Why do really need an EMR System?
Author: Venkat Sharma

Fairfield County Business Journal, September 2003 I was playing tennis with a respected physician friend who is a partner in a large practice in Fairfield County. During the changeover, I mentioned that I was going to a conference on Electronic Medical Record (EMR) systems to see the “state of the industry.”  I must have touched a nerve, as he described how his group looked at many medical record products and had yet to see one that fit their needs. His practice finally did acquire a product, knowing they had to compromise since the system they were looking for did not exist. As we continued our game, I could not help thinking about what constitutes the ideal electronic medical record system.

The industry is rife with products touting impressive technological features that claim to solve every possible need a physician could have. Of course, the cost of these systems is correspondingly high. Another physician friend described the product they had just acquired – a $100,000 system, with an additional $100,000 expended on staff training and office readiness for the product. And after all that, the doctor still had to sit at a keyboard while meeting with the patient. While some physicians may adapt to that model very well, I would imagine that most doctors (and patients!) would be disconcerted by a patient encounter where the doctor sits at a computer keyboard.

The primary question to ask is - why do we need an EMR system? If one distills it down to the basics, the primary need is to (a) facilitate a higher quality of care, (b) ensure documentation compliance, (c) maximize reimbursements, (d) ensure portability of patient information, and (e) decrease the amount of paper used in a physician office. So let’s probe these factors.

For proper quality of care, one must capture every relevant detail of the past medical history, current physical examination, and history of the present illness. Coding information is also important for analytical purposes and the process of capturing the information must be simple. The physician should not be forced to adapt to the computer. Data input has to be easy, allowing for the physician’s work style – allowing for paper and clipboard, as well as a stylus and tablet PC.

Information needs to be presented in a succinct way. Once the physician examines the patient and the lab reports, does the physician need to see any more information than the Plan, Impression, and Recommendation after the initial visit? EMR systems that inundate the physician with data and choices on a screen are wasteful and inefficient. Aggregation of the detail information is useful for future analyses for outcomes research and the effectiveness of medical technology and treatments. Also, some aggregated information can be used for other revenue generating purposes such as clinical research and efficacy information that can be sold back to the pharmaceutical industry. Since aggregation will not reveal patient information there is no negative HIPAA impact. A good EMR system will allow such information capture.

An electronic medical record will help ensure compliance and documentation support for proper coding. Physicians administering care cannot remember complex HCFA documentation guidelines and coding rules. Plus, there is usually not enough time for the physician to obtain and document a thorough medical history and exam. All too frequently physicians under-code to avoid negative audits; significant money is left on the table. A good EMR system should ensure that adequate information is captured for proper documentation to support coding and guide the physician towards the appropriate code to maximize revenues.

Many EMR systems on the market do not take into account the need for portability of patient information. While individual patient information can be pulled up, it is difficult if not impossible to transfer patient information as required by HIPAA.  A good EMR system will enable HIPAA compliant, easy transfer of an entire electronic patient chart with a click of a button, and systems that utilize open industry standards such as XML and HL7 are in a better position to do so. In fact, when using these standards, information does not have to be physically transferred – patients and their physicians can be granted secure access to their discrete record within the EMR system. Ideally, the EMR system could be accessed by another standards-based EMR system so that two different physicians in different parts of the country could access a “combined” patient medical record.

In addition to wasting real estate, paper charts also waste a significant amount of front office time.  Some systems on the market attack the paper-reduction problem - handwritten charts are scanned into a repository of images that can be pulled up electronically later. These systems help solve one problem, but they do not capture information in a structured way. Nor do they solve the infamous physician handwriting problem. Therefore, information cannot be accessed quickly, nor can it be analyzed for quality and efficacy of care.   EMR systems must do more than organize paper documents – they must capture the content of those documents in an intelligent database. EMR systems that are based on scanned documents do not do enough.  At best a scanner-based system is an interim solution while waiting for a more robust solution.

An intelligent medical record system that fits the physician’s work style, is electronic, helps proper coding, and allows portability will increase revenues for the physician, improve quality of care, and reduce filing and real estate costs.

Venkat Sharma is the CEO and Founder of iMedX, a physician productivity solutions company located in Shelton.