Elecronic Health Records and Virtual Office Visits

Why It's Time to Purchase an Electronic Health Record System
Why now?
The Institute of Medicine published "The Computer-Based Patient Record: An Essential Technology for Health Care" in 1991 urging physicians to adopt EHRs - originally called computerized patient records (CPRs) or, more recently, electronic medical records (EMRs). Physicians have been slow in adopting EHRs because the initial EHRs were costly, inefficient and did not follow any specific accepted standards. Over the years, The CCHIT Certification Commission for Health Information Technology an independent, 501(c)3 nonprofit organization was recognized as the certification body for electronic health records. The mission of the CCHIT is to accelerate the adoption of robust, interoperable health information technology by creating a credible, efficient certification process. It is prudent for the physician to purchase an EHR that has passed CCHIT certification.
Hardware and software became faster, more powerful and more affordable. Broadband connections became faster, more secure and more reliable. Scanning technology became faster and more efficient and voice recognition became more accurate. Information can now be filed and retrieved electronically faster than it can be manually. With the addition of functions such as electronic prescribing, allergy checking, drug-interaction checking and remote chart access, EHRs can do things that are impossible to do with paper charts and EHRs are becoming much more user-friendly.
Although a lot of the EHRs are still significantly expensive especially for a solo practice physician, several EHR companies are adopting an ASP model in which case the HER and data are hosted online and physicians access the EHR and data using a secure broadband connection via the internet. This saves a lot on hardware as well as software expenses. The physician is often charged a monthly fee rather than a huge upfront lump sum and enjoys the benefit and peace of mind that the software being continuously updated and the data is being continuously securely backed up and can be securely accessed from any remote location since it is hosted on the internet.
What is an EHR?
An EHR is software that allows you to create, store, organize, edit and retrieve patient records on a computer. Advanced EHRs also allow for electronic prescribing and medication refills, automatic formulary checking, electronic lab, imaging and referral ordering, automated charge capture, automated coding advice, interoffice and intraoffice clinical messaging, multiple note creation options, remote access to the chart, results flow charting, clinical alerts, patient education and disease management.
Creating, handling, filing and copying paper documents, forms and messages invariably involve more steps and time than performing the same functions electronically. Paper processes cost more and take longer. Fully implemented EHRs lead toward a "paperless" office, not as a goal but as a byproduct of the benefits they offer.
How EHRs improve care
EHRs improve communication, access to data and documentation. This leads to better clinical and service quality.
Clinical quality is improved by having more ready access to all relevant clinical information at the time of the patient encounter or phone call, receipt of clinical alerts at the point of care (e.g., being reminded of a drug interaction or allergy as you're writing a prescription), the ability to easily monitor and analyze patient outcomes, and the ability to easily identify patients who are due for health maintenance or other clinical tests and/or follow-up.
Service quality is improved through direct e-faxing of prescriptions to pharmacies, customized, typed patient education instructions and handouts printed at the point of care and, if desired, even the ability to provide copies of clinical notes to patients and/or consultants at the completion of a patient visit. Your office can be much more responsive to patients on the phone as well. Since the patient chart will be available at the time of the first call, many "we'll pull your chart and call you back later" interactions can be eliminated.
Patient perception of your clinical acumen may benefit as well. Coming improvements in patient service quality include the ability to offer patients secure Internet access to parts of their medical record such as medication lists, problem lists and test results as well as getting appointments online and virtual office visit online consultations
How can a solo physician in private practice afford this?
If an EHR is implemented well, it will pay for itself through cost reductions and revenue enhancements. It could even make you money or allow you to go home earlier. Savings include the following:
· Reduced transcription costs. Using an EHR typically cuts transcription costs by 50 percent to 100 percent.
· Savings in paper-chart-related costs. Using an EHR also cuts down staffing office machinery and office supplies by saving on paper, copying, printing, filing and storage. You no longer need that large bulky multifunction copier, printer, scanner and fax machine. You also no longer need those several filing cabinets covering all the walls of your office. All you need is a scanner that is slightly larger than a regular telephone and a network printer. Your computer becomes your fax machine. Your scanner becomes your copier and the internet becomes your filing cabinet (more on that in a later chapter).
· Improved staff efficiency. With an HER, searching for charts, consult notes and lab results is eliminated, appointments are automated, staff can answer phone calls more promptly and spend their time more efficiently in quality improvement efforts without the need for overtime charges.
· Increased Coding Accuracy. EHRs improve coding by reducing the common tendency to undercode, because they provide better documentation and typically incorporate an automated coding adviser. This feature alone may pay for the system. Revenue enhancements include increased income through improved coding, improved charge-entry accuracy, and improved provider productivity:
· Enhanced Charge capture. Automated charge entry eliminates missed or overlooked charges.
· Increased Productivity. With an EHR, provider productivity increases as a result of improved office efficiency. If you eliminate half an hour of paperwork, that's two more patients you could see per day or 30 more minutes you could spend with your family. ((Family Practice Management) November/December 2004, Vol. 11, No. 10, pages 11 Why It's Time to Purchase an Electronic Health Record System, The old reasons for holding off may have lost their validity. Kenneth G. Adler, MD, MMM)