BOSTON—The time for otolaryngologists to adopt electronic health records (EHRs) is now, practice management and information technology experts said at a session at the 2010 Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery, held here Sept. 26-29.
Explore This IssueOctober 2010
“If you don’t yet have an EHR, now’s the time to start looking for one,” said William T. Rust, DPharm, MBA, MHA, CEO and director of the Oak Ridge, Tenn.-based electronic health records company AllMeds. “The world of paper is very inefficient. EHRs will help with those inefficiencies. Educate yourself, get your team together, define your timeline on what you want to do.”
Part of the American Recovery and Reinvestment Act, passed into law last year, set aside incentives of up to $44,000 for practices and hospitals that show “meaningful use” of EHRs. Speakers at the session sought to clarify the government’s “meaningful use” guidelines, which are detailed in a 556-page proposal published by the Centers for Medicare and Medicaid Services (CMS) in January.
To receive the maximum amount of money offered, physicians who see Medicare patients would need to start using EHRs in 2011 or 2012. After 2015, the government will reduce Medicare payments to physicians who don’t have an EHR system in place.
Rust explained that because the rules are more lax, penalties related to the use of EHRs for Medicaid patients will not kick in until 2016. Specifics of the payment program, however, are determined by each state and not by CMS.
Rust said that with publication of these guidelines, most EHR vendors are now applying for government certification. “If you already have an EHR, you need to get with your vendor and ask them what their plans are,” he said. “…While most of the time upgrades are part of maintenance, there is a lot of education here. There are a lot of things the government made EHR companies put in their systems to help you meet meaningful use.”
Kelly Ladd, COPM, CMPE, CEO of Northwest ENT and Allergy Center in Marietta, Ga., and president of the Association of Otolaryngology Administrators (AOA), offered guidance on how to select an EHR system, a process she admitted can be “very confusing.”
“Narrow your search,” she said. “When you look at the scope of how many businesses are peddling their products, who can be relied on? Use your AOA [and other] societies—the AAO-HNS [American Academy of Otolaryngology-Head and Neck Surgery], AMA [American Medical Association], many of you have state and local societies. Talk to your colleagues. Do this before you sit down and say, ‘I want to invite vendor A into my office.’”
She also recommended that otolaryngologists find ways to offset the cost of adopting a system before they begin their searches.
Ladd said implementation should take four to five months, during which time otolaryngologists should meet with at least four or five vendors, take copious notes and solicit feedback from staff in other offices on which systems they like best.
“Getting six different perspectives of users that are critical to the success of your practice is something you need to think about as you look at the systems,” she said.
That feedback, she said, should be incorporated into a request for proposal (RFP), which should outline how the system will be adapted for an otolaryngology practice. Ladd noted that the RFP she put together for her practice was 50 pages long.
Most importantly, she said, otolaryngologists should hire an attorney to review all software, hardware and financing agreements before signing anything.
The Training Period
Jolene Eicher, chief operating officer of Advanced ENT and Allergy in Louisville, Ky., recommended that otolaryngologists set up a testing phase to help staff become proficient with the system before going live. “The last thing you want is to be in the exam room with the patient and you can’t bring that template up,” she said.
Eicher told otolaryngologists to be prepared for a complete change in their daily workflows and warned them not to try to mimic their old, paper-based systems. “A piece of paper is a sign of inefficiency if you’re on an EHR,” she said.
Practices may need to reduce their patient load while they incorporate EHRs, she said. She added that staff will be a little slower and less efficient at the beginning, and otolaryngologists should plan for five to six hours of training per clinical provider before the system goes live.
But, according to Eicher, the initial challenges of adopting an EHR system are worth the eventual results: a more efficient office. She pointed out that prior to adopting an EHR, the physicians in her group worked an average of 45 to 46 weeks per year and post EHR they worked an average of 43 weeks per year with the same patient volume but higher receipt per patient visit.