SUZANNE BOYD

Dr. Don McKnight, a urologist at Jackson Urological Associates, enters information into a patient’s electronic medical record.

Across West Tennessee, the use of health information technology in the physician office is as varied as the types of practices. Clinics use health information technology for a variety of reasons, including billing, electronic medical records (EMRs) and e-prescribing.

While there are benefits to the use of EMRs and other forms of health information technology, there are reasons for its slow adoption. These include costs, the inability to integrate different software systems used by a clinic and other healthcare providers, resistance to change and the difficulty in incorporating older records. The benefits of implementing EMRs and other health information technologies into a practice, however, can outweigh the issues involved with adoption.

Health information technology is a term that can include other information systems that keep track of medical information, such as practice management systems, that support an electronic medical record or electronic health record (EHR), a medical record in digital format. “EMRs are electronic filing cabinets that benefit the patient,” said Jeff Freiling, chief information officer for West Tennessee Healthcare (WTH). “Medicine is more complex and increasingly harder to keep track of. Computer and health technology software is just a tool to help manage the volume of information. It also provides an opportunity to have the information where it is needed.”

Jackson Urological Associates, P.C., (JUA) completely changed hardware and software to a practice management system in 2004 that included EMRs. “Our charts are scanned into the computer system, although some of our physicians still prefer paper charts,” said Mary Helen Cepparulo, clinic administrator for JUA. “We changed systems for several reasons, such as patient confidentiality, convenience, and reduction in chart related expenses.”

“We made the decision as the industry was saying it was the way to go,” said Sharron Hellums, administrator of Northside Medical Clinic, P.C., which went to a system that included EMRs in 2004 as well. “It does help with charts, their storage, and the amount of paper we use. It is convenient, it provides a check and balance system and has drastically reduced our chart chasing. Overall, it makes it easier to treat the patient more efficiently.”

In many instances physician offices have separate software for billing, practice management and electronic medical records that are either not integrated or compatible with one another.

Companies such as Xpress Billing Solutions (XBS), a franchise of American Billing Systems in Dallas, specialize in physician billing. By using the Internet for electronic billing, the system is updated every 24 hours with any new coding requirements. This option for physicians is designed to save practices money by decreasing denied claims, said Dennis Wozniak, consultant with XBS. They have a “success rate” of 98% on the first submission, he said. The cost for their services is dependent on the type of practice, the numbers of claims and the difficulty of those claims.

“Our company’s product is designed to help speed up the time it takes to collect money from both insurance companies and Medicare,” Wozniak said. “We can also help increase the amount collected as we offer other Patient Plans and a ‘computer’ collection program for practices to recover revenues from their patients.”

Many practices have computerized practice management systems that are compatible with other systems, even with local hospitals, that afford them the capability of exchanging health information necessary for timely, patient-centered and convenient care. WTH is taking steps to implement a system with area clinics that will integrate patient data between the hospital and physician offices, homes and clinics.

“All hospitals in our system are integrated with one another,” said Frieling. “We want to apply that same type of integration with clinics and doctor’s offices. The process entails designating a master patient index information number unique to the patient. This number is determined through the registration process and allows patient information, testing, etc., regardless of where it is gathered, to be stored in one record.”

Incorporating information from older paper medical records into the EMR is necessary to attain the wide accessibility of information, efficiency, patient safety and cost savings that an EMR can provide the practice and the patient. This requires digital scanning of the old medical record into the EMR, which can be expensive and time-consuming. The information may exist in various formats, sizes, qualities and even media type, which can complicate an accurate conversion to digital format. In many clinics, this conversion falls to medical records personnel or is out-sourced.

The adoption of EMRs into a practice tends to follow the 80/20 rule in that 80% of the work is spent on dealing with issues of change management while the remaining 20% is on technical aspects of the conversion. “The technology is the easy part even though it is constantly changing,” said Freiling. “It is the paradigm shift of changing the way people do business, and it can get real personal as some people have an innate fear of computers.”

Organizational issues can include restructuring workflow, dealing with medical, and support staff resistance to change, individualizing the software to accommodate physician practice patterns, and making it flexible for various providers, and opening dialogue between the caregivers and the information technicians.

“The change in our day-to-day healthcare delivery and the lack of computer skills in some of our staff began the tedious process of conversion,” said Hellums. “We worked with the vendor and a core group in our office the first year as we developed the file maintenance tables, templates and physician schedules. We revised procedures we knew would not work with the change the EMR would require. Today we are able to train new and existing staff ourselves when changes occur.”

Technology issues can revolve around software and hardware costs, updating the systems and template generation. Compatibility between practice software, billing software and EMRs can be an issue if different vendors are used. “At Northside Medical Clinic, each physician uses a wireless tablet, much like a laptop,” said Hellums. “These are expensive, and, in three years of use, we have already had to replace them, not to mention software upgrades or updates and the new technology that is constantly being developed.”

Other costs associated with an EMR system can vary significantly based on the specialty and the needs of the practice.

“In family practice, we see a broad scope of patients and ailments and a variety of services that we provide our patient base,” said Hellums. “Physicians appreciate the electronic prescription option, and we all love the flexibility it affords our physicians. If templates are not working, they always have the option to dictate all or part of the note.”

One factor that may increase the number of physician practices to adopt some form of health information technology is legislation requiring physicians participating in Medicare to use e-prescriptions by 2011.

Although the conversion can be taxing on all parties involved, the results provide more efficient patient care.

“Converting was a huge expense and a huge commitment, but we would not go back,” said Cepparulo. “It was labor intensive on the front end and everyone has a learning curve, but all in all things have improved and we are better at what we do.”



July 2008