For medical specialists, purchasing an electronic health record (EHR) platform is not an easy endeavor. Specialists...
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seek an EHR system that aligns electronic processes with particular clinical workflow and procedures. Considering that specialists do not often require the full functionality of a certified EHR system, some are tasked with purchasing a customized system. Others make it work with the system they have selected.
Cost of EHR platform can severely impact purchasing plans
The price tag that comes with buying an EHR system can be a steep one, particularly for smaller specialty clinics with limited resources. For many specialists, finding a system with custom-designed modules and software is often too expensive, which can deter them from purchasing the system they ultimately want. That was the case for Martin Freifeld, M.D., OB-GYN, who's currently retired after closing his office-based practice at the end of 2010.
When Freifeld originally opened his practice in Luzurne, Pa, he wanted a Medent Community Computer Service, Inc.-based EHR system because it had tailored OB-GYN functionality. However, the cost of purchasing a subsequent EHR platform implementation was too much to bear. Instead, the practice went with PracticeFusion Inc.'s free Web-based EHR system.
It was a concession of sorts. Though the online EHR platform was easy to use, based on Freifeld's computer-savvy nature, it nonetheless "was not very flexible and pretty generic," he said. The EHR system did come with templates to document patient visits and medical history, but they were "cumbersome and awkward" to set up. What's more, the only option for sending information to peers was faxing from the system's interface, Freifeld said.
A stable EHR vendor-practice relationship matters
Michael J. West, M.D.endocrinologist, The Washington Endocrine Center
Purchasing an EHR system generally requires a comprehensive relationship between a practice and vendor. Finding the right EHR vendor for your facility can be a difficult undertaking, but it does not have to be the job of a couple practice members. It can, and should, be a team effort.
"When we decided to go with an EMR system about six years ago, there were about 30 of us and we knew we wanted to expand," said Robert Sunshine, M.D., chief of urology at St. Joseph Hospital in Bethpage, N.Y., and also a founding partner of Advanced Urology Centers of New York (AUCNY), a division of Integrated Medical Professionals (IMP) PLLC.
IMP created a subcommittee to examine medical software that included patient records and a billing system, said Sunshine, adding that the subcommittee "interviewed people at Allscripts Healthcare Solutions Inc. and got a tour of the facility after concluding they had a program just for urology." By allowing the subcommittee to view the vendor's headquarters, a strong relationship between ACUNY and Allscripts was established.
Before purchasing an EHR system, test functionality
For specialists climbing into the EHR market, testing the prospective system is a crucial step. While addressing workflow and infrastructure also fits into the equation, caregivers must be able to operate the system efficiently. Considering that specialists often purchase software for particular functions within the system, testing said software cannot be overlooked.
"We had the vendor do an online presentation, where I would log in and take control of the computer" and the vendor would explain what to do, said Michael West, M.D., an endocrinologist at the Washington (D.C.) Endocrine Center, PLLC, which was established in December 2009. West, who currently uses PracticeFusion, said testing can help future IT snafus, which is exactly what occurred during the practice's first EHR deployment. The practice originally purchased a client-based EHR platform, but it was removed after two months because multiple modules within the software could not operate simultaneously.
Tailored EHR modules facilitate specialty-specific procedures
For Sunshine, having drop-down menu modules helps increase efficiency when treating patients. How did he manage to get customized modules? "Ask, and the vendor will build that into the software," said Sunshine. While that sounds simple, the benefits are robust if the vendor complies.
On a single EHR interface, Sunshine is able to select particular modules for tests -- such as prostate cancer, kidney infection, bladder cancer, urinary tract infection and other urodynamic testing. Additionally, drop-down modules can be selected for specific body parts associated with urology, which helps providers hone in on solitary areas that may need treatment. Each test, then, gets electronically processed into a bill that's generated for the provider and patient alike.
Other functions have been built into the EHR platform over the years as well, including a drop-down menu to make a diagnosis, prescribe medications and request a CT scan. Prescriptions can be printed and given to patients or faxed to a pharmacy -- and, while there are a plethora of medications available, a module was created for urology-specific medications so it's easier for the provider to choose.
Health information exchange key to advancing care, processes
Collaboration among different care departments is a common care tactic when a patient needs additional treatment. This is no different for specialists. For example, ACUNY's caregivers can exchange patient records both within the urologic department and externally.
"If there is an emergency, patient information, charts and custom messages can be sent to anyone in IMP," Sunshine said, adding that the same information can be sent directly to a picture archiving and communication system (PACS) within IMP's radiation oncology department.
While Sunshine has experienced success in transmitting and receiving data with different departments, West has solved only half that equation. The Washington Endocrine Center has an integrated lab that processes all blood and urine samples, the results of which can be deposited as structured data into patients' medical records. While that is helpful during appointments, West cannot send clinical notes to the lab to be examined by the in-house phlebotomist yet, but it's expected to be completed soon.
Stage 2 meaningful use proposal provides relief for specialists
The proposed meaningful use stage 2 criteria, released during last month's Health Information and Management System Society's HIMSS 2012 conference, offers new implications for medical specialists. These stem from new, proposed EHR certification criteria that will go into effect in 2014.
Under the proposal, EHR platforms will be able to meet a "base" level of meaningful use criteria in order to be eligible for certification, rather than having to meet all meaningful use criteria as the existing certification rule requires.
This is intended to make it easier for EHR vendors who sell to medical specialists, as the vendors will no longer need to meet meaningful use requirements that do not apply to a particular specialty (such as vital signs and ophthalmology). This will, in turn, allow specialists to qualify for meaningful use by using EHR systems for clinical procedures that fit their specialty, rather than by using less specialized, and potentially more expensive, EHR software.
Tip: A look at how specialists can meet meaningful use compliance
Series: How six specialties can approach meaningful use
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