Table of Contents Business Overview Problem Overview
Requirements for the Solution Business Problem Overview Breakdown
of the Requirements Redefining the Business Problem (One thing at a
time) Problem Breakdown HITECH ACT HIPAA Staying Compliant Required
Features ASP versus Client-Server Pricing EMR Software
Considerations Determining what features are really required
Deciding between ASP and client-server Testing out different EMR
software solutions Steps to Take Gradual Implementation Keeping
cost down Recommended Sources Post-Purchase and Conclusion
Slide 3
ENTegrity An Ear, Nose, and Throat medical practice located in
Scottsdale, Arizona. Employs three medical doctors, a physicans
assistant, a doctor of audiology, and several people for office
staff. Looking to switch to electronic medical records (EMR).
Slide 4
Current Situation Seven years of paper medical records Approx.
18,000 records per year, for a total of approx. 126,000 paper
records. Fax is used for exchange of records between facilities For
instance, between ENTegrity and the OR Doctors spoken notes are
sent to transcribers, transcribed, and then sent back
Slide 5
Business Problem ENTegrity is looking to switch to Electronic
Medical Records (EMR) What software to use? What changes need to be
made? How to ensure a smooth transition? How to be HIPAA
compliant?
Slide 6
System Requirements ENTegritys office manager outlined the
following requirements for the system: All medical records need to
be electronic and accessible throughout the practice by those who
need them Records need to be easily but securely exchangeable
between ENTegrity and external facilities (business associates
HIPAA)
Slide 7
System Requirements cont. Doctors spoken notes need to be
transcribed automatically Eliminate the need for third-party
transcribers Needs to be HIPAA compliant ENTegrity website needs to
be tied into the system so patients can access / print out their
required paperwork
Slide 8
System Requirements cont. System should keep track of trends
For instance, what insurance companies pay for a certain procedure
over time Needs to not exceed the budget $120,000 - $160,000 Needs
to be secure Firewalls / security solutions to protect personally
identifiable information (PII) Needs to be implemented by the end
of 2014
Slide 9
Breakdown of Requirements The stated requirements cover
multiple aspects of the system The system in this case refers to
ENTegritys entire IT infrastructure, including software There is
not one single software package that meets all these requirements
Multiple different software and hardware solutions would need to be
implemented
Slide 10
Breakdown of Requirements cont. Hardware Firewall Software
Electronic Medical Records Transcribing software Website design /
implementation Trend analysis Network Design Accessibility of
medical records throughout the practice Exchangeability of medical
records with business associates
Slide 11
Redefinition of the Business Problem At the basic level,
ENTegritys problem is to stay compliant with government mandates
and HIPAA This can be accomplished without implementation of:
Transcribing software Website integration Trend analysis First
things first Focus on staying compliant Implement additional
software solutions later
Slide 12
Staying Compliant The Health Information Technology for
Economic and Clinical Health (HITECH) Act assesses penalties to
clinics that have not adopted an EMR system by 2015. Under the
HITECH Act, healthcare providers must demonstrate meaningful use of
their EMR system Meaningful use is demonstrated by meeting certain
objectives for three stages over five years
Slide 13
Staying Compliant cont. Demonstrating meaningful use of EMR:
Stage 1 Data Capture and Sharing 2011-2012 Electronically capturing
data in a standardized format Using that information to track key
clinical conditions Communicating that information for care
coordination processes Initiating the reporting of clinical
measures and public health information Initiating the reporting of
clinical quality measures and public health information Using
information to engage patients and their families in care Stage 2
Advance Clinical Processes 2014 More rigorous health information
exchange Increased requirements for e-prescribing and incorporating
lab results Electronic transmission of patient care summaries
across multiple settings More patient-controlled data Stage 3
Improved Outcomes 2016 Improving quality, safety, and efficiency,
leading to improved health outcomes Decision support for national
high-priority conditions Patient access to self- management tools
Access to comprehensive patient data through patient-centered
health information exchange Improving population health
Slide 14
Staying Compliant cont. If a company meets the criteria for
demonstrating meaningful use: Can qualify for $44,000 or more in
economic stimulus incentive payment for adopting and implementing a
certified EMR system. If not: Medical reimbursements will be
reduced by 1% in 2015 and an additional 1% every subsequent year
The average American Academy of Family Physicians (AAFP) user is
reimbursed 20% by medicare
Slide 15
Staying Compliant cont. HIPAA: Privacy Rule Requires
appropriate safeguards to protect the privacy of personal health
information Security Rule Requires appropriate administrative,
physical, and technical safeguards to ensure confidentiality,
integrity, and security of protected health information Breach
Notification Rule Requires HIPAA covered entities to provide
notification following a breach of unsecured protected health
information Unsecured PHI means it is rendered unusable,
unreadable, or indecipherable to unauthorized individuals through
(1) encryption or (2) appropriate destruction of the media on which
it was stored.
Slide 16
EMR Software Considerations There are hundreds of EMR systems
available, targeted at every type and size of practice. The
following questions and considerations will help ENTegrity make the
right choice 1. Narrow the list down to vendors whos software
matches ENTegritys business and size Visit offices similar to
ENTegrity and see their EMR system in action
Slide 17
EMR Software Considerations cont. 2. Try out the software Most
vendors allow you to log in to a sample account or will send you a
sample CD. Make sure these trials are used by the same people that
will eventually use the EMR software 3. Look for HIPAA compliance
as part of the evaluation Most EMR software will meet HIPAA
requirements, but you should still make the vendor provide details
on how it does so
Slide 18
EMR Software Considerations cont. 4. Look at the software
features to make sure it has what you need / want Can the system
handle multiple staff members accessing the data at the same time?
Are labs, x-rays, and other types of information (incl. from
external sources) easy to manage and access? Can it be accessed
remotely? Does it have built-in reporting?
Slide 19
EMR Software Considerations cont. 5. How will data be entered
into the medical records? Keyboard and mouse? Touch screen?
Handwriting recognition? This will determine if you need to
purchase desktops, laptops, or tablet PCs for each doctor or exam
room
Slide 20
EMR Software Considerations cont. 6. Portability of data How
easy is it to change to another solution or vendor? The patient
data is always yours, regardless if youre using ASP or
client-server (see next slide) Vendor needs to be able to provide
you with usable information if you switch
Slide 21
EMR Software Considerations cont. 7. ASP versus client-server
ASP = Application Service Provider With an ASP solution, the
software and data reside on the vendors servers, and staff members
access it through specialized client-software The advantage is that
the software and data is managed and maintained by specialized
professionals They typically have multiple layers of security,
uninterruptible power supplies, fail-over, etc. A lot of the HIPAA
security rule requirements might not have to be implemented locally
with an ASP solution The disadvantage is that the software or data
cant be accessed without an Internet connection
Slide 22
EMR Software Considerations cont. 7. ASP versus client-server
Client-server means to run the software in-house and save data on
local servers. This gives more control, but it also requires
maintaining and configuring security and storage hardware, as well
as keeping regular backups. ENTegrity might need to purchase and
maintain a lot more security hardware / software to be compliant
with HIPAAs security rule if it decided to go with a client-server
product
Slide 23
EMR Software Considerations cont. 7. ASP versus client-server
For a relatively small practice with no specialized IT team on
staff such as ENTegrity, ASP is the recommended way to go No need
to purchase and maintain expensive security equipment Cost is
spread out monthly, rather than a lump-sum up front Internet
interruptions are rare As long as the network is configured
correctly beforehand
Slide 24
EMR and MPM Many offices that switch to EMR also implement
medical practice management (MPM) software Tracks patient
demographics, visits, and diagnoses Collects, transmits, and tracks
billing information and insurance payments Manages appointment
scheduling Etc. It is advisable to first implement one system, get
used to it, and then to implement another Dont implement multiple
new systems at a time
Slide 25
Pricing Client-server Software ranges from $2,000 to $15,000
per user Medium sized practice could easily spend $50,000 on
hardware and software to install an EMR system Determine what you
really need Dont pay extra for options that you dont need or will
rarely use
Slide 26
Pricing ASP Usually includes setup fees of less than $1,000 and
monthly fees ranging from $50 to $300 or more Some ASPs charge for
actual usage $0.50 per updated chart, $0.80 for a new record,
etc.
Slide 27
Steps to Take Determine what software features you need Get
input from everyone who will use the software for this Determine if
you wish to implement an ASP or client- server solution ASP
typically recommended for small to medium sized practices without
an IT staff Visit other, similar practices to see their EMR
solutions
Slide 28
Steps to take Meet with your business associates and get their
input For instance, the OR from which you need to receive patient
data or reports. Chances are they already have a system set up for
this, for their business associates that already use EMR. How is
this done? Build a test plan Create a script that walks through the
most common office tasks. Use this when evaluating the trial
software so you can compare them better
Slide 29
Steps to Take Contact vendors for information / trial versions
/ demonstrations Test out multiple EMR solutions thoroughly Have
them tested by the people that will use the software Meet with the
office staff and discuss the results Finally, purchase the
software
Slide 30
Post-Purchase Dont expect to switch systems from one day to the
next Issues will occur with any new system People are used to the
old system Make sure that the paper charts are still available and
the old system can still be used when needed As people start
getting used to EMR and less issues occur, gradually fade out the
old system A complete switch to EMR can take years
Slide 31
Post-Purchase cont. Scanning of the paper charts With 126,000
paper charts, this can seem like a daunting or even impossible task
Remember; HIPAA requires keeping medical records for 7 years. It
does not require that these all be electronic Not every single
chart needs to be scanned. The trick is distinguishing between what
does and what doesnt need to be electronic
Slide 32
Post-Purchase cont. Different conversion methods to consider:
Scanning everything up front With 126,000 charts, this would be an
enormously time-consuming and costly task. Hiring an outside firm
to scan everything There are companies that will come on-site and
scan in everything for you It will still require ENTegrity staff to
help / oversee the process It will be a significant up-front
investment Scanning charts for patients as they come in By scanning
only charts for patients that come in that day (or the next), and
limiting the conversion to only the last 3 or 4 visits, the work is
spread out over several months or even years and only relevant
(recent) information is included
Slide 33
Conclusion Switching to EMR by the end of 2014 and staying
compliant with HIPAA and the HITECH ACT should be manageable Assess
readiness of ENTegrity and software needs Meet with vendors and
test different products Make a purchase decision by the end of 2013
Implement EMR gradually over 2014 Display meaningful use by the end
of 2014
Slide 34
Conclusion cont. From the research done, a budget of $120,000 -
$160,000 seems very manageable - high, even Ways to keep cost of
this project down Opt for ASP over client-server implementation
Drastically reduces up-front investment and spreads the cost of the
project out over time Scan medical records for patients as they
come in Eliminates up-front cost of scanning everything at once,
either through hiring a third party or investing employee man-hours
for this task
Slide 35
Final note on HIPAA compliance There is no single product or
solution that guarantees HIPAA compliance Products or services cant
be HIPAA compliant. Only institutions can be HIPAA compliant,
through comprehensive processes Keep that in mind when looking at
EMR products / services Ask how a product or service will help
ENTegrity to be HIPAA compliant
Slide 36
Vendor Options There are many different vendors to choose from
Three options that seemed well-suited to ENTegrity: HealthFusions
MediTouch http://www.healthfusion.com/ Great reviews Easy to use
Relatively low cost Designed to work well in combination with
iPads
Slide 37
Vendor Options cont. Waiting Room Solutions
http://www.waitingroomsolutions.com/ One of the first web-based EMR
solutions designed to enable doctors to run their whole Practice
Enterprise; not just electronic health records (EHR), on one
platform. Company CEO is a practicing physician, so software design
is very intuitive.
Slide 38
Vendor Options cont. Medios
http://www.ioshealthsystems.com/electronic-health-records/ Scalable
solution that can be fit for many different practice sizes Can be
integrated with Medios PM (Practice Management) Has an integrated
meaningful use dashboard that can be used to keep track of a
medical practices compliance with ONC Standards Other vendor
options: http://www.softwareadvice.com/medical/web-based-emr-
software-comparison/
Slide 39
Recommended Sources EMR Buyers Guide. Contains a lot of good
information on preparing to implement EMR
http://www.buyerzone.com/healthcare/electronic-medical-
records/buyers_guide_electronic-medical-records.pdfhttp://www.buyerzone.com/healthcare/electronic-medical-
records/buyers_guide_electronic-medical-records.pdf About HIPAA.
Contains myths and facts about HIPAA compliance and EMR
http://abouthipaa.com/wp-content/uploads/The-Truth-HIPAA-HITECH-and-Data-
Backup-NOV12-FINAL.pdf
http://abouthipaa.com/wp-content/uploads/The-Truth-HIPAA-HITECH-and-Data-
Backup-NOV12-FINAL.pdf Tips on converting paper charts to
electronic medical records
http://www.kevinmd.com/blog/2010/09/converting-paper-charts-electronic-medical-
records.html
http://www.kevinmd.com/blog/2010/09/converting-paper-charts-electronic-medical-
records.html Guidance on Risk Analysis Requirements under the HIPAA
Security Rule
http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/rafinalguidancepdf.pd
f
http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/rafinalguidancepdf.pd
f How to implement EMR: Is your practice ready?
http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-1-assess-
your-practice-readiness
http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-1-assess-
your-practice-readiness Web-based EMR software comparison
http://www.softwareadvice.com/medical/web-based-emr-software-comparison/
Slide 40
DISCLAIMER The author of this presentation is NOT an expert on
HIPAA Although a lot of research has been done to ensure the
accuracy of the information in this presentation, independent
research and fact-checking is encouraged before making any purchase
or implementation decisions