Many Reasons for EMR Adoption

Why are doctors still not embracing adoption of EMR (electronic medical records)?

If you had asked me this question a few months ago, I would have stated the “C-word” (change) as the barrier.  While a small number of our population welcomes change, most people must realize personal benefits before traveling a different road.  And of course, there are those who will dig their heels into the dirt and move into change kicking and screaming.

Rebecca Johnson blog photo

Rebecca J. is the Director of Education for Eyefinity/OfficeMate

The following excerpt comes from a story in the October 5th edition of the AOA News:

“Doctors who begin using EHR’s by 2011 or 2012 can receive the maximum reward, up to $44,000 over five years through the Medicare program (75% of Medicare-allowed charges up to a capped amount each year).  But if you wait until 2015, there are no incentives.  Doctors should make plans to implement EHRs in practice before the end of 2010.”

The second group of individuals I spoke of can now realize the personal benefits of EMR adoption:  Improving patient care while enjoying the financial benefits offered by the American Recovery and Reinvestment Act of 2009 (ARRA).  This was evident in the exhibit hall booth at Vision Expo West when I repeatedly heard doctors state, “I am ready to go paperless; I just don’t know how to get started.”

I plan to use the Eyefinity/OfficeMate blog site as a vehicle to communicate Best Practices of EMR Implementation.  I would like to hear from doctors who have successfully implemented ExamWRITER electronic medical records in their practices.  What did you do right?  What would you have done differently?  In addition, I would like to hear from doctors who are still on the fence and those who have purchased ExamWRITER but can’t seem to get off the ground. What is holding you back from getting started?  What challenges have you experienced in your EMR implementation?  Leave a comment here or email me at rjohnson@officemate.net.   Let’s make this happen – 2010 is right around the corner!

17 Responses

  1. I read in a previous post that the suggestion to develop for the iPad, iPhone or other various devices was being passed to the development team. What is the progress on such development?

    • Thanks for the comment, Matthew. Yes, we agree that the iPhone, iPad, and the various Google Android-based devices are amazing, and they are making waves in the world of healthcare.

      We understand that your mobility and patients’ perception of technology in your practice are important to you. Those ideals are also important to us. You can achieve mobility and improve patients’ perception of technology in your practice today, without having to wait for future development, by using a Motion Tablet PC. These tablets feature cutting-edge technology, are fast and mobile, and they look great, too. Best of all, they can run OfficeMate and ExamWRITER today.

      • It would be nice if Officemate cared more about its customers rather than its contractual obligations. Customers demand product like the ipad, much cheaper, more user friendly, and more functional. Instead, eyefinity offers these motion tablets, which are very expensive and gaudy.

      • I’m not sure that an tablet/mobile browser application will meet the heavy weight performance requirements of OfficeMate. In my opinion, a browser virtual session is untenable. To create a mobile/tablet app on either IOS or Android, a complete rework of the underlying officemate/examwriter application will be needed.

        I believe that Eyefinity has purchased either the rights or the technical talent for a new application that will replace the existing one. Backward compatibility may need to be sacrificed to some extent if it is to meet the competition now present in the market place. If Eyefinity attempts to cater too much to backward compatibility, I believe it will cripple it so much that it will be similar to the old Mac OS on Motorola processers and the newer OS on Intel. The whole thing has got to be scrapped for better speed and performance in a cloud infrastructure.

  2. I’ve been reviewing ExamWRITER in actual patient encounters. In my opinion, the wireless performance is much weaker than the wired environment. Has your support or technical team seen this before?

    • Decreased performance is part of the nature of wireless networks. This decreased performance can affect ExamWRITER and other programs that access your network or the internet. For many years now, our system specifications have said the following in regard to wireless networks:

      “Wireless networks offer significantly lower performance and reliability than wired networks; therefore, Eyefinity/OfficeMate recommends hard-wired networks in environments where high performance is necessary” (From http://www.officemate.net/examwriter_sys_req.aspx#network)

      Placement and configuration of your wireless router can affect wireless performance. Additionally, the physical construction of your building (for example, older buildings with thick walls or dense construction materials) may impair your wireless signals.

      You may consider consulting your local network technician to investigate your wireless setup. Depending on how your practice is laid out, you may need to relocate your wireless router, invest n a wireless bridge, or hardwire your exam room.

      • Thank you for your reply. It begs a further question. In today’s modern optometric office, a wholly wired and tethered office does not reflect the needs and requirements of the many offices who may want the roaming feature of an untethered terminal.

        Does OfficeMate have a roadmap to develop and deploy native OS applications (namely, iPad/iPhone; Palm/WebOS; Android) for OM and EW products?

      • Currently, you do not need to be hardwired. You can use OfficeMate and ExamWRITER on a laptop of tablet in wireless environments using 802.11g and 802.11n technologies.

        Thank you for your suggestion about integrating with such mobile devices as the Apple iPad. I will forward your suggestion to our Development team. They are always happy to receive suggestions and comments from our customers about making our software better and easier to use.

        If you have additional comments or suggestions, you can submit them through our web site at http://www.officemate.net/contact_feedback.aspx.

  3. Dear Rebecca,

    I began using Examwriter about a month ago. My main challenge is that I feel like I am immobile. I am thinking about getting a mini laptop. I use a mini laptop for my personal use and I love the mobility. The only worry I have is that the minimum monitor requirement is 15inches. The mini is 10.5. Any recommendations?

    • Dr. Thompson,
      It is nice to hear from you. I too, love my “baby laptop” due to its mobility. Since I have not personally put ExamWRITER on this laptop, I checked with the manager of our hardware department. His answer:

      As long as the mini-laptop can sync to a resolution of 1024 X 768 you will be okay.

      If the resolution is lower than 1024 X 768 parts of the screen may appear hidden.

      Rebecca

  4. On the converse side of this question, what are the “obstacles” or “barriers” to EMR adoption and use? Is it:

    1) Insufficient familiarity with computers?
    2) Lack of available technical talent in the office?
    3) The perceived entry and maintenance costs of EMRs?
    4) the uncertain role of CCHIT or “meaningful use” rules?

    • Dr. Horn,

      You have listed four definate obstacles to EMR adoption. Based on my experience, I would add to your listing:

      5) The value of EMR adoption is not recognized.

      Many doctors do not see a reason to fix something that they feel is not broken. The paper records have worked fine so far, why change?

      In reality, as I am certain that you know, there is great value with EMR adoption. To name a few:
      1. Increased effeciency (after the initial training period)
      2. Legibility of records
      3. Financial savings: materials used to make a chart; less staff required, less office space required
      4. Increased patient safety and quality of care
      5. improvement on capturing charges due to automated documentation of charge codes to the fee slip.

      • Ms. Johnson,

        Thanks for your post and reply.

        Much of the financial value of EMR rests with what is called in the industry revenue cycle management. Admittedly, EMRs significantly improves the cycle times for payment, but this advantage is only possible if the business process model can take advantage of that feature.

        In a hospital I once consulted, the EMR could or would not release the final record of the patient for medical coding and billing until the patient was discharged. This caused the billing to wait another 30-60 days. I had recommended that the coding and billing be done simultaneously and they realized a cycle time improvement of 1/3 of what it was.

        Do doctors using Officemate coordinate their business workflow to take care of this advantage? Well, maybe that could be the reason that doctors don’t see value with an EMR.🙂

  5. We have a small private practice running OfficeMate. While we have a very small number of excellent opticians and a rather knowledgeable computer expert available, we can’t justify the additional costs associated with EMR. Let’s face it, running computer systems is now a core competency at such a shop. So after all the license and SLA charges, there’s the training costs, the indirect costs of the immense disruption of an office flow that works just fine as it is. Given the complexity of OfficeMate, I find it difficult to the extreme to ask our staff to learn what would promise to be exceedingly more complicated.

    • Hello, Scott.
      Thank you for your response! You bring up two points that I hear frequently: 1) Justification for EMR implementation cost; 2) EMR efficiency.

      I will discuss implementation costs first.

      • You mention in your response that “running computer systems is now a core competency” in eyecare practices. Having been in eyecare for 27 years, I remember this same cost justification discussion around purchasing computers for our practice. We seemed to be doing fine with our scheduling book and peg-board billing system; therefore it was difficult to justify the costs associated with purchasing the hardware, software, training and “down-time”. Things sure have changed since then. Few doctors would consider opening a new practice without purchasing computers, as we now recognize the gained efficiencies of a good Practice Management System. We will experience this same paradigm shift with EMR over the next few years as doctors realize the value propositions of charting electronically (see Dr. Hom’s comments on this same thread).
      • Good News! As a VSP doctor practice, your office is eligible to receive OfficeMate and/or ExamWRITER at a deferred software fee through the VSP and Eyefinity/OfficeMate Healthcare Technology Program. This program, which is currently available through December 15, 2009, helps position VSP doctors to seek federal incentive payments through the HITECH ACT, which encourages the adoption of EMRs throughout the healthcare continuum, including eyecare. VSP doctors can take part in this risk-free offer and are only responsible to pay for the software license if they receive federal incentive payments beginning in 2011.

      http://www.officemate.net/pr_06262009.aspx

      As for EMR efficiency, it has been my experience that there is a learning curve that initially increases the amount of charting time. The key to minimizing the learning curve is training. Recently, I spoke with a doctor who was frustrated because he found ExamWRITER it to be less efficient than documenting on paper. After a few minutes discussion, he confessed the he did not take any of the training classes offered through OSSU (OfficeMate Software Solutions University) that come with his ExamWRITER purchase. He was pleasantly surprised to learn that there are ways to make ExamWRITER work much more efficiently for him and quickly signed up for the courses. In 2010, the Eyefinity/Officemate Education Department will be offering several ExamWRITER Education Opportunities, including:
      • 2-Day ExamWRITER Education Events throughout the country
      • Brown Bag eLearn sessions (free 30 minute ExamWRITER learning opportunities held during the lunch hour in all time zones)
      • Virtual User’s Group Meeting July 2010
      (one full week of online OfficeMate and ExamWRITER education)
      Watch your inbox, mailbox and our website http://www.officemate.net for information on these events. The information will be posted before January 1, 2010.
      Scott, you also mentioned the “complexity of OfficeMate”. I am very interested in learning the challenges that you are currently experiencing with OfficeMate and discussing this offline with you. Please email me at rjohnson@officemate.net to set up a phone conference.

  6. I have talked to potential optometry and general medical EMRs across the nation. Few mention ARRA financial incentives as either a justification or a rationale to launch an EMR/EHR in their practice.

    What I see is the lack of an apparent value added proposition to start an EMR/EHR. Let’s look at some myths.

    1. There are financial incentives to do so. – In reality, if an office doesn’t already formalize their business processes, the financial incentive to deploy an EMR is trivial and irrelevant.

    2. I can become more efficient. – Efficiency is probably best described as either the rising revenue per employee or the cost per employee. EMRs may impact these figures, but so can other factors. Doctors may feel more comfortable employing these other factors before an EMR

    3. I can get paid faster – This is probably relevant, but it can be neutralized if there are ill-defined objectives, plans and processes present in an office.

    What might be value propositions?

    1. With marketing or promotional budgets either dear or constrained, analytics may be necessary to target specific of your patient base or market audience. Such explicit and concise methods of advertising may be preferred over general advertising. And it is only possible if you have an EMR.

    2. The most valuable asset in your practice is your patient records. Having an EMR will give any doctor many more options for redundancy in either the unintentional or intentional acts of mischief.

    3. Patient record integrity doesn’t necessarily mean the safety of the physical record. Patient record integrity may also mean legibility. While something may be readable now, will it be readable in five years or with a new doctor.

    In summary, the rational or impetus for the adoption of EMR rests not on any single factor. Nor would any single factor be relevant for any particular doctor. What a EMR vendor may achieve is a heightened sensitivity to some of the issues that I have introduced.

    I look forward to reading more of your organizations efforts in pursuing EMR adoption.

    • Dr. Hom,
      I appreciate your comments regarding the value propositions of EMR adoption. I was an ophthalmic technician who struggled with handwritten charts for many years, so I particularly enjoyed reading your value proposition #3. I once worked for a doctor whose handwriting was so illegible there were times when he could not decipher his own writing.
      I agree that financial incentives should not be the sole reason for EMR adoption, however for the doctors who can realize the value of EMR the financial incentives make “now” a great time to begin.

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