#16 Going From An Old EMR To A New EMR: Featuring Dr. Seth Kaplan [Pediatric Practice Management AwesomeCast]

Meaningful Use and ARRA have brought a huge interest in practices adoption Electronic Medical Records for the very first time. But there is also large number of practices that are in the process of going through the process of switching to their second EMR.

In fact, our practice is one of those practices ready to make the transition.

Chip and I thought it would be good idea to talk to somebody that has gone through the transition and learn a little more about how this process works, what are some of the considerations we must remember not to forget, and a few lessons learned.

Today, our special guest is Dr. Seth Kaplan, who transitioned from his original EHR and tells us about the lessons he learned.

Don’t forget to visit the PPMMC Google+ page, and PCC.

To listen or view:

 

11 Questions to Ask A Potential EMR Vendor About Their Software

Software demos are notoriously biased. EMR representative will generally show you the stuff that works really well. They will show you the stuff that will make you say, ooh, aaah.

Nothing wrong with that. When I’m showing something off, I want to share the best of what I have too.

But one of our main jobs as leaders of our medical practices, is to shift through the nonsense and get to the nitty gritty.

So how do we know, from a practical stand point, that the software we are evaluating can handle real world examples?

The best way to understand if a piece of software will work for you is to see it in action. Not from a representative’s point of view, but from a practice point of view.

I know what you are thinking… but I don’t know what questions to ask the EMR rep that will help me get a practical sense of how the EMR works.

Wonder no more. Suzanne Berman, MD, SOAPM member extraordinaire, wrote down 11 Questions that I think will really put an EMR through a ringer. As you will see from her questions, she emphasizes the importance of seeing  how the system performs extracting data.

Take a look at these questions and have them ready the next time you meet with an EMR vendor.

  1. “Show me how I recall all asthmatics who haven’t had a spirometry in >6 months.”
  2. “The next time this family calls or comes in, SOMEONE needs to get a correct mailing address. Please mark the chart on all the siblings so it will alert the next time someone opens the chart.”
  3. “Show me all patients who are behind on their checkups.”
  4. “Which of our patients don’t have a current Framitz Flopulitz form on file?”
  5. “I need to pre-order my flu vaccine for next year. I need a breakdown of how many VFC vs payable kids, 6 to 36 months vs big kids we had last year and how many shots/mist we gave; then I need this year’s numbers to extrapolate.”
  6. “I saw a kid with something like this last year — the specialist recommended a great treatment regimen, that I’d like to try again. Nuts, can’t remember that kid’s name. I do remember charting “Spoke with Dr. Matheson” — the specialist. How can I look through all the charts for a teenage girl seen in 2011 where the phrase “Spoke with Dr. Matheson” appears?
  7. Me, Dr. Speedy, and Dr. Talksalot are all vying for a limited number of shared exam rooms. Which of us a) has the most visits; b) runs on time vs. behind; c) has the most patients in the office at once [i.e. does the most double/triple sib appts]?”
  8. “How many active patients do I have? Exclude cross-cover patients, patients who’ve transferred, patients who we discharged, and patients we haven’t seen in X months. Oh yeah, and please show age distribution.”
  9. “How do I mark this kid’s chart as “African-American child adopted by Caucasian couple — do not ask “are you mom?” when family comes in — sensitive issue” so my receptionists stop putting their foot in their mouths?
  10. “I’m doing a sick and a well visit on the same day. Where do I chart the different bits?”
  11. “How can I find all kids who got vaccinated with Lot X? The mfr is recalling that lot.”

Of course you are free to add your own questions based on situations you’ve encountered. Oh, and don’t assume this is all the due diligence you have to do. Search the web. There are tons of articles that can help you with this process as well.

Lastly, I’d like to mention that data input is also important. The program ought to feel intuitive and easy to input data into. But don’t forget the data output. This is often an overlooked aspect of the EMR evaluation.

What question or request would you add to this list?

Dr. Suzanne Berman is a general pediatrician in private practice in Crossville, Tennessee.   Her family works, lives, goes to school, worships, and buys stuff from Walmart all within the 38555 zip code. Dr. Berman is a regular contributor to the Survivor Pediatrics blog. To read all her post, click here.

Part II: Ditching Your EMR For a New One? Here’s How To Prepare

image credit: softskills

For this post, we are going to be looking at how we can leverage what we already know from our experience of implementing and managing an EMR system in our office.

If you missed the previous post, scroll back or click on this link.

Chip, for those of us that are thinking about replacing our EMR, surely we can take advantage of the lessons we’ve learned and use them during this transiton, right? What are some of those lessons?

Take advantage of the fact that you should have suffered through the learning process of managing your IT infrastructure at this point. If your remote office connection is finally broad enough, you’ve nailed down the tablets you like to use, and your wireless interference issues are resolved, your second EHR experience will benefit greatly as a result.

If it happens that you still have significant hardware or networking problems with your existing EHR, you should make every effort to resolve them before your new EHR is in place or you will drag your bad experience into the new world.

Now that I’ve figured out my wireless challenges and hardware needs, what is next in terms of leveraging our experience?

When you migrated to your first EHR, you had to answer important questions about the flow of people through your office, many of them for the first time. How do we get paper into the EHR? How do we find our nurses? How do we manage orders? Who is in charge of our clinical protocols?

Use this understanding to your advantage and identify how your new EHR will fit into your existing patterns.

Work flow needs, check. What else?

This time around, you know how much and what kind of training you need. Chances are that you didn’t get enough training the first time around. Or that you had access to sufficient training but not everyone – particularly the doctors – took advantage of it. Recall how your first EHR on-line went and mandate full training for the new EHR.

No matter how cool the new EMR appears, there seems to always be featrues that the docs love in the old EMR that the new EMR doesn’t have. What can we do about that?

Every EHR has features in it that the users love, even if the balance of the EHR feature set is negative. Isolate those few features you can’t imagine living without and discuss them with your new vendor. Perhaps the new EHR has a similar or even better feature set.

The real trap to look for here are those features that have become a definitive part of the flow in your office that will no longer exist, for better or worse. You will need to figure out how to redirect the flow in your office before you go on-line.

One of the things that bores me to tears in business, is having to read contracts. But of course, contracts are very important. Especially the ones you have to sign. Talk a little bit about what to look for in our new contract with our new EMR vendor?

Your last EHR contract may have made things difficult. If there are any terms from your existing EHR client that made things difficult for your practice, such as the inability to extract data from your own EHR, now is your chance to do it right.

All this time we’ve been talking about the EMR, but what about the practice management system?

The often overlooked project in any EHR installation is the relationship with the billing process. At the very least, all of the questions you’ve addressed relating to your EHR need to be addressed, again, with your PM. Will you need to change PMS? Do you have new third party relationships to manage (such as a clearinghouse)? Are there features of your PMS that you can’t live without or will require significant retooling once it changes?

Too many practices overlook the impact of a system change on the most important department in the office.

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I hope you found this discussion useful. By the way, I know Chip tried very hard to keep this discussion vendor agnostic. If you work for an EMR vendor or have switched EMRs and have something to add or correct Chip on, feel free to drop me a note.

Part I: Ditching Your EMR For a New One? Here’s How To Prepare

As many of you know, EMRs have been around for some time. Although I wouldn’t go as far as to say they have matured as a product, there have been some progress in terms functionality (notice I didn’t say innovation).

The new word around the block is that apparently, practices are leaving their old EMR for new shinier ones. Now, some people say that moving from one EMR to another EMR is actually harder than moving from paper charts to an EMR. I find that hard to believe, but hey, what do I know.

Regardless, moving from one system to another is always a challenge and one that very few of us have actually gone through. So, let’s say you are planning to ditch your old EMR, what are the things you need to think about in order to start going down this huge transition?

Chip Hart from Physician Computer Company (my new vendor by the way), sat down with me recently and gave me the scoop on how, based on his experience of doing several conversions, is the best way to go about this monumental task.   It’s worth noting that they weren’t all conversions to PCC.  Chip tells me they’ve had plenty of people switch from one EHR to another and not PCC.

Chip, what is the biggest thing I need to be concerned about when taking on an EMR transition?

Data conversion. How will your data move from EHR1 to EHR2? This issue is, by far, the biggest obstacle in the process of transferring from one EHR to another.

Really? But it is all data isn’t it? Transfering 1s and 0s from one file to another should be easy and quick, is it not?

Any vendor who makes promises about what data can be transferred between the systems without analyzing your actual data is just guessing. Every EHR is different and often very different from practice to practice. Experience with a particular conversion is great, but not a guarantee. Many EHR vendors can’t even transfer data from one of their own systems!

OK, what is the second biggest concern that we need to consider?

You will likely need to manage a three-way balance of timing, cost, and quality for both vendors.

Whew, sound like a lot of work. OK, in your experience, what would an ideal EMR conversion look like?

In an ideal circumstance, an EHR conversion would work as follows:

  1. Comprehensive data from EHR1 is transferred to EHR2 well in advance of the transition to EHR2
  2. Over a matter of weeks the quality of the data transfer to EHR2 is reviewed by your office. Confirm everything from discrete data points like vitals to the transfer of scanned images to your narrative/notes.
  3. Then, on the last day actively putting data into EHR1, repeat the data transfer so that your database is as up-to-date as possible.

On paper this seems pretty smooth, but I know that in practice this isn’t always the case. What are some of the hurdles that come up during this process?

Sometimes, your relationship with EHR1 has deteriorated to the point that access to the database is limited. Additionally, many EHR companies restrict database access or export in their agreements with you. Their reasoning should be obvious, be prepared to fight for your data.

Let’s say my relationship with my old vendor is good. Anything I need to be aware of still?

If the relationship with EHR1 is good, and they are capable of delivering data to EHR2 in a timely and consistent manner, it is perfectly reasonable for them to charge for this service. The range of reasonable charges can be quite broad based on a variety of technical factors, but note that the amount of effort by EHR1 is not usually tied to the size of the practice or volume of the data…so a greater charge for a larger practice usually reflects EHR1’s expectation that a larger practice can afford to pay more.

Anything else?

As noted, make sure that TIMING is a part of any discussion you have relating to data conversions. Some vendors will take 2 to 3 to 6 weeks (or more!) to deliver data to you, the effective of which on a transfer can be devastating. Sometimes, it can take a few days to then convert the data – if you come with 800GB of images, you can’t transfer that in 15 minutes. [Future PediatricInc.com readers will laugh at that comment.]

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For my next post, I will posting Chip’s comments on how to leverage what we already know (as seasoned EMR users), to make the transition into the new EMR a successful one.

Chip Hart is Physician’s Computer Company Director of Pediatric Solutions at Physician’s Computer Company and he blogs at Confessions of a Pediatric Consultant. Chip also contributes from time to time to PediatricInc. To read Chip’s previous contributions, click here.

Lastly, I’d also like to point out that these are the types of discussions that we have on SOAPM, which is the Section of Administration and Practice Management at the AAP. As I’ve said before, if you are in private practice, and you are not  a member of SOAPM, you are missing out.

What is the Benefit of an EMR in a Medical Practice?

Today, I have another guest post. This time it’s from Dr. Suzanne Berman MD, FAAP. Dr. Berman is also a contributor to Survivor Pediatrics. In this post, she gives insight into the real benefit of having a EMR. For example, many docs believe that a EMR will help them chart faster. But as Dr. Berman points out, that is not always true. 

The real benefit of an EMR isn’t being able to put data in/chart faster – this is great if you can do it but not everyone can point/click/type faster than they can check boxes–

…the real benefit of an EMR is getting practice-wide data quickly OUT of it.

When docs test drive EMRs, they want to see “How do I put in the vitals?  How do I issue an Rx?”  As far as getting data out, they want to see patient-specific, single-patient data: “Show me the kid’s growth chart.”  “Show me their pattern of no-shows.”

But the real ROI is learning how to get data OUT – report writing and so on.  Most docs never learn this, or expect the administrator to do it all.

I’ve posted on SOAPM before about how we found $3K/month in lost revenue in labs we weren’t billing for by cross-checking the number of, say, strep tests documented in the chart vs 87880’s billed for – at a cost of $100/month.   Is $3K/month a huge cash cow? Nope, but it’s something we wouldn’t have had otherwise.

We get another perhaps $1000/month for running reminders on missed E&M, 99050, etc.  and we already run a pretty tight ship.  Other practices have found similar results from cross-checking vaccines, etc.

By reporting on how many different days I saw kids at our local hospital (place of service 21 or 22) I can give our practice’s accountant a nice list of work-related mileage from our office to the hospital.  This is maybe $500/yr in tax savings for me and my husband.  Is this ginormous? Nope, but since the report is already there and it takes 2 minutes to run and print, $500 earned in 2 minutes work is pretty good.

Having the computer do the various annual reports that are required of the various programs we participate in saves my nurse administrator time.  How many VFC vaccines from a certain lot did we give between date A and date B to self-pay vs. Medicaid patients? How many H1N1 vaccines did we give during a period?  Point, click, print, fax, move on.  No hand tabulating.  No adding up long columns of numbers by hand.

There’s a new Framitz machine that’s now CLIA-waived!  It’s on sale, $5000, and the cost per test is $3.  Insurance reimbursement is $8.   Is it worth it? Depends on how many Framitz tests we sent out last year — and with a couple clicks, I can see what the ROI on a new Framitz machine would be.

I don’ t expect everyone to be the data mining geek that I am – but I posit that you will never reap the rewards of an EMR if you don’t know how to get practice-wide data intelligently OUT of it.

And that’s the trouble with spending a lot of time on scanning old data into the EMR – it’s clunky and time consuming, and you have to do it, but the data you’re putting in can’t be extracted in any meaningful way (unless you are doing some really awesome indexing) to do the cool things I’m talking about.

 

Should I Open a Medical Practice in This Environment?

In the past few months I’ve been asked a couple of times what advice I would give to someone that is opening a practice from scratch. And in the same conversation I’m asked, do you think, considering everything that is going on now, if it is a good idea to open a medical practice.

My short answer is, go for it! My long answer is, well, more complicated.

First, I think it is important to assess one’s priorities and determine the true motivation for opening up the practice. Motivation – or the reason why – is very important because if one opens the clinic for the wrong reasons, failure is often the consequence.

Here is why… during the journey of opening one’s own medical practice, one will no doubt be challenged, get burned out and perhaps even question if this was the right thing to do or ask yourself if this is even worth it. If one’s motivation is fragile and things get tough, the likelihood one will preserver through it will be more difficult.

Thus, in our experience, the motivation has to be more than money, be your own boss or just to say you have your “own” practice.

So the question for me isn’t whether the conditions are right to open up a practice, but rather, do you have the right motivation to open up a practice in this environment. Because what one selects as the reason is what will give you the strength to forge ahead regardless of good or bad times.

Once you’ve settled that, then you can move on.

I jotted down these 12 points regarding opening up a practice. They aren’t really advice or tips per se, but more my thoughts. Here we go:

  1.  First thing first… join SOAPM. What is SOAPM? Glad you asked. Go here and here to find out.
  2. Location, location, location. Just like any other business, location is very important. Research the area. Figure out the type of “patient mix”, demographics, access and all those great things that make a great location. Tip: Census data can help you get started with this research.
  3. Understand that working for yourself is going to be more stressful and more difficult than working for someone else. Why? Because the buck stops with you.
  4. Although the work is more stressful and probably work more than you’ve ever worked in your life, the personal and professional rewards will be much greater than you’ve ever experienced (and potentially even greater financially).
  5. Understand that the practice is a “business” just like anything else. What that means is that at the end of the day, more money has to come in than go out. Don’t forget that because you can’t help people in need if you are in need.
  6. As soon as you can, hire a real business manager.
  7. Be prepared to make sacrifices. For example, sacrifice time with your family.
  8. I’d recommend finding “consultants” to help you get things in order. They will cost you money but it is a good investment. Also, find people to handle your hospital and insurance company credentialing process.
  9. Try to find other “solo” physicians in the area that you can share the on call schedule with you. Otherwise be prepared to work 24/7 until you find another doc.
  10. Although it is expensive, start the practice with a good EMR and a very good Practice Management software. Thanks to Obama, there is an opportunity to get financial help with this expense.
  11. Join a physician buying group ASAP. This will help you offset one of the largest expenses in a pediatric office (i.e., vaccines). Group Purchasing Groups will also help you get discounts on other items.
  12. Remember, if failure is not an option, either is success.

This list is not comprehensive. There are many, many more things to consider. But I figure it is enough to get you thinking about a few things before you begin the process.

The AAP also has some resources in this area: For example, Practice Management Consultant

For those that started a practice recently, what advice, tips or pearls of wisdom would you give someone that was starting today? 

PediatricInc: Top 10 Post of 2011

In case you missed them, here are the top 10 post for 2011.

  1. Is Your Front Desk a Command Center?
  2. Top 11 Pediatric Facebook Pages
  3. Patient Collection Letters, What is Your Approach?
  4. Medical Practice Advertisement
  5. Tip #3, How To Save $80,000
  6. How Social Media Can Transform Your Medical Practice
  7. Can Costco and Your Medical Practice Have Something in Common?
  8. Does Your Medical Practice Have a Problem with Bad Debt? Here is a Solution
  9. Ten Hidden Cost When Implementing an EMR
  10. Seven Reasons Why Medical Practices Have Yet to Adopt EMRs

The list is ranked by total traffic. Funny what people find more interesting. Usually, my top 10 are not the same. Here are some of my favorites:

  1. What Can A Practice Learn from Bon Jovi?
  2. 10 Practice Management Reports You Haven’t Thought of
  3. Can a Medical Practice Learn from an Airline?
  4. Small or Big: What is the Future of Small Private Practices
  5. How Do You Approach No Shows?

Did you have any favorites you’d like to share with us? Which one did you find the most helpful? Leave a comment down below. I’d love to hear from you.