The One-Two Punch of Ill-Considered EHR Decisions

Many articles published lately like “Dissatisfaction” leading to EHR replacement trend, discuss the chronic unhappiness and dissatisfaction of Electronic Health Record users. Weeping and gnashing of teeth over electronic record systems is pervasive, and the sources of pain are common and recurrent. 

Still, most every EHR issue that appears or re-appears can be boiled down to one of two root sources. Systems are unusable because of either absence of realistically usable clinical support, or lack of real-time billing functionality. Or both.

Key points from this article include:

·       Practice management has grown as a focus for systems. Whereas in the more distant past, documentation-even CPOE have held sway, the nitty-gritty of running the operation is now the number one priority for systems.

·       The number clinicians replacing their EHRs in any one year has increased 59 percent since 2014

·       Billing functionality is a strong need for EHR buyers. It is the top-requested functionality (45 percent) ahead of claims support (27 percent) and patient scheduling (23 percent).

·       Practice management includes, not surprisingly, management of a facility’s patient population.  Hence, 28 percent of buyers are looking for patient tracking capabilities: monitoring assessments, treatment plans, progress notes, etc.



A parallel and significant problem arises when a facility decides to replace their EHR: the replacement becomes a new bombshell that can bankrupt the facility doing the change.  Buyer’s “remorse” from Electronic Health Records replacement ranks up with car purchases and marriage. Well, maybe not marriage. But in all cases, an unfortunate and costly initial mistake is often compounded by a second mistake.

The key question to ask is whether the EHR can support both the provider and the business side of the practice. Either alone won’t work, and the absence of any one key part creates a vicious cycle. For example, even though the financial side may be given priority, but chronic dissatisfaction of the provider team leads to decreased productivity and further exacerbates any lingering financial woes.

Find an Electronic Health Record System that can support everyone.

Avoiding the Potential Legal Quicksand of Opening ann Urgent Care

Opening an urgent care can be a fulfilling experience but to be successful takes more than good medical care.

The Top Four Legal Issues to Consider When Opening an Urgent Care Center article describes significant legal issues that need to be considered during the planning stages. In addition to the usual components of a business such as location, leadership, work-flow processes, and timing; the medical business has certain legal concerns.

1.       Corporate practice of medicine is outlawed in some states and mechanisms including a “friendly PC” model can be used.

2.       State licensure requirements including a CLIA certificate of waiver for laboratory testing, x-ray permits, and any other licenses needed in that state.

3.       Understanding any EMTALA requirements is key to the viability of the center. Particular attention needs to be paid to the “naming of the center”.  Adding the word Emergency will imply, the center is a 24 hour practice that is specifically under the EMTALA laws. Hospital owned urgent cares must have their legal team evaluate any responsibility to the law.

4.       Have your insurance contracts in order prior to opening or face a potential cash flow issue. These negotiations take time.

Some other issues of particular significance are:

1.       Location, Location, Location

2.       Times of service

3.       Types of providers

4.       Credentialing those providers. This is a cumbersome time consuming task which may need to be outsourced.

5.       Marketing-Establishing contact with the local community by providing school physicals, blood pressure checks, flu shots, etc.

6.       Being undercapitalized and suffering cash flow issues

7.       Picking an Electronic Health Record and Practice Management system that is efficient and pays for itself.

8.       Understanding the difference between using a billing company and doing self-billing.

9.       Hiring the right practice manager.

10.     Not expecting a “paycheck” right away.

11.     Fill in the blanks

12.     Hiring a consultant to help with the start-up, if these steps are too daunting or too much aggravation.

With a proper vision, an urgent care can be an enjoyable way to provide quality medical care. This can lead to career longevity and adequate reimbursement.

Search Engine Optimization

Being technologically impaired according to my offspring, I never understood the mechanics of how Google, Bing, and other search engines know how to deliver advertisements in my mail as well as different web sites I visit.  The term for this process goes by the acronym SEO (search Engine Optimization). 

SEO is accomplished through keywords on which searches are initially based.  On the other hand, after the keywords themselves are injected into the mix, there is the rank given to the website, which determines whether it will appear on the search results, and where on the returned links it shows up.  Larry Page, one of Google's founders, first introduced the concept of rank; hence, the first algorithm used for ranking was called Page-rank(though many have mistakenly thought it meant to reference web-page rank).  Rank, in essence, determines the "popularity" of a given site for the keywords submitted.  Popularity is determined through complex formula that analyze not only how many hits a site has, but also how many other webpages link to the site receiveing the ranking.  Industries have appeared over the last decade that promise to increase ranking and improve hits on a website.  Hence search results, in general, must be viewed with a measure of skepticism, as with any advertising.

The following is a description of an optimal EHR having multiple keywords within the content.

The EHR is being used in hospitals, emergency departments, urgent cares, family practice and specialty private offices to fundamentally change work flow and processes.  The EHR contains databases, charting systems for physicians, physician assistants, and nurse practitioners, nurses, and support staff.  CPOE (computerized order entry), patient education, e-prescribing, report generation, and tracking board.   The database has the ability to scan in outside document or attachments in the record, which can be imported to the contemporaneous patient encounter.  The medical record should be voice activated technology and ICD 10 ready.  It should also be able to send secure faxes with reports to the private medical office.

The Practice Management side contains registration, real-time insurance eligibility checks (extremely important with the initiation of the ACA (Affordable care act), scheduling, medical coding assistants (an estimated level of service), billing with revenue cycle management, and multiple efficiency and reimbursement reports.  The data should be backed up redundantly in the cloud to allow instant update.

In the modern world the internet both watches and has a great influence on your potential behaviors.

Using an EHR to Expand Your Urgent Care Practice

In a world where you have to document in a specific way, one should take advantage of the data accumulated in the EHR to accentuate your practice.

1. Auto fax all appropriate documentation to the primary care provider or appropriate specialist the patient has been referred to: a) PCP will consider you an adjunct to their practice rather than competition; b) encourage the PCP to send patients to the UC rather than the ED, if they are confident of your capacity and capabilities; c) create a specialist list that wants and appreciates your business; d) patients will appreciate the cohesiveness of care without having to repeat more tests and spending excess time explaining what might have happened.
2. Select an EHR that gives condensed summary of events rather than 10-15 pages that nobody will read.
3. Use your practice management reports to keep track of where your patients are coming from: walk-in, after hour referral, overflow referral, Google search.
4. At the end of every quarter send every referral provider a report of how much business you are sending and/or returning to them.  Most surgical specialists do not realize the direct impact you may have on their bottom line.  This can dramatically help when favors are needed that do not necessarily have to be solved in the ED.
5. Your practice management system's ability to keep up with real-time authorization, coverage, co-pays, and payments dramatically speed up the front-desk leading to more satisfied customers.  If one can eliminate 15-20 minutes of the office visit, which is a great bonus and encourages repeat business.

Conclusion- make sure to purchase a software suite (Practice management and documentation) that improves your bottom line!