“Mind the gap” is a warning for passengers to take caution while crossing the gap between the train door and the railway platform. Introduced in 1969 on the London Underground, this warning also serves physician practices well as they pursue the important goal of implementing an electronic medical record (EMR).
EMR Gap in Design
Back in the early 90’s when the healthcare technology industry began to design EMRs, the fundamental problem they were attempting to solve was how to properly and efficiently automate the process of documenting a physician’s clinical exam of a patient. As they grew to understand more about the process and data they were collecting, they realized as a by-product of documenting the exam they were capturing much of the same data used by practice management (PM) systems for a claim form to be completed.
In the original design of many EMRs, charge capture and medical coding was an afterthought rather than an objective. When important elements are left out of the original design, customers often create their own typically inefficient, time-consuming, and unproductive workarounds. This is often the case with accurately and efficiently capturing and coding an encounter.
Making sure that your EMR selection team identifies costly design gaps during the evaluation process can help set proper expectations and save time and money.
EMR Gap in the Selection Process
As an ancillary feature and benefit of EMRs—untested in the real world—that EMRs could replace the superbill began to appear in sales presentations. Many EMR demonstrations concluded with the following promise, “…and then once the exam is over, you can electronically send the charge data to your PM system for automatic posting.” Since an EMR’s ability to capture and properly code charges is not a primary focus in the selection process, it receives very little scrutiny by most EMR selection teams.
Because properly capturing and coding an encounter is an integral part of every patient visit, this lack of scrutiny during the EMR selection process can create costly problems during implementation—gaps in workflow and productivity. Taking a step forward by automating your clinical processes should not force you to take a step backward with regards to your administrative and financial processes. “Mind the EMR Gap” now or pay the price later!
When you look at the typical project plan for an EMR implementation, the clinical components are typically the focal point: template selection and customization, physician training, clinical workflow, etc. Automating the charge capture and coding elements are usually placed at the bottom of the work list and may never get fully implemented.
This gap in implementation planning often results in practices being forced to produce costly, manual workarounds as needed. This is a dangerous financial hazard for your practice. In order for physicians to be paid for what they do, accurate and efficient charge capture and medical coding processes are necessary. Any attempt to automate the charge capture and coding process will have to be done in a manner that does not slow down the physician or increase the likelihood of denials.
Taking a step forward by automating your clinical processes should not force you to take a step backward with regards to your administrative and financial processes. This gap that may one day be filled by much needed enhancements to current products (possibly after all of the clinical and meaningful use issues have been addressed). Until that time, healthcare practices would be wise to “Mind the EMR Gap”!