Government funding incentives (ARRA HITECH Act) to implement electronic health record systems (EHR) are driving most physicians towards the selection and implementation of EHR applications that are appropriate to their practice. However, even though the average practice takes more than 120 days to select their EHR solution, 87% of practices spend no time evaluating the service levels and uptime associated with these installations, instead leaving this important criterion in the hands of the software provider. Even when asked, some vendors avoid this growing need and offer no solution at all, leaving it as a point of exposure for the practice. Neglecting the amount of system downtime that a practice might experience could cost the average 5-physician practice nearly $25,000 if the product is down just ten hours during the course of a year. Therefore before selecting an EHR product, the practice should not only consider price, functionality, usability, support, and training. It must also determine the practice’s exposure to the potential effect of system downtime. This will impact the overall practice efficiencies, staff and client satisfaction, and the ability to provide care.

Why Is Controlling Downtime Costs Important

As seen in the AC Group 2010 Healthcare Technology Survey, four of the top five healthcare applications deemed most important over the next four years relate to mission critical clinical applications. These applications include Electronic Health Records (EHR), patient portals, Clinical Information Systems, Clinical Data Repository, and Point-of-care clinical decision support.

Why are clinical applications so important now? A few years ago a group of leading Fortune 500 companies and other large healthcare group purchasers worked with the federal Office of National Coordinator (ONC) to established three standards that healthcare organizations must meet to get group members’ business; number one on the list is implementing an EHR system. Since then, numerous organizations have pressured physicians to start adopting EHR applications. These organizations estimate that clinical applications can improve the quality of patient health and can reduce serious prescribing errors by more than 50 percent. They believe that overall better healthcare monitoring and clinical reasoning can improve patient safety, which in turn equals improved financial value – not just for employers, but also for providers, consumers, and payers of care as well.

The downtime issue escalates when a healthcare organization deploys applications that are used primarily by Physicians. For example, at this year’s MGMA conference, a panel of physicians agreed that system speed and availability was critical in their decision to use an ambulatory EHR application. The panel agreed that, if the system was NOT available a minimum of 99% of the time, then they would not consider the application reliable enough to use in the future.

What this panel failed to consider or realize is that 99% uptime translates into an average of more than 87 hours of solution downtime annually. The cost associated with that amount of downtime is tens of thousands to hundreds of thousands of dollars, depending on practice size.

Cost of Downtime

To help understand the cost of downtime associated with Electronic Health Record (EHR) systems, AC Group conducted a study during 2010 designed to shed more light on this important issue. It was determined that, in the rush to adopt Electronic Health Record (EHR) applications, system availability requirements associated with the underlying IT systems are often overlooked. This can result in significant costs – both financial and operational – based on the probable downtime per year associated with different systems and configurations. As the practice becomes increasingly reliant on electronic records, the software application should have little-to-no downtime, as any downtime can adversely affect the care of a patient and increase operating costs.

To effectively implement critical applications, whether EHR or PMS, the clinical community must be assured that the application will be available and reliable when they need it. To accomplish this, physicians and administrators MUST insure that their EHR vendor’s software and the hardware platform it runs on will operate at a committed level of uptime acceptable to the practice. Software providers may or may not recommend or provide a high-availability platform solution (either hardware or software) for their applications. But, that does not mean practices and clinicians should not make this a requirement for the critical applications that they depend on to run their practices and care for patients. Having said that, physicians should expect that the responsibility to require service levels and obtain availability SLAs will fall to them.

An EHR vendor who cannot provide an availability solution that meets today’s industry definition of high availability –less than one hour of unplanned downtime per year – can easily cost the practice more than $488 per hour of downtime for each physician in the practice. For the average server deployed in most practices to support an EHR application, the expected downtime averages 87 hours per year. Even traditional server cluster options which promise high availability statistically average over four hours per year, with complex operating requirements which add significant additional costs in equipment, maintenance and administration. On a per physician basis these costs, as well as the disruption to operations and patient care, can be staggering.

Healthcare executives’ concept of acceptable downtime, and conversely uptime, for critical applications has historically lagged virtually all other industries. A review of 37 vendor contracts indicated that vendors are only providing an uptime guarantee of 96%. What does 96% availability mean, and is that sufficient? Is 99.99% uptime even attainable at reasonable cost, and what cost is reasonable? What amount of downtime are you willing to accept? What does a vendor’s uptime guarantee really mean to a healthcare organization and patient care? The differences between uptime levels in terms of financial impact and practice disruption will amaze even the most experienced healthcare provider and healthcare IT executive, alike.

Value of Uptime

Time is money. A practice committed to an EHR solution will suffer both financial and care-giving consequences if that system is unavailable to them. How much impact depends on these factors:

• Level of technology in use by a physicians practice: Practice Management (PM) only, PM and EHR, Clinical Outcomes and Decision Support
•  Size of the physician’s practice
• The level of uptime (i.e. ability to use the system) delivered by the total solution

Obviously, the greater a practice’s reliance on technology, the greater the impact when the application goes down in terms of the average cost of the outage itself. That is, a practice that still relies on manual data entry and practice management will not suffer the same pain as a full-blown EHR-based practice because they rely on technology less to conduct their routine business. (Conversely, the paper-based practice does not realize the many benefits of a smooth-running EHR solution.) It is not only the time required to manually conduct business during the outage that contributes to cost. It’s also the time required to bring the automated systems up to date post- recovery. We refer to this as the multiplier effect – the average cost per employee for a minute of downtime, plus the cost of time needed to return to normal operation after system recovery.

The 2010 Downtime Study

AC Group conducted time/motion studies of various size practices, in varying stages of EMR deployments, to determine the average cost per minute of downtime for small, mid-size and large physician practices. The three-month study was completed on November 1, 2010 and was based on actual healthcare organization man-hours, salaries, and workload numbers by individual enterprise department. The study evaluated the amount of time each practice spends (1) collecting, (2) reporting, (3) organizing, and (4) disseminating information. Note: throughout this paper we use the overall term “Information” to describe these four functional areas. Some of the detailed findings included:

•  Nursing spends 57.4% of its annual man-hours on automated “information”, (collecting, reporting, organizing, and disseminating information).
•  Non-nursing departments (registration, scheduling, billing, etc) spend 87.4% of their man-hours on automated “information”.
•  The typical EHR-enabled practice spends 71.45% of all man-hours on automated “information”. This is compared to the average non-EHR enabled practice that only spends 28% of its annual man-hours on automated “information”, but spends an additional 48% of man-hours on manual “information”.

Using this information, the AC Group was able to identify and validate that for every minute an EHR application is down the average physician practice spends 2.15 minutes to perform the required tasks manually plus the time required to update the computer systems once the system is back up and operating. Using the average practice’s actual financial, man-hour, and workload statistics, the AC Group determined that the average cost of downtime was $8.13 per minute per provider, which equates to a median across all practice sizes and specialties of almost $488 per hour.

Summary

Based on the findings from this study, compromising on software and/or hardware uptime assurance can be financially punishing in the long-run, not to mention operationally disruptive with increased susceptibility to data-entry errors during recovery. This discovery renders even more apparent the extreme importance of evaluating system uptime specifications when measuring and rating the performance of a vendor’s product.

Again it is important to note here that the overwhelming majority of EHR software vendors will not include uptime SLAs in their contracts without specifically being required to do so. If required by the healthcare organization, almost every vendor indicated that the cost of the system would increase from 5% to 20% for each 1% increase in uptime guarantee over and above the standard 96% uptime level. Considering the uptime assurance solutions on the market today, there is little justification, if any, to attach such a 5-20% premium for ensuring such mission-critical applications remain available without exception. The best availability products will be industry-standard (i.e. Windows, Linux, x86 processors), require no special skills to operate and manage, will monitor, self manage and automatically remediate system issues, reduce opportunity for human-induced system failures, and deliver an excellent return on investment when evaluated on Total Cost of Ownership (TCO) basis.

The healthcare industry must continue to align its IT expenditures with business initiatives by adapting a comprehensive system for determining IT strategies, expenditures, and staffing requirements based on best practices. Healthcare organizations must drive enterprise-wide systems that sustain a constant innovation cycle in the new competitive environment. To accomplish this, they must learn to match their healthcare organization skills and requirements with their current business environment, or face extinction.

Although software vendors rarely provide uptime commitments, a physician’s practice should require written documentation that the proposed EHR application meets today’s generally accepted standards for high availability (i.e. less than one hour of unplanned downtime per year on average) in actual installations, or that its software is certified to run on high-availability products from other vendors with no performance impact.

The challenge ahead for healthcare organizations is enormous. We all know that operational and cost barriers exist when selecting a system; nevertheless, the potential benefits of clinical applications and EHR, in terms of patient safety and quality of care, operational efficiency and cost reduction, competitive advantage, and market share gain are tremendous. We believe that every healthcare organization is in a great position to help enhance recording, reporting, and dissemination of clinical data. To accomplish this, the healthcare organization MUST insure that the vendor can guarantee an adequate system uptime, especially with EHR applications. Those who succeed will receive industry-wide recognition and ultimately reward for their organizations. Key to evaluating clinical systems must be the healthcare organization’s recognition that downtime costs are an important factor for every healthcare organization. Healthcare organizations must ensure that downtime is minimized through close system management and by working closely with each technology provider.

Availability Options

Regardless of whether the physicians’ office maintains its own IT staff, or has consultants come onsite to manage IT operations, or relies entirely on a third-party to oversee its EHR applications offsite sight unseen, system downtime still levies the same cost on the practice. Any choice made to provide uptime still possesses levels of complexity in operations and ongoing management, and requires a base level of professional skills to operate reliably. It is vitally important, as we have demonstrated, that those who make the purchasing decisions and/or take responsibility for IT system health know the level of uptime they should expect from offerings provided by their software provider, value-added reseller, or managed service provider.

Following is a description of common platform, software and hardware offerings deployed in conjunction with EMR applications. Each has its own characteristics and ability to provide uptime assurance.

Robust standalone server:

The current generation of x86 servers includes features like redundant fans and power supplies, hot-plug PCI card, and mirrored memory, offering improved reliability over unadorned commodity servers. They can be expected to run at 99.0% uptime reliability, with complementary average downtime of more than 7 hours per month. The issue with standalone servers is not so much reliability of the individual server, but rather the time it takes to affect repair or replacement, and return EMR applications to full production.

Cold standby:

Keeping a second server on hand to provide back-up is an option, but undesirable for mission-critical such as EMR applications. Connecting a replacement server to a shared disk array, or moving disks from the primary server to the back-up generally requires a skilled administrator. It also scarcely improves protection against downtime, although it could provide some benefit to getting online a bit more quickly (assuming the back-up server works when called upon).

Data replication:

This off-the-shelf software option replicates data files synchronously or asynchronously from one or more servers to a target server. Should a source server fail, the target server takes over either automatically or through manual intervention. Depending on the product chosen and overall system configuration complexity, this option may push uptime reliability to as high as 99.9%, or three-quarters of an hour of downtime per month.

High availability clusters:

Two or more ordinary servers connected by software into a single network are the basis of an HA cluster. The cluster configuration is difficult to build, operate and manage. Although Microsoft has made recent improvements to Windows Cluster Service, this approach to availability remains fundamentally complex. Clustering is re failure-recovery technology. When one node in cluster fails, the application fails over to a survivor node – not as easy or as quickly as it sounds. Invariably, there will be failover delay, and data that had not been committed to memory (in-flight data) will be lost. This custom-built option can achieve 99.9% uptime and, if meticulously designed, configured, administered, and maintained by skilled staff, may achieve 99.95%. Clusters are frequently cited as offering the highest availability, but that is only because it is the best uptime major server vendors can offer.

Virtualization software:

Many view virtualization software as an availability solution unto itself. It is not. It does have such attributes, but they come at a cost, both in licensing, additional equipment, stringent configuration requirements, and management tools, not to mention the complexity of, and skills required to use virtualization software in the first place. Availability will be no better than a cluster, but virtualization does provide other benefits such as reducing the number of physical servers needed to support a greater number of applications, and all the cost savings associated with reducing server count.

High availability software:

Software products have come to market in the past few years that provide better availability on commodity servers than clusters, are significantly less expensive, as well as simpler to use and maintain. The software essentially creates a high-availability computing platform upon which to run EMR applications. The best of these products proactively manages and monitors its own operation, prevents downtime and data loss from occurring (unlike clusters), supports multiple operating systems, and has virtualization software built in. Regardless of whether the physician installs the software or the value-added reseller delivers it as part of a total solution, it is easily accomplished and produces a high-availability computing platform exceeding 99.99%, i.e. less than five minutes of downtime per month on average.

Continuous availability servers:

Designed specifically to prevent downtime and data loss from occurring in the first place, “fault-tolerant” servers include complete component redundancy and error detection circuitry. Automatic fault detection and correction is engineered into the design so that most errors are resolved without the user or the application being impacted at all. You can expect better than 99.999% uptime from this platform, or just seconds of downtime per month. While the cost may be higher at the outset, the uptime performance and operational simplicity of fault tolerant server is very cost effective from the perspective of total cost of ownership (i.e. advantages in software licensing, maintenance, staffing, software patching and updating, etc.). © 2008 SYS-CON Media Inc.

Source: http://www.sys-con.com/node/1900855

The cost, physician practice size, and lack of technical resources still present barriers for small healthcare providers in adopting electronic health records and participating in the meaningful use incentive program.

Solo practitioners and small practices find it difficult to locate a lender willing to offer them an unsecured loan, said Dr. Sasha Kramer, a solo practitioner dermatologist in Olympia, Wash. Others who try to finance their electronic health record (EHR) system with the vendor have no leverage in negotiating terms because of their limited market share.

Kramer was among public and private health IT experts and physicians who spoke at a June 2 hearing of the House Small Business Committee’s health care and technology subcommittee.

Two years ago, Kramer purchased and deployed an EHR system that cost more than $41,000. It took four weeks to learn and integrate. Although quick by many standards, it reduced the number of patients she saw by 75 percent, from 4 per hour to 1 per hour, and slashed her revenues, she explained.

Two years later, she has to replace that EHR because her vendor was acquired and no longer supports her system. “I have to invest $30,000 in a new system and take time again from my patients to learn it,” she said.

“Despite these factors, I fully support the infusion of health IT into physician practices. It is a critical component in improving the healthcare delivery system and, more importantly, providing optimal patient safety and care,” Kramer said.

For instance, she has each patient’s chart and information for each visit and can track drug interactions and medication refills and past medical history. “It is much easier to communicate with other providers, and I am able to operate more efficiently with less employee time spent pulling and organizing charts,” she said.

Dr. Farzad Mostashari, national coordinator for health IT, is familiar with the difficulties of solo physicians and small practices acquiring and deploying health IT. Before coming to the Office of the National Coordinator for Health IT (ONC) in 2009, he led the New York Primary Care Information Project where in three of the city’s most underserved communities in one year’s time more than 1,000 providers went live with EHR systems.

ONC has funded 62 regional health IT extension centers nationwide that are now assisting more than 70,000 mostly primary physicians with EHR purchase, implementation, project management and other technical challenges of establishing and becoming meaningful users of certified EHRs. ONC also lists more than 700 certified EHR products on its website.

“I make no bones about the transformation of workflows and processes and the difficulties that many practices, especially smaller practices, will face as they make this difficult transition. But it is a rewarding process and ultimately will not only lead to improved patient care and coordinated care but will help those practices succeed financially over the long run,” Mostashari said.

Kramer urged Congress to provide sufficient financial resources so solo physicians can establish health IT and to consider delaying the penalties that take effect in several years for those who do not become meaningful users until such time that a functional integrated EHR system is widely available. She also said that some physicians should be exempted from financial penalties so that they are not pushed into early retirement, which could further exacerbate the physician shortage.

Andrew Slavitt, CEO of OptumInsight, a health IT services company, said that the temporary financial incentives will not be enough to compensate for provider productivity losses. Meaningful use is just a starting point for private sector innovation revving up.

Capabilities that enhance provider productivity are not driving the purchase and design of EHR technology.
“New product development is focused on satisfying the regulatory hurdles of the payer, CMS, rather than simple innovations that improve productivity,” Slavitt said.

Slavitt suggested that federal policymakers align the requirements that physicians are subject to among multiple programs. He also urged continued federal investment in health information exchanges and the extension centers, which have proven to be a strong tool to provide expertise for small practices. The Small Business Administration should also supply business loans to small providers.

Source: http://www.govhealthit.com/news/congressional-panel-explores-barriers-small-provider-ehr-use

WASHINGTON – Even doctors who have purchased and successfully implemented electronic health records (EHRs) do not always know what they’re buying until the system is up and running.

ONC director Farzad Mostashari made that point to a room full of chuckles on Wednesday while giving the closing keynote address at the Government Health IT Conference here in Washington.

The problem: While there are nearly 750 EHR products certified for meaningful use stage 1, adequate apples-to-apples comparisons of features and prices do not exist today.

Competition is a wonderful thing, said Mostashari, but “classic causes of market failure,” in this instance prohibitively high switching costs, vendor or data lock-in, among others, weaken the competitive landscape.

“We need to create a better marketplace,” he said. “We want as little government involvement as possible, but no less.”

The goal of meaningfully usable, more effective EHRs will help physicians put patients at the center of their own care, said Mostashari, who has been spreading his patient-centric principles since he became national coordinator. On Wednesday, he drilled down into three of the tactics ONC is planning to take.

Building upon his well-established and well-known five principles – good governance, keeping eye on the prize, but with both feet on the ground, using markets to foster innovation, and opening the benefits of health IT to everyone – Mostashari said that the meta principle is putting patients at the center of information flows, literally.

Achieving that means freeing the patient data, empowering patients by raising awareness that they can access their own data and teaching them to learn from it, and creating a platform for innovation, such as the Innovations Initiative (i2), a developer challenge with which ONC hopes to open doors to collaboration and innovation.

“Patients have a right to their records,” Mostashari said. “We need to liberate it from the entities that hold it.”

Source: http://www.govhealthit.com/news/mostashari-we-need-better-marketplace

Electronic Medical Records (EMR) software typically comes with a cost for set-up and training. Every new software system needs attention to detail in the beginning stages of use. A complex EMR Software is no exception. While the Graphic User Interface (GUI) make the medical software appear easy to use by the medical practice staff, the software code and “behind the scenes” calculations are complex and very logically structured.

Set-up costs are based on a variety of factors. The term “No Free Lunch” applies to EMR as well. There are some different EMR software systems on the market that have a zero charge for set-up. The set-up charge is designed to provide the medical practice with a robust content of clinical data and applications in place. These tried and proven data bases structures are more than a matrix to be completed by the end user. The idea of having a free training and set-up offer is a good one. If you are willing to take the time and invest your knowledge and create your own EMR. Why reinvent the wheel? The time spend on template creation and content management and maintenance can be more than bargained for. The time spent in this task of EMR template creation can be better spent seeing patients of leisure activities. The ongoing maintenance and updates are up to the practice. A nominal set-up fee can be money well spent.

Training costs are based on the level of tech savvy at the provider and staffing levels. Appropriate levels of training in the beginning can deliver a tremendous return. Paying a fee can be another well justified cost. The training can show the provider and staff the most efficient and effective way to maneuver through the system. Some people are tech savvy and can pick up the system usage quickly, while others take more time and resources to get up to speed on the software. Trying to “figure it out on your own” can be a difficult decision to go back and correct. The investment in time and money can get you miles ahead. Applying what you have learned as a beginning user can lead you to more advanced training and superior documentation in a more expedited manor. The learning curve can be lessened, and faster, high documentation levels can be achieved.

In summary: the cost of Set-up and training can be recouped fast and with a higher return on investment than a shrink wrap out of the box EMR Software. This is your practice and keeping it a successful practice along with patient care are very important.

Source: http://www.bizmaticsinc.com/blog/category/emr-training/

Electronic medical record vendors are taking steps to ensure not only that their products have all the bells and whistles required under meaningful use rules, but also that the products are easy for physicians to use.

Though a system’s so-called usability has been one of the barriers to physicians adopting EMRs, there have been other pressing issues that vendors, as well as the government, have focused on in an attempt to spur adoption of health information technology.

“It’s been a natural progression rather than, ‘We forgot about that,’ ” said Edna Boone, senior director of health care information systems for the Healthcare Information and Management Systems Society, of the recent focus on making systems easier to use.

The EMR market is expected to grow an average of 15% annually, mostly because of the government’s meaningful use incentive program, according to a market report by New York-based research firm Kalorama Information. But the marketplace has become quite crowded, and overall usability is the main factor that will keep vendors competitive.

“In the EMR market now, you don’t have a clear leader either in total market share or physician loyalty,” said Bruce Carlson, publisher of Kalorama Information and author of the report. “Given that, there is an opportunity for somebody to really come out with a much better EMR usability to become kind of the golden standard and come close to capturing the market or being the one that physicians are saying, ‘Look, we want to get this system.’ “

“How many clicks, how many screen flips, how many keystrokes?” he wrote in the report. “These are the micro-factors that are going to be important in physician adoption of EMR and continued use of the systems.”

Vendors are doing several things to make systems easier for physicians:

Reducing click counts and the time it takes to accomplish tasks. Some vendors are trying to streamline how quickly it takes physicians to get something done, realizing that if a task takes longer on an EMR than with paper, it won’t be done on an EMR. For example, Carlson cited physician testimony to a Dept. of Health and Human Services committee detailing that it took 10 minutes to order a mammogram on an EMR and two minutes and 15 seconds to enter a family history. On paper, those tasks take only a few seconds. Vendors are realizing that is a waste of physicians’ time, Carlson said.

Improving screen-design elements. Font size and colors either can enhance or hinder the user experience. Small type sizes are hard to read, as are certain colors against a particular background. Vendors are making changes that will lead to clearer screen views.

Creating consistencies in screen designs. An inconsistency in the way the layout changes from screen to screen can confuse system users and lead to errors. Sue Reber, marketing director for the Certification Commission for Health Information Technology, which developed a usability rating system as part of its proprietary EMR certification program, said consistency in color coding and the placement of design elements are factors that contribute to a system’s intuitiveness.

Reducing information overload. The amount of information on a screen not only can make it difficult for users to navigate through the system but also could result in important information being missed. Vendors are tweaking designs to limit the information on main screens to data that will be needed and used the most.

Reducing alert fatigue. Vendors are trying to create meaningful alerts that are tools for physicians, not annoyances they will learn to ignore. Systems are becoming easier to customize based on the user’s needs.

Matching system flow to workflow. For years, vendors and technology experts said installing an EMR required physicians to adjust to what the technology needed to manage the flow of patients through the office. Experts say now more vendors are taking the opposite tack: working with physicians and adjusting their designs so EMRs better fit in with what the practice is already doing.

Building forgiveness into data entry. Systems are being designed to help users correct mistakes easily. Adding features such as a back button that allows users to go back to the previous screen or data field to correct mistakes or omissions easily is another way vendors are making systems more user-friendly.

Efforts are under way to add usability checks to the criteria technology vendors must design their systems to meet to be certified for meaningful use. But because of the competitive nature of the marketplace, vendors aren’t waiting for it to become a requirement.

Boone said many are hiring usability experts during the design phase of their systems’ development. Many also are going through the Certification Commission for Health Information Technology’s proprietary certification program voluntarily in addition to the meaningful use certification. CCHIT’s five-star usability rating has been used by several vendors to set their products apart from the competition.

“There’s no doubt that good usability of a product is going to be a market [feature] that will drive sales,” Boone said.

Source: http://www.ama-assn.org/amednews/2011/06/20/bica0620.htm

By Rosemarie Nelson, MS
Principal, MGMA Health Care Consulting Group

Health care is all about the patient, and efficiency from the moment he or she walks in the door will make you and your customer happier. From filling prescriptions to scheduling, here are my top 10 must-do’s to improve your medical practice’s work flow.

1. Issue prescriptions and refills at the visit.
   If the follow-up visit is a year from now, provide a full year of the patient’s medication(s) and eliminate a phone call (or a fax or e-transaction from a pharmacy) that will pull a nurse away from supporting physicians.
2. Adopt e-prescribing.
   Stop your staff from pulling charts to check patients’ medications and recording new prescriptions. Maintain all patient medication information electronically for easy access.
3. Stagger staffing hours.
   Create a late-day nursing position so you always have coverage without paying overtime. You’ll also prevent upheaval among nurses as the negotiations for “who can stay” take the nurses away from their work.
4. Staff up for peak times.
   To start on time and stay on time, have sufficient staff to prep and room patients, and answer phones first thing in the morning and again after the lunch break. Part-time staff can supplement your full-time staff so you don’t have excess capacity as the workday ends. 
5. Use your telephone auto-attendant wisely.
   Patients want your phones to be efficient; they don’t want to waste time getting transferred or having to repeat their story. Provide a short directory – no more than three options – for incoming calls: make an appointment, speak to a nurse/doctor or other. Short and simple.
6. Use your Web site to offload incoming phone calls.
   You’ll meet your return on investment in months if you promote online interactive services. Encourage patients to use your Web site to schedule appointments, request prescription refills, get diagnostic test results and complete their visit registration – including medical history.
7. Clean up appointment-scheduling templates.
   Generally a short appointment slot and a long appointment slot will do the trick for any physician’s calendar. When a practice gets too fancy and tries to control the demand for appointments by forcing them into a predefined, structured template, gaps occur in the physician’s day and causes patients to wait a long time for some types of appointments. Get the patients in and keep the doctor’s day full with two appointment types: long and short.
8. Reduce denied claims by verifying patient insurance eligibility and coverage benefits.
   Match MGMA better-performing practices with a 3 percent denial rate on first submission. To see how much you’ll save, let’s assume your denial rate is 5 percent (only 2 points higher):
• You generate 25 claims each day for each doctor.
• Each physician works four days/week and 48 weeks/year for a total of 4,800 claims.
• If your practice has an extra 2 percent denied, that’s 96 claims denied each year per physician.
• It costs between $25 and $40 to re-work a claim. (According to Physicians Practice and Susanne Madden of The Verden Group.)
• Reduce denials to better-performing status (3 percent) and you’ll reduce costs by $2,400 to $3,840 annually.

Imagine what your staff can do instead of reworking all those claims.

1. Use your bank’s lockbox service to file explanations of medical benefits (EOMBs). Based on my 15 years of experience, even a solo physician’s office spends 60 to 90 minutes every week filing and retrieving EOMBs. Improve your accounts receivable status by devoting that hour to real work instead of filing. A bank lockbox service accepts all your payments, deposits the checks on the same day, provides Internet access to electronic copies (usually for 90 days; you can then transfer them to CD). Who wants to spend time filing when denied and outstanding claims need follow-up?
2. Track patients using your practice management system’s appointment-scheduling tools.
   Avoid paper and lights and flags and intercoms and instant messaging – use the inherent features in your practice management system to smooth patient flow. Let your nursing staff keep the charts for the day so they can prepare for patient visits and use the scheduling system to “arrive” patients electronically. Nurses can also use the system to assign exam rooms and let physicians know who is up next. The system will also help you route patients to your lab or other departments and alert the receiving staff to their arrival.

Source: http://blog.mgma.com/blog/bid/24623/Top-10-tips-to-improve-overall-practice-work-flow

Walnut Creek based Hearty Medical Solutions in partnership with gloStream announces their 15 day EMR Success Guarantee.

Many doctors have confirmed that EMR success comes through solutions that are… 

• Easy-to-use and will get your practice to full productivity quickly.
• Highly personalized and offer control and flexibility over workflows and content.
• Interoperable with other systems.
• Supported locally with quick response times.

 Based on this feedback we’ve partnered with Microsoft and gloStream to offer a proven and certified EMR solution that comes with a money-back guarantee.

 We are a local company specializing in providing personalized EMR and medical technology solutions and support to medical practices.

• We use gloDNA, a proven quick-start implementation process to get you back to full patient load quickly and effectively.
• We guarantee the combination of local support, quick-start implementation, and easy-to-use solutions from Microsoft and gloStream that will provide you with a successful implementation.

 Hundreds of doctors have gone through the gloDNA process successfully. We’re so confident you’ll get back to full productivity within 15 clinic days that we’ll refund your money for software and services if you don’t.

2011 is the easiest year to achieve Meaningful Use status and get your grant money. Call or email me right away for your free gloDNA EMR consultation and to see if you qualify for the 15-Day Success Guarantee.

 It’s critical that you get started today.

 Chris Hearty
President
Hearty Medical Solutions
cjhearty@efficientEMR.com

Watch Dr. Bill Crounse, Senior Director of Worldwide Health at Microsoft, discussing the guarantee. View the short video here.

What Wayne Gretzky Can Teach Us About Fixing Our Health-Care System

In getting doctors to adapt to new medical technology, designers can learn a lot from the ice hockey legend.

In my last post on Co.Design, I wrote about how mandatory implementation of electronic medical records (EMRs) technology is forcing highly skilled physicians out of practice. The trend is primarily affecting the older generation of physicians, who didn’t grow up with computers. These doctors aren’t used to interacting with a big screen between them and their patients, and the technology hasn’t been designed to be user friendly.

Some doctors will spring in to action and get on board with the EMR system, as the government will begin levying fines on medical practices where physicians don’t. But others will quit altogether. And we’ll lose an unknown percentage of our top medical talent.

There’s a shortsighted assumption held by many in the health care community that the use of EMRs will get easier when the older generation is gone. On a purely human level, there’s something wrong with this strategy of morbid attrition, where we’re waiting for the old dogs to die out so the system can be based around new tricks. But the “change, pay up, or quit” approach we’re taking to designing and implementing EMRs is backwards for highly practical reasons, as well. The older generation may be affected the most, but when they’re gone, all the same problems will still exist.

It’s not just an old person’s thing

I understand the conclusion that EMR technology is just an old person’s problem. There is a non-debatable correlation between how old a doctor is and how much they struggle with EMRs. Many have poor typing skills, a lack of familiarity with conventional user-interface elements like drop-down menus, even discomfort with a mouse and keyboard. The older you are, the less new things seem “new” and the more they seem “newfangled.” No surprises here.

Older physicians may be the proverbial “weakest of the herd,” but there’s a deeper problem at work: We seem to think it’s OK to create technological monstrosities that fundamentally change the way people do their jobs, and then expect them to adjust accordingly.

Don’t force it

Why do so many doctors and practices use these systems? Because they’ll be fined if they don’t. But behavioral economics research clearly shows that there are many more effective incentives than fear of punishment. Simply put, everyone should want to use an EMR because it makes his or her practice better, safer, and more efficient.

Gretzky’s broader point applies to the design of complex UI’s.

It doesn’t work when dictators impose their will on people, and it doesn’t work when technology does, either. It has been estimated that 20-30% of EMR systems are uninstalled within a year, often due to physician dissatisfaction. Think about it: You’d have to be really dissatisfied to uninstall a system that costs around $120,000 per doctor to implement. With that in mind, it’s not hard to infer that lots of doctors are living with systems they wish they could afford to replace. Physician acceptance is essential to the functioning of the system, and the design community needs to step up and make an impact there.

Play where the puck is going to be

There’s a great quote attributed to Wayne Gretzky, which he supposedly said when a journalist asked him why he was such a great hockey player. It goes something like, “A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be.” I suspect that he wasn’t thinking about information systems when he said it, but there’s a broader point to his message that applies to the design of complex user interfaces, because of a thing called Moore’s Law.

If you’re a geek like me, you probably already know Moore’s Law. You may even own a T-shirt with a humorous saying about it. If not, here’s the upshot: Computational power has more or less doubled every two years since the mid-20th century and will continue to do so until 2020 or later. One of the consequences is that it becomes increasingly cheaper to make more technologically complex products. In short, the amount of technical complexity foisted on consumers is only going to get worse, and it’s going to happen faster than it ever has.

So, yes, I agree that when the medical old guard retires, dies, or quits, the remaining physicians will be more comfortable with today’s technology. But at that point, we’ll just be playing where the puck is.

We’ve seen it in every domain, where technological change is happening faster and faster. Moore’s law says that the rink we’re playing on is on the side of a very steep hill, because not only is the puck moving, it’s accelerating.

Too old for technology?

To be clear, this isn’t a manifesto on designing for old people. It’s a manifesto on designing for people. My point is that with technological innovation getting faster, the age at which you’re “too old for technology” is going to get increasingly younger, or you’ll be forced to change your life around more and more frequently to fit the needs of a new system.

The only way to keep up with the puck — or Moore’s Law — is to design for what isn’t changing anytime soon: human nature. We’ll drive adoption up, training costs down, and realize more of the benefits EMRs promise if we do. It all comes down to a fundamental truth about people: We are great at adapting when we want to, but we absolutely hate being forced to change.

We’re great at adapting when we want to, but we hate being forced to change.

Electronic medical records represent an incredible technology with nearly limitless potential. I truly believe in their importance to fixing health care. They just need to be done right. And “right” means using design to break technology to the will of the physician, as opposed to using training to break physicians to the will of the technology.

But the fact remains that less than 20% of doctors actually use fully functioning EMRs (some studies say as low as 4%, some as high as 17%). And at the end of the day, that low of an adoption rate is plain bad for business.

Doctors don’t want to use EMRs, per se. They want what they pulled 100-hour weeks in med school for: outcomes. They want to keep healthy people healthy and make sick people better; they want to prevent errors that hurt their patients and jeopardize their careers; and they want to look their patients in the eye, understand what they feel, and use their intuition. And being able to streamline billing, improve research, and reduce cost doesn’t hurt either.

If EMRs can deliver all of those outcomes without requiring people to completely shift the way they do their work, then everyone wins. If they can’t, we’ll only get the early adopters to change willingly, and we’ll have to pull everyone else kicking and screaming. I think we can get where we need to be someday, but not without an attitude adjustment.

 

Roderick McMullen

Roderick McMullen is a designer at Continuum Advanced Systems, in Boston. He has a master’s in human-computer interaction from Carnegie-Mellon University, and undergraduate de… Read more

Source: http://www.fastcodesign.com/1663849/what-wayne-gretzky-can-teach-us-about-fixing-our-health-care-system