EMR, How Do I Make The Switch

The decision to go to EMR and to actually implement it can be a very intimidating and tormenting process. Then why should I do it. The logic for this is abundant. The preeminent reason is that the federal government will pay you substantially to do so. This stimulus is called the ARRA. That alone would do it for me. Improved productivity in the office, which means better patient care, and a more efficient staff are some side effects of using EMR If you have come to the realization that your staff spends half of their day chart hunting, then it is time to go EMR. If you are just starting out and about to open an office, you should not even be considering using paper charts. In this article, I will explore:
What is the ARRA.
What about my paper charts.
What EMR system should I use?
Do I need to change or add hardware?

ARRA
The federal government wants to give all medical practices $44,000. All you have to do is demonstrate " meaningful use" to get your $44,000.00 from Uncle Sam. If this alone does not motivate you to transit to EMR, I don't know what will. The US government wants all Americans to have an electronic Medical Record, for obvious beneficial reasons, and is prepared to pay out to those offices that make this move. Payment amounts are made based on what year you can establish a Meaningful Use of a certified EMR system. Payments are made to offices over a 4-5 year period. Read this article for more on the American Recovery and Reinvestment Act of 2009

Scan them, of course.
You may choose to farm out your scanning work, or do it in house. I recommend doing it in-house. If you outsource this, the digital files still have to be put into your database and attached to a patient account. Also, think about what to do if a patient calls to make a last minute appoint for today, but her chart is offsite being scanned. I advise that all charts for week one of EMR be scanned the week before and additional appointments are made, those charts get pulled and scan them within a day, during week one, charts for week two are being pulled and scanned, etc. After charts are scanned they should be kept in a bin for shredding. I encourage you to use a document shredding service to handle your shredding work as this is very inexpensive and well worth the savings in having a staff member attempt to shred this enormous volume with your little office shredder. The shredding company will provide you with a large enough bin to accommodate you scanned charts. Once a chart has been scanned, it should not be available for any staff member to use, for obvious reasons, so make sure the scanned chart ends up in the shred bin.

Try to avoid getting a scanner because it is cheap or on sale. I did this and wasted many hours of un jamming the scanner and just waiting for a very slow scanner to complete it's work. I bought several of the Fujitsu ScanSnaps. This is a very competent scanner but is not well suited for your chart scanning because of it's slower speed and propensity to jam. This scanner would fit the requirements for use by the receptionist or your billing person as these staff members will need to do some light scanning such as driver license, insurance card, EOB, etc., basically no more than a few pages at a time, and scanning work that will not disrupt the patient flow if jam ups occur.

The Fujitsu 6140 will be able to tackle the job of scanning charts with no problem. This scanner costs about 2-3 times more than the ScanSnap, but is worth the difference. Scanning time is about three to four times faster than the ScanSnap. Three or four times the speed may seem minimal, but it has a huge impact when you have dozens of charts to scan for the day. Moreover, this unit will rarely ever jam. This alone is worth the additional cost. If you do your research, you'll find that there are software companies that can develop a direct scanning interface with your EMR/PMS that will scan the documents directly into the patients account. This is money.

This is a tricky question. This is a complex question to answer. I will cover some issues to consider when making this decision. First, make sure that any EMR system that you are considering is certified, If it is not, you will not get the Incentive money from the government. This is important as you want to get your $44,000. 00 from Uncle Sam, and you won't if the software is not accredited. Second, This issue is not entirely imperative, but is a tremendous bonus. Think about purchasing your EMR from the developer of your PMS, if you already have one. The reason I mention this is that if you do have your PMS already, then, this will likely only involve buying the EMR module for the existing software. This means that the user interface will be the same as the PMS. Your employees will already have a familiarity with the user interface and time will be saved in not having to train them on this aspect. Additionally, all of your office computers will only have to run one piece of software which will perform all tasks needed in the office such as, appointments, billing, EMR, ePrescribe, etc.. If you choose not to go this way, you encounter compatibility issues with your existing database and new EMR.

Again with the dicey questions.
You EMR vendor will be able to tell you if your current hardware is up to the task to run their system. Hopefully, if your computers are not too old, you may just need to increase the memory (RAM) which is very inexpensive today. As far as the hard drives are concerned, this may be an issue only on your server as this is where the database will live including all scanned attachments. The scanned documents will use up lots of space, so make sure your server hard drive is large enough. Furthermore, keep in mind that your external backup device will need ample storage capacity as well.

Clearly, it would be great if your EMR had capability with iPad and iPhone as this would incorporate an "always accessible" component. However, it is plausible that you will have to buy additional computers. For this, I suggest purchasing used computers on eBay. If you had to buy one new computer, this should be the server. This is the most critical machine in your office and if budget allows, buy new. I have purchased 90% of my office machines in this manor, and have not regretted it.