It’s surprising to think that an estimated 40% of healthcare providers are still using paper charts today, even though the HITECH Act that gave providers financial incentives to move to Electronic Health Records (EHR) software was passed over a decade ago. Lawmakers have since continued to incentivize the implementation of EHR systems certified for meaningful use through reimbursement programs such as MIPS and CMS. They have also added the stick to that carrot approach, passing legislation allowing for increasingly heavy fines for non-compliance with HIPAA regulations. Yet many doctors still refuse to budge, even after all these years. What would make so many willingly decide to forgo the benefits of such a widely adopted technology for the hard grind of the Stone Age? Let’s discuss the two most common reasons.
Familiarity and Location
A lot of the providers who are still using paper charts with no plans to transition to an EHR system have avoided transitioning to EHR out of familiarity. As many are quick to say, “If it ain’t broke, don’t fix it.” The problem with this cliché is if everyone thought this way, “the better mouse trap” would never come about. I would still be watching a black and white TV and driving a Ford Model T. Actually, not even a Model T. I would be pushing a steam-powered automobile. You wouldn’t be reading this article from your phone or tablet. Innovation dies with this statement. So that argument literally gets us nowhere. Familiarity should never be the reason to avoid growth.
Those providers who live in rural locations have a different set of technological challenges that impede the transition to EHR. With the majority of today’s EHR systems now being cloud-based, fast and reliable internet service is essential to its operation. Most rural areas simply can not deliver the bandwidth to needed to support it. Their only option is to work with a legacy EHR system designed for on-premises installation, but this comes with its own set of problems and requires a much higher level of on-site IT support, which is also scarce in most of these areas. But help is on the way.
Much of the case for the T-Mobile and Sprint merger was built upon an accelerated path to 5G and an ability to serve rural communities. They plan to use lower-band frequency to enable 5g service delivery outside of the densely populated urban areas, whereas Verizon’s and AT&T’s ultra-high frequency millimeter wave (mmWave) technology will deliver much faster speeds to densely populated areas. The merger will still make some use of mmWave but will also heavily leverage mid and lower-band frequencies in their deployment. Those devices on the mid and lower frequencies will not experience anywhere near the performance of mmWave, but they will still experience a drastic improvement over their current service. There are still other issues like weather-related volatilities (ie. rain-fade) that present further challenges to 5g as a viable solution to the rural high-speed internet service delivery issue, especially for business applications. The reality is this is many years out at best.
Low-Orbit Satellite for High-Speed Internet
But there is hope. A viable solution is being rolled out as you are reading this. Elon Musk’s SpaceX Starlink program and Amazon’s Kuiper project both promise to deliver a solution to this issue on a more accelerated timeline via low-orbit satellites. Though Kuiper just recently received FCC approval and is not expected to be available until 2026, SpaceX Starlink is already available in some parts of the US and Canada, with plans for rapid expansion right around the corner in 2021. In fact, on October 24th, SpaceX launched 60 more Starlink satellites into orbit from Space Launch Complex 40 (SLC-40) at Cape Canaveral Air Force Station in Florida.
The Benefits of EHR
Many providers who don’t have the constraints of locality make the argument that using paper saves costs. But does it really, or is it just a fallback to the “if it ain’t broke don’t fix it” stance? Continuing to use paper may seem like a good option when only looking at the costs of the initial investment in a HIPAA compliant EHR solution and the process development and optimization necessary for maximum return on the investment. But this is before you consider the amount hemorrhaged on a monthly basis through costs for paper, toner, and copier leasing and maintenance fees.
This is nothing in comparison to the costs of paying each clinician or staff member for all the additional hours it takes to manually update case notes, complete customer intake forms, or fax patient information to business associates. The time lost and expenditures multiply with each additional staff member. There are additional challenges that make paper charting inherently inefficient and antagonistic to productivity and cost effectiveness. From difficulty finding files to illegible notes on charts, time and money are lost just by not being able to develop and follow streamlined processes. Much of the time spent completing and correcting paperwork at a cost could and should be spent delivering improved patient care and growing your practice. Or, as Warren Buffet, the “Oracle of Omaha”, so eloquently summed it up, “Price is what you pay. Value is what you get.”
Process Optimization, Productivity, Profitability
There are also the potential added benefits of control and standardization. These are both necessary elements of process development and optimization. With paper systems, there are often no ways to really enforce policies in real-time, so filing errors are frequent, mistakes are more common, and as they are usually caught later, valuable time is wasted remediating them. And what’s worse, the doctors in these situations find themselves paying staff members to do the same work twice. There is also the issue of data redundancy, or lack thereof. What happens in the case of flood or fire? Chances are, everything lost cannot be recovered.
By contrast, use of an EHR system standardizes processes like intake, case notes updates, and billing. Storage policies force all staff members to save sensitive documents in encrypted, protected locations. When staff members are trained to follow repeatable, refinable processes, they become more efficient at those tasks, and more able to contribute to further refinement of the processes. Add to that the ability to automate certain tasks like scheduling and forms population and reconciliation, and a well vetted, designed, implemented, and optimized EHR strategy employed by a well-trained staff becomes an investment that pays exponential dividends. This translates to decreased administrative overhead and physician burnout and increased patient count and improved service delivery. And the ability to backup and archive all patient files ensures availability. The benefits are many, but here are a few of the end results of a well-implemented migration to an EHR solution.
Choosing the Right EHR For Your Organization
All of these benefits can be realized with the right EHR solution but with literally hundreds of EHR applications out there, finding the right EHR solution for your organization can be like finding a needle in a haystack, and requires thorough research and vetting, while implementing the solution requires thorough planning, training and execution. Among some of the things that you should look for in any EHR application:
Knowledge and design specific to your specialization. A cardiologist’s needs will be much different from an ophthalmologist, which will in turn differ from a dentist, and so on. Be sure that your EHR vendor has experience specific to your specialization, check all review sites, and pay special attention to reviews from customers in your field.
Responsive customer support. There is nothing more frustrating during an outage than the inability to get vendor assistance when you need it. Network or core application outages, even short ones, can prove very costly for an organization. Verify the types of support (phone, email, chat), hours available, and customer service ratings for your prospective EHR vendor.
Interoperability with labs, pharmacies, coding applications, vendor interfaces, etc. The ability to seamlessly exchange records with other providers, submit billing to clearinghouses, comply with CMS, MIPS, and MACRA regulations, and collaborate with courts or other entities connected to the delivery and verification of healthcare services to the patient is critical to operability, productivity, scalability and ultimately, the profitability of any practice. For example, some EHR applications are even pairing up with ride sharing apps like Uber and Lyft to allow scheduling of transportation from within the EHR application. This is just another way that integration allows further streamlining and improvement of the entire experience for the patient as well as the practice. It also plugs another leak in the revenue stream by reducing missed appointments.
- The ability to customize and adapt to changes in the market and legislation, and
the size of their research and development team. Are they able to digitize forms and workflows specific to your practice and comply with the laws specific to your particular state? The product that works today can very easily be rendered inefficient or obsolete by an industry change tomorrow. Cloud-based applications give us some insulation against that, but any EHR software company must have the ability to quickly pivot with changes in HIPAA laws, state laws, criteria for reimbursement, CDT and ICD-10 code changes and additions, the list goes on. Choosing the wrong EHR vendor can potentially set you up for failure going forward and hamstring your ability to keep up with or outpace your competitors in a new world where agility is king.
- Onboarding process. Learn how the prospective EHR vendor onboards new clients. How do they import existing documents into the system from your previous EHR vendor? From paper records? How do they ingest active patient records as opposed to patient archives? And how are they stored and retrieved in accordance with HIPAA laws if necessary? How is staff training on the new application structured and delivered? These are just a few questions to which you must have answers in order to ensure a successful transition to your new EHR system.
At Nutech Solutions we have worked over the years to deliver, secure and optimize several EHR software solutions for both those aimed at enterprises and smaller practices, and don’t endorse any one particular solution in general, as different EHR vendors are better suited for different specialties and applications. But we do endorse EHR as a critical piece of your comprehensive healthcare service delivery plan, and we highly endorse taking your time and getting the expert help that you need to choose not only the right EHR solution for you, but also the right supporting applications, systems and processes to make your transition and operation smooth and successful. Should you need any help answering questions and getting through the decision-making process, we’re here to help. Give us a call or schedule a consultation below.
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