Electronic medical records (EMRs) are here to stay. Although only an estimated 7 percent of practicing physicians in the United States have made the transition from paper, President Obama has laid out the incentives(or rather, penalties) for making the transition. Now is the time to get serious about adopting an electronic health record.

An electronic medical records system must meet a number of standards in order for it to justify the staff effort and the financial investment required for a successful implementation. Many physicians may have once considered the transition to an EMR, but the daunting task of making a seamless transition from the paper world to the world of byte storage, the cost of EMRs, concern for loss of productivity and income during the transition period are some of the most common reasons cited for not making the commitment.

Other considerations such as return on investment of the EMR, possibility of EMR downtime and unavailability and data backup are among other justifications for remaining in the primitive paper world. My perspective on the “ideal” EMR is one that is completely integrated, self-contained and web-based. The ideal EMR must enhance the patient experience, streamline office workflow and increase the four Ps: productivity, profitability, professional and personal satisfaction.

The patient experience should be enhanced through improved ease and accuracy of patient scheduling, via the telephone, referring physician offices and through the internet via an interactive patient portal. This enables the patient to input their own insurance, demographic, and past medical information and submit for review by the office intake coordinator for completeness before uploading their information to the official office medical record.

The obvious advantage here is offloading the work of data entry from the office staff to the patient, which also has the potential of increasing the accuracy of medical information data input and decreasing patient wait time in the office at the time of their initial and subsequent appointments. The patient experience should also be enhanced through improved, interactive patient and family education by viewing of educational material on an exam room computer while the patient is waiting and by the physician within the patient encounter.

Use of visual aids embedded within the EMR including diagrams and drawing programs, as well as other links are designed to further engage the patient in the evaluation and treatment planning process. Improvement in documentation of the patient exam and treatment plan, as well as immediate recording of the specifics of the exam and nuances of the treatment plan, and immediate creation of letters of correspondence with referring physicians and other involved physicians are also critical ingredients in enhancing the patient experience.

When the patient can actually watch and read what you have sent to their physician, as the auto-populated letters are generated and edited on the spot, they are more likely to respond with an improved confidence in you as a physician.

The last and equally important aspect of enhancing the patient experience is the auto-population of letters of predetermination with the appropriate indications (with ICD-9 codes), historical and prior treatment history as well as procedures requested(with CPT codes). The end result should be minimal if any rejections and a consistent flow of patient approvals without unnecessary delays due to procrastination of dictation, delay in review and editing of dictations, and the inefficiency of having to reschedule patients due to missed pre-determinations.

The ideal EMR should also streamline office workflow by improving efficiency and accuracy of patient data entry, physician and ancillary staff documentation, and tracking of patient cancellations, pending examinations, laboratories, and outstanding procedures. Decisions for different tests and procedures should be easily discerned from the EMR.

Redundancy should be reduced over time in the transition from the paper record to the EMR. This transition may require weeks to months to be made completely, but once successfully made, the record should be handled only once per encounter, with all medical and nursing documentation, letters of physician and insurance correspondence and all coding and billing completed at the termination of the physician-patient encounter.

What follows are the natural byproducts of the above:

Increased productivity is achieved through the maintenance of a full patient schedule through the utilization of “patient cancellation” and “to be scheduled” queues. These lists are created in an ongoing fashion and allow last minute cancellations to be filled with patients in these two lists.

Conservatively, this function will enable an additional number of new patient appointments, follow-up appointments or diagnostic examinations or procedures to be salvaged.

One can easily calculate the net result to their bottom line over the course of 1-5 years. How then, can one afford not to have an EMR with these types of functions? Professional satisfaction naturally occurs when one is providing the best possible patient care, in an efficient and accurately documented record.

Your patients will regard you as technologically forward thinking in your practice management as well as your patient treatments as you are able to showcase results of your procedures with respect to visual outcomes, patient satisfaction surveys and share with them your patient demographic information and your distribution of different methods of care or treatments.

Personal satisfaction is the final result as you are able to finish the day’s work on time without cutting corners, rushing through patient exams or cases, or reviewing the day’s charts on your desk and trying to decipher your handwriting only hours after the ink has dried.

Incentives to Adopt in 2009
There are incentives to adopt an EMR this year, including:

•    Adoption of HER (EMR) technology. The American Recovery and Reinvestment Act of 2009 (HR1, Section 4201) has added an incentive to eligible Medicare providers for adoption and meaningful use of Certified EHR Technology. The payments begin in the year 2011 in an amount up to $18,000, with continuing annual payments of $12,000, $8,000, $4,000 and $2,000 for years 2012 through 2015 respectively. A single professional could therefore receive up to a total of $44,000 for adopting an EHR early, and could risk actually having their Medicare payments reduced by up to 5 percent if they fail to use EHR’s by the year 2015.
•    IRS Section 179 Expense Write-Off. The Economic Stimulus Act of 2008 extends the expensing of qualifying property (whether purchased outright, leased or financed) up to $250,000 for the years 2009 only. This amount will fall to $125,000 for 2010, and to $25,000 for years 2011 and beyond. The Act also extends the 50 percent bonus depreciation provision for property placed in service before Jan. 1, 2010.
•    e-Prescribing. For 2009, eligible professionals will receive e-prescribing incentives in the amount of 2 percent of the total estimated allowed charges for professional services covered by Medicare Part B during each reporting period (one year). The incentive will remain 2 percent for the year 2010, will drop to 1 percent for years 2011 and 2012, and again to .5 percent for the year 2013.

Whether to choose an EMR that uses a web-based server (ASP or ASP Hybrid) or a client-based server, one that uses a touchpad versus a standard Mac or PC mouse-driven drawing program are just two of the issues to be considered.

In my opinion, the more important question is the completeness of the system. Does the system you are considering have a comprehensive scheduling program with an internet portal for patients? Does the system have a complete patient documentation module with drawing capabilities, storage capabilities and referral letter auto-generation? Last, does the program contain a complete billing and coding module with electronic eligibility determination, electronic CMS 1500 claim submission and remittance functionalities? Are all three modules integrated into one system or do they require add on programs to allow them to function?

Do your research, talk to other physicians currently using EMRs and get their feedback and before you make the decision regarding which system to purchase, make a site visit to a practice that is currently using your front runner to see how it works in the real world. It is no longer a question of if but rather a question of when to make the transition from paper to EMR, and 2009 appears to be the year.

Dr. Joseph Magnant, MD, FACS, a board-certified vascular surgeon and vein specialist,  founded Vein Specialist at Royal Palm Square in Fort Meyer, Fla. He is also physician director of VeinSpecEMR, a company that offers an EMR product.