Meaningful Use Traps EMR and EHR Vendors
There is a vast difference between what electronic medical record (EMR) or electronic health record (EHR) vendors are delivering and developing today and what physicians and their practice leaders want. The natural market-driven improvements that occur when software begins to achieve widespread adoption have been hijacked by an outside force. HITECH has not only injected the federal government into the EMR market by bringing a checkbook and gun to the game, but has also come between the healthy process of customers giving vital feedback to software vendors that allows vendors to improve the flexibility, usability, and economic benefits of their products.
Unfortunately, for the next 3-5 years the development cycle of EMR vendors will be largely driven by the federal government’s meaningful use requirements, which have more to do with public policy than physician productivity. Understandably, most of the meaningful use focus is directed at the collection and distribution of clinical information. As a result, there is not only a gap between what EMRs are delivering today and what physicians desire from a clinical perspective, but there is also a costly gap that relates to the administrative side of a practice—the collection and distribution of financial information needed to accelerate the revenue cycle.
Don’t Slow Physicians
Physicians are not accustomed to spending more than 3-5 seconds recording CPT and ICD-9 codes to financially document what he or she did during the patient exam. In fact this documentation, which is critical in order for physicians to receive timely and accurate reimbursement, has been one of the most productive processes in a physician practice for many years. It is so quick, easy, and intuitive that it often escapes critical analysis and discussion during the EMR evaluation process.
The charge capture process almost always begins with a busy provider and a paper encounter form. Replacing this process with anything that requires more than 3-5 seconds is too much time for a physician to invest. EMR vendors may require the physician to spend 5-15 seconds to get the charge captured and sent to administration for review. That may not seem like much time, but to a physician who sees 45-50 patients a day, it is a tremendous amount of time. As one administrator at a busy orthopedic practice said, “Saving an orthopedic surgeon 10 seconds makes you king/queen for a day.”
This difference in time and process creates a gap between what the physician expects from their EMR and the reality of what is delivered. More importantly, this gap is rarely identified during the sales cycle; by the time the practice realizes the gap exists, they are well into the implementation of the EMR. At that point the practice is committed to the clinical solution and must make an accommodation on the financial side (i.e., a step backward). Most choose to either have the physician take the time necessary to use the slower EMR functionality or revert back to a manual paper process.
Information in the Wrong Places
Just because healthcare technology can deliver medical coding information and feedback to physicians, does not mean it is the most appropriate or productive thing to do. Feedback where it will not be used or where it will slow a physician down is not progress at all. Clinicians intuitively recognize that actionable diagnostic information is most valuable when delivered to the appropriate individual at the appropriate time. The same is true with information that is necessary for proper reimbursement of services.
As physician practices accelerate the adoption of EMR’s in order to achieve meaningful use, they need to make sure a step forward in automating their clinical process does not produce a step backward in the billing process. Just because technology allows you to give coding feedback directly to the physician during the patient exam, does not mean it would be wise to do so. Physicians did not go to medical school and invest years of training to also hold the role of a medical coder. Asking busy providers to spend additional time coding or to take action on coding feedback makes no sense at all and would be analogous to shooting yourself in the foot.
Over Promised, Under Delivered
Miscommunication between software vendors and physicians is not only common, but has become an expectation among experienced healthcare administrators and consultants. Most miscommunication begins during the sales cycle. While it is usually unintentional, it is extremely expensive with the brunt of the cost being borne by the practices themselves (Caveat emptor!).
EMR/EHRs were originally conceived and developed primarily as a clinical application to replace the paper chart. During the design stage that began two decades ago, the focus was on understanding, automating and accommodating the manner in which a physician documented the clinical aspects of a patient exam. Little to no thought was given to the financial processes as that was the domain of the billing system.
An EHR can be a powerful tool for providers, patients and other constituencies involved in the delivery of healthcare. The capability to accelerate the billing process by delivering charges has always been an afterthought, a byproduct of documenting the clinical encounter. As such, most systems have been designed assuming that physicians and their staffs will be willing to be less productive on the administrative side in order to realize the benefits of the EMR itself. All too often this gap is not uncovered until installation and training has occurred. The unintended consequence of this productivity and workflow gap can be disastrous to the revenue cycle and is almost always paid by the practice.
White Plume Technologies Fills the EMR Gap
The EMR gap between EMR/EHR and PM systems is a fundamental reason White Plume Technologies exists and is thriving today. White Plume fills the productivity and accuracy EMR gap by accelerating the charge capture and coding process.
White Plume understands a step forward with automation of the clinical side of a practice should not be a step backward in the financial and reimbursement side. Practices today have a choice. They could wait until their EMR vendor eventually completes all of the future meaningful use requirements and can return their attention to what clients are asking for from a revenue cycle perspective. Or practices can take action now by accelerating the process to get them where they want to be.
“Under promising” during the sales cycle and over delivering with the actual product, its capabilities, the way we install, and how we train practices to use our products has become a hallmark of White Plume Technologies. It is a foundational principle for our entire company. Beginning with our sales professionals, our entire organization strives to “under promise” during the sales process and then over deliver on results.