Paperless_Healthcare

Paper vs. Technology: How Health Care Providers Manage Patient Records A Case Study of HIMG Johnson, Estep, Fridley, Marriott, and Stone 1 Paper vs. Technology: How Health Care Providers Manage Patient Records A Case Study of HIMG Since the medical industry began, it has used hand-written notes as a means of recording patients’ information. This system has worked just fine for hundreds of years; however, times have changed. Society, as a whole, is moving farther and farther away from the era of writing things by hand. Instead of letters, there is now e-mail. Instead of newspapers, there are articles on the Internet. Books are even being printed online and can be viewed on electronic devices instead of being printed and viewed in physical books. All industries, whether they be technical in nature or not, have adopted more and more technology and now use paper and the art of hand-writing information less often. Undoubtedly, with all this in mind, one could begin to ask him/herself a series of questions. Why then, has our health care system been so slow to adapt to the times' Why do the majority of primary care physicians still choose to scribble down hand-written notes about patients in paper charts that are kept in file cabinets' Why do so many health care professionals insist on keeping themselves open to making the same errors in patient records that they have been vulnerable to for centuries' Switching to a paperless system just makes sense. Paperless systems have marvelous capabilities that doctors cannot readily compete with their old-fashioned charts. For instance, electronic medical records (EMRs) can automatically update themselves when new information on Johnson, Estep, Fridley, Marriott, and Stone 2 a vaccine becomes available from the Centers for Disease Control (A Buyer’s Guide to Medical Software, 2010). EMRs allow for quicker transmittance of information in everything from billing to a patient’s test results—and that is just the tip of the iceberg when it comes to the overwhelming benefits of EMR. Benefits of Electronic Medical Records The benefits of switching to an electronic system are numerous. The first and most obvious benefit is efficiency. Efficiency is an important aspect of any business, but is especially pertinent in the health care industry. Patients’ information can be accessed in a timelier manner and the information is much more accurate (Telegenisys, 2008). This quick access to patients’ information can also be potentially lifesaving. Tragedies such as Hurricane Katrina and the fires in California have especially highlighted how beneficial electronic recordkeeping can be. The people injured in these events benefited from electronic medical records as many of them were treated with more ease (and probably had better outcomes) than those who did not have EMRs (“EMR Review Project,” 2010). Most facilities that adopt EMRs maintain their information in a secure off-site location (Higgins, 2010). This means that even in the event of a catastrophe, those records can be accessed. Another benefit of switching to an electronic system would be increased patient safety. In the day of hand-written, paper charts, when a doctor wanted to learn about a patient’s medical history, they had to solely go on information that the patient gave them Johnson, Estep, Fridley, Marriott, and Stone 3 about things like medication they may be allergic to and/or previous surgeries they have received (Higgins, 2010). When it comes to these primitive types of records, what happens if a patient forgets something' Without doubt, there could be potentially life-threatening consequences. When doctors have the ability to share records electronically, they can pull up a complete review of a patient’s medical history (Higgins, 2010). Electronic records take the human error out of the equation because EMRs do not “forget” pieces of a patient’s medical history. A third and very important benefit of EMR systems is that health care providers can save a great deal of money by using such a system instead of old-fashioned, paper charts. Not only would money be saved by not having to buy paper and file folders, but the providers can save a great deal on the cost of labor and space as well (Lin, 2010). Imagine the amount of time, money, and effort that can and would be saved by being able to retrieve information by just simply using a couple of keystrokes as opposed to staring at thousands of file folders, searching through those files, pulling the needed patients’ files, and then re-filing them. In addition, an EMR system comes with the added benefit of security. There are many ways in which an EMR system is more secure than a paper one. First of all, with an EMR system you can keep track of who accessed what file(s) and when they accessed it (Lin, 2010). It is much harder (if not almost impossible) to keep track of such activities in a paper filing system. With an EMR, one must have a valid user name and password Johnson, Estep, Fridley, Marriott, and Stone 4 to access any part of the system (Lin, 2010). This makes any sort of unauthorized access to files much easier to prevent. The final benefit of an EMR system is that any organization that decides to use such a system will receive support for that system. Most EMR systems come equipped with access to and integration with many medical regulations, medical codes, and new information (“EMR Project Review,” 2010). An EMR system can be integrated with HIPAA and the Department of Health & Human Services, to name a few, to ensure that their most up-to-date information is always available to health care providers (Telegenisys, 2008). Also, if the system goes down, the organization has access to technical support in order to help restore the system as soon as possible (Telegenisys, 2008). What happens if a patient’s file gets lost in an EMR system' It can be recovered rather quickly and easily. On the other hand, what happens if a patient’s physical, paper file is lost' It most likely will never be recovered. EMRs Make Financial Sense Not only are there so many operational benefits to adopting an EMR system, but there is also government funding available to assist in the switch from paper files. The Department of Health & Human Services just announced in September of this year that they would add $20 million just to support rural health care systems in switching (United States News Release, 2010). This is in addition to $162 Million that was added in March to assist all health care facilities in switching (Lewis, 2010)-- which was in addition to Johnson, Estep, Fridley, Marriott, and Stone 5 hundreds of millions of dollars that were already pledged by President Obama through the American Recovery and Reinvestment Act of 2009 (Goldman, 2010). Government funding is not the only financial reason to go ahead and switch. According to a recent study by Frost & Sullivan, the changes in reimbursement practices by changing to an EMR system will result in an increase in revenue of $3 billion by the year 2013 (Lewis, 2010). Now that the benefits of implementing an EMR system are clear, we can confidently explore some options of different systems that organizations can implement. There are more EMR software producers than one could count. Even General Electric is in on the action with their EMR software, Centricity (Higgins, 2010). How then, would an organization go about selecting what system is right for them' There is a great deal of information available online to help health care providers select what system would be right for them. This helpful information that one can find includes, but is not limited to, such things as lists of features and reviews from real customers. Similarities and Differences between some EMR providers Here is a comparison between five different EMR providers as found in “Electronic Health Records Software Systems” found in A Buyer’s Guide to Medical Software in November of 2010: Johnson, Estep, Fridley, Marriott, and Stone 6 First, let us compare the Centricity system produced by GE and the Intergy system produced by Sage. EMR Product | Centricity | Intergy | Producer | GE | Sage | | | | Feature: | | | Installation, Training, Support Issues | 5 | 5 | General Overview | 1 | 3 | Adolescent Privacy Features | 3.5 | 3 | Prescription Generation, Transmission | 4 | 4 | Standard & Flexible Format Reporting | 5 | 4 | Online Patient/Parent Access & Interactions | 3 | 3.5 | Lookup Features, Identifying data | 2 | 3 | Immunization Data Handling, Analysis | 3.5 | 2.5 | Tracking Disclosures, Parental Appendices | 5 | 4.5 | Growth Parameters, Percentiles, Curves | 4.5 | 5 | Linkages between Family Members | 1.5 | 3.5 | Documentation/Assessent of Developmental Milestones | 4 | 3 | Ease/Methods of Data Entry, Incl Peds Terminology | 3.5 | 4 | Data Pertaining to Birth History | 4 | 3.67 | Awareness/Comparison to Age-Base Values | 4 | 3 | Practice Management Integration | 4 | 4 | Costs, Subjective Value, ROI | 3 | 3.5 | | | | Ratings: (5) Excellent, (4) Very Good, (3) Satisfactory, (2) Fair, (1) Poor, (N/A) Not Available/Applicable | | | | Total Rating | 60.5 | 62.17 | Next, let us compare Next Gen by Next Gen Healthcare Information Systems, Encounter Pro by Encounter PRO Healthcare Resources, Inc., and MEDENT by Community Computer Service, Inc. Johnson, Estep, Fridley, Marriott, and Stone 7 EMR Product | NextGen | Encounter Pro | MEDENT | Producer | NextGen Healthcare Infromation Systems | EncounterPRO Healthcare Resources, Inc. | Community Computer Service, Inc. | | | | | Feature: | | | | Installation, Training, Support Issues | 3 | 2 | 5 | General Overview | 3.25 | 4 | 4 | Adolescent Privacy Features | 2.5 | 3.33 | 3 | Prescription Generation, Transmission | 4.5 | 3.33 | 5 | Standard & Flexible Format Reporting | 4 | 4 | 4 | Online Patient/Parent Access & Interactions | 3 | 3 | 4 | Lookup Features, Identifying data | 4.75 | 5 | 5 | Immunization Data Handling, Analysis | 3.5 | 4 | 4 | Tracking Disclosures, Parental Appendices | 3.67 | 4 | 3 | Growth Parameters, Percentiles, Curves | 3.75 | 5 | 5 | Linkages between Family Members | 1.5 | 3 | 4 | Documentation/Assessent of Developmental Milestones | 2.25 | 4 | 4 | Ease/Methods of Data Entry, Incl Peds Terminology | 3.25 | 2.5 | 3 | Data Pertaining to Birth History | 4 | 3.5 | 5 | Awareness/Comparison to Age-Base Values | 4.5 | 4 | 5 | Practice Management Integration | 4 | 5 | 3 | Costs, Subjective Value, ROI | 3.5 | 2.5 | 4 | | | | | | | | | Total Rating | 58.92 | 62.16 | 70 | Johnson, Estep, Fridley, Marriott, and Stone 8 It is clear that MEDENT by Community Computer Service, Inc. is the overall highest rated system out of these five, but that does not mean that MEDENT is for every organization that is looking to implement an ERM system. Organizations and their cultures vary just as people do; what might be right for one organization is not right for all organizations. There are two ways to better understand ERM systems: use one yourself or talk to people who use one on a daily basis. For this project, our group did the latter. In order to gather research, group members interviewed and talked with several different members of Huntington Internal Medical Group, from administrators to staff to doctors, about their use of an ERM system. After a brief introduction to the organization, the results of this study will be shared. HIMG Huntington Internal Medical Group (or HIMG, as it will be referred to from now on) is a major health care provider for Western West Virginia, Southern Ohio, and Eastern Kentucky. This over sixty member medical provider group is located on Route 60 in Barboursville, West Virginia. According to the organization’s professional website, it is seen as a “medical mall” with every kind of doctor one could imagine, different types of medical testing, a pharmacy, physical therapy center, and walk-in clinic all in one place (2010). With all of these different types of medical assistance all available in a Johnson, Estep, Fridley, Marriott, and Stone 9 one-stop shop, it is easy to see how EMR could help these doctors efficiently and effectively share the medical records of their patients. HIMG and EMR In order to gather some background and other basic information about HIMG and its use of EMR, our group decided to interview Nate Cantrell, the IT specialist for HIMG in early October 2010. Nate said that HIMG began switching over to EMR in late 2005, early 2006 and at the present time, 95% of the medical records that are needed by the organization’s employees is in electronic form. HIMG employs a third party to file their old-fashioned, paper charts as they move towards making all of their charts electronic. All of the daily functions of HIMG are electronic now from patient scheduling to check-in and check-out to prescriptions and lab work orders. Test results come back very quickly through ERM, but images from x-rays, ultrasounds, and such are not available in ERM just yet. Mr. Cantrell says that HIMG was an early adopter of ERM in this area in order to gain a competitive edge. Their strategy of early adoption seems to be working as this implementation has made HIMG more efficient as all charges are done by the physicians on their electronic pads for real time bills that cuts the turnover time for payments from 90 days down to 35 days. Of course, not everything is positive with HIMG’s ERM system. There are some physicians who do not like the change and so are slower to completely adopt it. In Johnson, Estep, Fridley, Marriott, and Stone 10 addition, there can be added frustration if the system is not working properly. Technical issues aggravate doctors who like immediacy. The most difficult part of the switch to ERM is the integration between the systems of the laboratories, images, and charts. ERM is used companywide at HIMG, but the administration uses it less than the actual medical providers. Patients even have access to their own electronic medical records; there is a patient portal towards the front of the building for patient’s to look up their own medical charts, see test results, and even get information on upcoming procedures. Additionally, patients can electronically request their records in order to take them wherever they want and/or need to. Nate said that the system HIMG uses is an “ever evolving” system that releases one fix and two enhancements once a year. The current system that they use is driven by PC hardware and Windows software. This Intergy system by Sage is not perfect, so, of course, he would like to see it perform better than it currently does. This system does have a current on-site and off-site back-up. As an administrator, Mr. Cantrell wishes that one day soon, the system will have an enhancement that makes it easier to audit who is accessing charts, when, and why. With the implementation of the ERM system, Nate said that his job has become more difficult since technology now plays a bigger role in the daily business procedures. On the other hand, he says that patients tend to like the system because the turnover time for everything is much less than it used to be. This new system has affected the employees of HIMG in a few ways; the system makes it easier for the employees to Johnson, Estep, Fridley, Marriott, and Stone 11 communicate, it has downsized the transcription and medical records departments, but it also gives them a scapegoat if something goes wrong. Physicians want the system to evolve even more to offer voice recognition so that they can transcribe their own notes. Also, the organization wants to make a move towards Telehealth and mobile phone applications for iPhone and Blackberry for records and billing. Users of ERM at HIMG Several different individuals that actually use the ERM system at HIMG on a daily basis in order to execute their jobs were interviewed later on in October, after Nate Cantrell, the IT specialist. These individuals include Joanna Hughes, the Director of Operations; Rebekah Roof, a medical assistant; Dr. Carico, Family Physician Practice Member and Board Certified Family Physician; Carla Hamlin, CPC, charge entry clerk; and Jeri Cornwell, Cardiology Manager. Since each person interviewed uses the system to perform a different job at HIMG, each person’s comments, thoughts, and feelings about ERM will be addressed in separate sections of this paper. Joanna Hughes- Director of Operations As the Director of Operations at HIMG for fifteen years, Joanna Hughes has been using ERM for over five years to directly supervise records, audit staff members, address patient complaints, and dismiss patients. Ms. Hughes said that ERM makes her job easier since the system has little wait time, all access, and rather instantaneous responses. With Johnson, Estep, Fridley, Marriott, and Stone 12 that said, she went on to say that the she would still like the system to become quicker and have more navigation. Despite her wishes for more speed, Ms. Hughes stated that overall, she has a positive feeling about the current ERM system and thinks that implementing it was a good idea. Rebekah Roof- Medical Assistant Rebekah Roof has been a medical assistant with the clinical staff at HIMG for nine years. She has been using ERM for the past five years to perform clinical duties like gather/check medication information, vitals, and test results, as well as send in pharmacy prescriptions for patients. Ms. Roof loves the new system and believes that its implementation was a great idea. She feels that the current ERM system makes her job easier because instead of having to search for physical charts, all one has to do is push a button and the charts are literally at your fingertips. As much as she loves the system, Ms. Roof does wish that the system would eventually have more folders that are labeled for additional categories to help with organization. Dr. Carico- Family Physician Practice Member, Board Certified Family Physician Dr. Carico has worked at HIMG since 1994. He has been using ERM since 1992 for Beta testing with a previous organization. He said that HIMG tried using a medical manger before deciding to implement the current EMR system that he likes so much now. Dr. Carico uses ERM to order lab work, prescriptions, check lists, perform billing, look at Johnson, Estep, Fridley, Marriot, and Stone 13 patients’ history, check physical exams, look at x-rays, do follow-ups, and make electronic notes to specialists. He feels that ERM makes him more consistent. The doctor feels that the system makes him “attend to the details,” helps him provide better patient care, provides financial productivity of existing income, has led to a more organized staff, and make the staff more efficient at relaying information from one to another. What is the doctor’s favorite part of the ERM' The more efficient, on the spot results from the lab work that he orders. Dr. Carico went on to mention some things that he wishes would improve about the system; the doctor wants a more complete collapse and backup since it currently slows down due to server capacity from time to time. This slow down does not interfere with the patients’ as the doctors have learned to manage around that, but it does slow down their ability to order labs and prescriptions when it is not working properly. Dr. Carico was very insightful about the current ERM system, but he also provided some great information about the different types of doctors that HIMG employs. The first type of doctor that HIMG has is known as a T-Rex. There are few of these stubborn doctors that are too set in their ways to change left in the organization. However, Dr. Carico believes that these few dinosaurs could be led into the technological age if the system was more adaptable to the needs and wants of these doctors. The second type of doctor employed at HIMG is the begrudging kind. Dr. Carico believes that about half of the doctors are in this group as they know how to use the new tools, but just do not like to do so. Begrudging doctors tend to complain the entire time that they Johnson, Estep, Fridley, Marriot, and Stone 14 are using the system. The last type of doctor at HIMG is the enthusiastic doctor. Dr. Carico believes that the rest of the doctors are enthusiastic about the current ERM system as they like the new way of thinking and working and take the initiative to create their own sheets to utilize in their own practice. Carla Hamlin, CPC Carla Hamlin is a charge entry clerk at HIMG. Ms. Hamlin was able to share some insight into the billing system at HIMG. She said that everything used to entered “painstakingly by hand” on a type writer, but now they can generate the bills electronically. Due to this electronic turn, most of the time, they do not even have to take the time to stuff bills into envelopes. The only thing that still has to be done the old-fashioned way is if there is a secondary insurance provider, they do still have to print something out and mail it, but everything else is electronic. This new system’s efficiency has led to better, faster responses and payments from patients. Hamlin said that the switch to electronic billing was difficult due to the different learning curves of the users. Not everyone has gotten the hang of it yet, but it is seemingly positive now. She went on to say that there really is not a need to change/improve the system because it is rather efficient the way that it is now. She even mentioned a scrubber that is in place to ensure patient’s safety that checks for things like drug interactions. Johnson, Estep, Fridley, Marriot, and Stone 15 This new system has never caused the billing department to lose much time because even if it does go down, the clerks can just prepare the information that needs to be inputted while waiting for it to come back up. This does lead to small delays, but nothing major at all in regards to the billing process. Positively, the Intergy system has improved the accuracy of the billing department. Jeri Cornwell- Cardiology Manager Jeri Cornwell is currently the Cardiology Manager and OSHAA Safety Officer at HIMG. She said that despite going to ERM, there has been no safety decreases for patients in any way and then went on to mention the scrubber that checks for prescription interactions and allergy reactions that was mentioned by Hamlin earlier. Cornwell said that the ERM system is safer than the old, paper system when it comes to privacy. Before, just about anyone who wanted to could access and read a patient’s chart, but now accessing and reading charts requires login codes. The system even keeps a record of every time information is viewed. Additionally, there is an auditing system available to show who looks at what and when. This system even allows for the blocking of certain people from accessing certain charts. Patient privacy and security is a top priority for HIMG. The patient portal was something that Cornwell was able to talk about that the other users really were not. She said that the information on the portal is very limited and that one must be confirmed as a patient and have a pin number that is given to them at HIMG in order to access the Johnson, Estep, Fridley, Marriot, and Stone 16 information. Therefore, the portal is rather safe and secure. There are other things that keep patients’ information safe and secure at HIMG. There is a timeout feature on laptops so that no computer has access to one chart for an extended amount of time. The staff is also trained extensively on logging out of their computers if they are leaving their desks for any reason. Additionally, all fax machines are kept out of areas that patients have access to in order to make sure that no one sees a patient’s information that should not see the information. Final Thoughts Overall, the staff at HIMG seems to really appreciate the benefits that ERM offer. All of those interviewed agreed that ERM has made the organization more efficient and better at caring for patients. Just about everyone seemed to think that the system could use some tweaking to make it better, but that they saw the implementation of the system as a good move for the organization. Clearly, the positives outweigh the negatives. After talking to employees of HIMG about ERM, it easy to see why the government is so insistent and financially supportive that all medical providers move towards an ERM system and let the old-fashioned paper charts go. Johnson, Estep, Fridley, Marriot, and Stone 17 Works Cited "Changing Trends in Healthcare Information Management and Electronic Health Records." Telegenisys. Telegenisys, JUL 2008. Web. 19 Nov 2010. http://www.telegenisys.com/whitepapers/changing-trends-in-healthcare-information-management.pdf. "Electronic Health Records Software Systems." A Buyer's Guide to Medical Software. Software Advice, n.d. Web. 19 Nov 2010. http://www.softwareadvice.com/medical/electronic-medical-record-software-comparison. “EMR Review Project." American Academy of Pediatrics. N.p., n.d. Web. 19 Nov 2010. http://www.aapcocit.org/emr/readreviews.php. Goldman, David. "Obama's Big Idea: Digital Health Records." CNN Money. CNN, 12 JAN 2009. Web. 19 Nov 2010. http://money.cnn.com/2009/01/12/technology/stimulus_health_care. Johnson, Estep, Fridley, Marriott, and Stone 18 Higgins, John. "The Big Business of Electronic Health Records, Part 2." CRMBuyer 18 MAY 2010: n. pag. Web. 19 Nov 2010. http://www.crmbuyer.com/story/70016.html'wlc=1290522375. “HIMG.” An official website. 2010. http://www.uhswv.com. Estep, Jennifer; Fridley, Keri; Johnson, Katherine; Marriott, Robert; and Stone, Chris. HIMG Employee Interviews (attached). October 2010. Lewis, Nicole. "EHR Revenue to Hit $3 Billion in 2013." Information Week Health Care 31 AUG 2010: n. pag. Web. 19 Nov 2010. http://www.informationweek.com/news/healthcare/EMR/showArticle.jhtml'articleID=227200057&queryText=EMR%20funding. Lewis, Nicole. "Feds Add $162 Million to EMR Funding." Information Week Health Care 16 MAR 2010: n. pag. Web. 19 Nov 2010. http://www.informationweek.com/news/healthcare/EMR/showArticle.jhtml'articleID=223900079. Johnson, Estep, Fridley, Marriott, and Stone 19 Lin, Kenny. "New Electronic Medical Records Software Could Improve Your HEalth." Healthcare Headaches 13 OCT 2010: n. pag. Web. 19 Nov 2010. http://health.usnews.com/health-news/blogs/healthcare-headaches/2010/10/13/new-electronic-medical-records-software-could-improve-your-health.html. United States. News Release. , 2010. Web. 19 Nov 2010. http://www.hhs.gov/news/press/2010pres/09/20100910a.html.