEO, RGI Insurance Services
Mike Rosenthal is an Associate in Risk Management (ARM) and CEO of RGI Insurance Services. RGI Insurance Services provides all types of insurance for doctors and medical groups such as medical malpractice, workers compensation and group benefits as well as risk management services, human resource services and OSHA compliance services.
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