Study shows time physicians spend on their EHRs

The electronic health record (EHR) was developed to enable independent physicians to be more effective and more efficient. Electronic records significantly reduce the possibilities of duplication and, worse, errors in healthcare records. EHRs also enable physicians to collaborate with other healthcare providers, ensuring that patients receive quality care in a timely manner.

Many physicians, though, are finding that they are spending more time with their EHRs than with their patients. A recent study found that “physicians from family medicine, internal medicine, cardiology, and orthopedics spent nearly 2 hours in the EHR and on other desk work for every 1 hour of direct patient care.” An article in the Annals of Family Medicine indicates that factors such as “increased structured documentation requirements, computerized physician order entry (CPOE), inbox management, patient portals, and a redistribution of tasks previously performed by clinical staff to clinicians has led to more work that is not direct face time with patients.”

At Elation Health, we understand that the patient-physician relationship is the key to providing quality healthcare and that physicians need to spend more face-to-face time with their patients. Elation’s EHR solution is designed to be more efficient so that the independent physician spends less time on the computer and more time interacting directly with the patient.

Entering and re-entering information has remained a time-intensive and cumbersome part of adopting electronic health records. Elation reduces this need by prioritizing automation throughout the workflow. While most EHRs rely on a linear workflow that forces back-and-forth screen toggling and extra clicks, Elation’s Cockpit View surfaces everything the independent physician needs in a unique three-pane console, providing more flexibility and more efficiency. All the necessary information is right in front of the provider, on two screens.

With Elation’s EHR solution, the independent provider is able to use the Dynamic Problem List when charting to pull in specific patient information, lab results, and notes from a previous visit with just one click — helping to maintain a more comprehensive and longitudinal patient record, more efficiently. The provider can focus on face-to-face patient interactions, knowing that the patient’s electronic medical record is accurate and current.

Tyler Comstock
July 8, 2019

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The importance of a certified EHR

Independent physicians that take advantage of certified electronic health record technology (CEHRT) will be able to participate in a number of incentive programs offered through the Centers for Medicare & Medicaid Services (CMS) and its Innovation Center. The newest CMS Innovation Center initiative, Primary Care First, requires the use of 2015 Edition CEHRT for participation in payment models designed to benefit smaller practices.

In addition, as described by The Office of the National Coordinator for Health Information Technology (ONC), “Using certified health IT improves care coordination through the electronic exchange of clinical-care documents. It provides a baseline assurance that the technology will perform clinical-care and data-exchange functions in accordance with interoperability standards and user-centered design. The benefits of standard data capture and interoperable exchange of information include enhanced patient safety, usability, privacy, and security.”

CMS now requires eligible providers to use 2015 CEHRT to meet the requirements of the Promoting Interoperability Program as well. CMS states that “CEHRT gives assurance to purchasers and other users that an EHR system or module offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria. Certification also helps health care providers and patients be confident that the electronic health IT products and systems they use are secure, can maintain data confidentially, and can work with other systems to share information.”

Another CMS payment incentive program, the Merit-based Incentive Payment System (MIPS) encourages independent physicians to use certified EHR technology to aid in the process of attaining the 25 points allocated to Advancing Care Information. In fact, using CEHRT is required for reporting Advancing Care Information measures for most providers participating in the program.

ONC emphasizes that certified health IT “plays a vital role in establishing a nationwide, connected, and interoperable health information infrastructure.” CEHRT can help an independent practice offer:

  • Electronic prescribing
  • Patient-specific education resources
  • Secure e-messaging

A Drummond seal guarantees that a product meets industry standards and that it is interoperable. Opting to choose an EHR software that is Drummond Certified™ has many benefits:

  • It can save an independent practice money as the Drummond seal guarantees the operability of the software. Exploring and investing in multiple products is no longer necessary.
  • It can save an independent practice time. By choosing to look for the Drummond seal, selecting an EHR is made easy since compliance, reliability and industry standards are all covered by the Drummond Certified™ seal.

Damien Neuman
June 21, 2019

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How to best utilize EHR technology as an independent physician

Picture it: Patient A needs to see a specialty physician. Her independent physician must send a referral and then, of course, will want to see the specialty physician’s notes and any test results. So, Patient A’s independent physician calls the specialty physician, then faxes over a written referral. After Patient A sees her specialty physician, those notes and test results are faxed back over to the independent physician. Many of the notes are handwritten and some are difficult to read. All of the paperwork is stored in a file on a shelf.

Now picture the independent physician using electronic health records (EHRs). The provider reviews the patient’s medical data before the visit, including all notes input by the specialty physician and laboratories that provided healthcare services to Patient A. Referrals are made online and all information is clearly written and categorized so there are no misunderstandings based on misread handwriting.

In the second picture, the independent physician has utilized the EHR technology to create more efficiencies within the practice, saving time and reducing the likelihood of potential errors that could be devastating to the patient and to the practice. The provider is able to chart faster, as the patient’s data is available with the click of a mouse and notes can be added and reviewed in real time.

Utilizing EHR technology can save the independent physician approximately 10-15 hours per week, time that can be better spent interacting with patients and responding to follow-up communications. A more efficient practice, more secure patient data, and less time spent on charting are keys in combating physician burnout and providing higher quality care for patients.

The Office of the National Coordinator for Health Information Technology (ONC) details a number of significant benefits for the independent physician who utilizes EHR technology:

  • Providing accurate, up-to-date, and complete information about patients at the point of care
  • Enabling quick access to patient records for more coordinated, efficient care
  • Securely sharing electronic information with patients and other clinicians
  • Helping providers more effectively diagnose patients, reduce medical errors, and provide safer care
  • Improving patient and provider interaction and communication, as well as health care convenience
  • Enabling safer, more reliable prescribing
  • Helping promote legible, complete documentation and accurate, streamlined coding and billing
  • Enhancing privacy and security of patient data
  • Helping providers improve productivity and work-life balance
  • Enabling providers to improve efficiency and meet their business goals
  • Reducing costs through decreased paperwork, improved safety, reduced duplication of testing, and improved health.

Tyler Comstock
May 30, 2019

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What is the patient load sweet spot for independent physicians?

Independent physicians tend to be more satisfied with their career choice, experiencing less burnout than their employed counterparts. Autonomy and the ability to make their own decisions about how they run their practice are significant components in their level of satisfaction as well as in the quality of care they provide their patients.

How many patients should the typical independent physician be seeing? The standard number for a primary care panel size has typically been accepted as 2500 patients per physician. However, a study published in the Journal of the American Board of Family Medicine (JABFM), “A Primary Care Panel Size of 2500 Is neither Accurate nor Reasonable,” states just that – 2500 is not an ideal number.

The authors cite the source of the 2500 figure as an article published in 2000 that “speculated about the upper range of a panel size that could be reasonable under certain circumstances.” No actual data or review of physician panel sizes were included as factors in deriving that number, though. As the study in JABFM points out, “on average, family physicians address approximately 3 problems per visit. It is estimated that a family physician would need 21.7 hours per work day to deliver recommended care to a panel of 2500 patients.”

Given that independent physicians are autonomous, they can have more control over exactly where the sweet spot is for their practice, in terms of their patient load. As Association of Independent Doctors (AID) executive direct Marni Carey points out, “Doctors who work autonomously in small practices … want a say in how their day goes and how the practice is run. If that means they can only see 15 patients a day and do a great job, rather than see 35, they get to make that decision.”

The JABFM study emphasizes that “There is not a simple equation for determining an ideal panel size. Multiple factors must be considered, including factors specific to the patient population, the physician’s personal needs, and the practice’s finances and infrastructure.”

The independent physician must manage patient load with practice efficiency and success. That means calculating how many patients it will take to ensure the practice is financially feasible and that the physician has ample time to devote to each patient. It also means calculating what it will take to continue the job satisfaction and lower rate of burnout that independent physicians tend to enjoy overall.

Tyler Comstock
May 30, 2019

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Are you an independent physician considering joining an ACO?

Accountable care organizations (ACOs) are attractive to independent physicians for a number of reasons. ACOs offer independent physicians the benefits of a larger organization while still enabling them to retain their autonomy. The Centers for Medicare & Medicaid Services (CMS) defines ACOs as “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.”

The independent physician benefits from an ACO because, in the words of CMS, “when an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.” A recent article in Modern Healthcare adds that “As the healthcare landscape grows more complex in the push to value-based care, independent-practice providers … are increasingly looking to ACOs as a way to successfully adapt to payment reform while also keeping their autonomy.”

Physicians like Dr. Pablo Quintela, based in Hollywood, Florida, and who joined the ACO Orange Care Group, say the decision is a relatively easy one. Orange Care Group “provides Quintela with support services to manage his small practice … through one of its four ACOs. It helps him correctly bill claims to the CMS, coordinate care for his Medicare population and prepare for the quality requirements of MACRA through educational sessions and tools.”

Dr. Mary Tilak, based in Indiana, joined Community Healthcare Partners, a Medicare ACO operated by three-hospital Community Healthcare System, and enjoys the ACO’s ability to invest in health information technology as a larger organization. Tilak says, “Without health information technology, you can’t do this kind of collaborative care and move up in value-based purchasing, so it becomes critical to make these investments. That is where these large organizations can come in to help,”

Orange Care Group also invested heavily in health information technology to benefit its 450 independent physicians who may need to coordinate care for their patients. Many of its members use different electronic health record (EHR) systems and the ACO’s ability to invest in IT enables those separate systems to “easily understand and compare patient outcomes data.” Orange Care Group has also partnered with hospitals on data sharing “so doctors are notified if their patients are admitted to the emergency room and require follow-up care.”

Tyler Comstock
May 30, 2019

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How to evaluate an independent clinic

For independent physicians, their practices are their businesses. Even though the obvious focus for the physician is the patient’s healthcare outcomes, the practice must also run efficiently and effectively in order to properly serve those patients. Evaluating the practice on a regular basis will help the independent ensure that the practice is in the right place and on the right track to success.

When evaluating an independent clinic, the physician should look at a number of factors that determine the practice’s success, both financially and in terms of its patients’ well-being.

Practice management efficiency – workflows. Does the practice have in place an efficient workflow system? An evaluation should include a close look at clinical staff, in particular as to whether they are performing appropriate jobs in the most efficient manner. What are the responsibilities of the front desk staff? Review the technology workflow as well. Does the patient have a well-laid out path from the front door to the exam room, in terms of human contact as well as the transfer of the medical record?

Financial stability. Independent physicians know their trade well and have a sincere desire to focus on patient needs. However, the practice is a business and must be financially stable to ensure its success. A review of the practice’s financial records is necessary to have a clear picture of where the practice stands. The independent physician and the appropriate practice team member can take advantage of industry resources to determine the best way to manage payer reimbursement, cash flow, payroll, and budgets.

Communication. An evaluation of the independent clinic must include a close examination of the communication processes and effectiveness, both internally and with patients. Patient engagement is critical for the independent physician. Providing a convenient and secure method of communication will help both patient and physician ensure that patients’ questions are answered promptly and accurately, contributing to improved healthcare outcomes for those patients.

Accessible patient data. Is the independent practice taking full advantage of an electronic health record (EHR) solution? An efficient system provides the patient’s medical data at the touch of a finger and offers the independent physician access to other providers’ notes on that patient, to optimize care based on a coordinated care plan. An EHR designed for practice success allows the independent physician to document visit notes, order lab tests, e-prescribe, and write referrals in any order, all from the same screen.

Tyler Comstock
March 27, 2019

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How to search for a new EHR for an independent practice

Searching for a new electronic health record (EHR) solution can be a daunting task for anyone. For the independent physician managing a practice, overseeing staff, and providing quality healthcare to patients, it can be even more challenging. There are a few things to keep in mind in the search for a new EHR that will help the transition go a little smoother.

Making the decision to implement a new EHR is the first crucial step. Understanding what the practice needs in terms of efficiency and the ability to provide quality care is critical. Before making a final selection, the independent physician should exam certain criteria, including:

Cost. The American Academy of Family Physicians (AAFP) stresses the need to compare “apples to apples” when looking at the cost of EHRs. It is important to understand the pricing structure as well as anything that might be included in the contract related to licensing, leasing, and purchasing. Creating a spreadsheet that outlines the details of each EHR’s cost will help the independent physician clarify the various cost structures.

Ease of implementation. A busy medical practice is focused on patient needs. The independent physician and the practice’s staff should not have to spend extraordinary amounts of time on implementing an EHR. The independent physician should contact EHR vendors to request proposals, asking for details on the implementation procedure, including the total time required to get set up and to be fully functional.

Training. Another consideration that should be included when asking questions in the search for a new EHR for an independent practice is whether the vendor offers training for all staff members who will be involved in using the system.

At Elation Health, we understand that the primary focus of the independent practice has to be on providing quality healthcare to patients. That’s why we designed our clinical first, cloud-based EHR to take less than an hour to learn. We’ll even migrate previous patient data free. In addition, with Elation’s extraordinary 24/7 support, independent physicians and their staff are assured of being able to get help from our team of dedicated user success specialists within 30 minutes or less – 365 days a year.

Tyler Comstock
March 22, 2019

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Health Affairs article suggests CMS may need to support small practices more for MIPs

The Centers for Medicare & Medicaid Services (CMS), in its zeal to reinforce the need for value-based care among all healthcare providers, may be slighting smaller independent practices, according to an article published in Health Affairs earlier this year. Performance data from CMS’s Merit-based Incentive Payment System (MIPS) shows that “small practices performed considerably worse in terms of Composite Performance Score (CPS) and financial penalties compared to their large practice counterparts.”

Health Affairs suggests a number of ways in which CMS can be more supportive of the many small practices participating in MIPS, so that all can be more profitable and more successful.

Medicare could implement additional incentives for quality reporting. Small, independent practices may not have the resources available to them for “information technology and other support systems to facilitate automatic reporting, perform manual reporting, or achieve the MIPS end-to-end quality reporting bonus.” As a result, they often are not able to adhere to CMS reporting requirements that are necessary to earn the bonus. Health Affairs suggests that possible solutions could include “scoring adjustments that apply only to small practices, such as a higher end-to-end reporting bonus amount (for small practices only) or increasing the bonus points per measure (i.e., earning more points for fewer measures reported for small practices only).”

CMS could modify MIPS rules to reduce quality reporting burden for small practices. Simplifying or reducing the 50 potential measures for independent physicians to report would significantly reduce the reporting burden on those smaller practices. In fact, “CMS has set a precedent in the Improvement Activities domain, where small practices receive double weighting for reporting relevant activities.”

CMS could also adapt approaches from other payment models to provide small practices with resources necessary to meet MIPS goals related to quality reporting or care redesign. Other models, including the Accountable Care Organization (ACO) Investment Model and the Comprehensive Primary Care Plus (CPC+) model offer alternatives for financial strategies and incentives.

Finally, the article suggests, “new fee-for-service billing codes implemented through the Physician Fee Schedule could be encouraged, or their use could even be incentivized as part of quality measures, among small practices in MIPS to offset costs from initial investments required to deliver care coordination services, improve quality, and/or contain costs.”

Greg Miller
March 5, 2019

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Why cloud-based EHRs are on the rise

Convenience, reliability, and security are critical features of an electronic health record (EHR) system. For the independent physician, a cloud-based EHR can mean additional time spent with the patient and less time spent with maintenance and necessary updates to the system. Cloud-based EHRs are on the rise as more physicians find that these valuable features are important to their practice success and their ability to provide quality healthcare to their patients.

Globally, the healthcare cloud computing market is projected to reach $44.93 billion by 2023, from an estimated $19.46 billion in 2018. One of the major factors in this growth is the advantage of cloud usage. According to a report posted on PRNewswire, North America accounts for the largest share of this market, which can “primarily be attributed to the increasing adoption of EHRs among medical professionals.”

Independent physicians are recognizing the advantages of cloud-based EHRs in increasing numbers. With cloud-based EHRs, much of the administrative and maintenance burden is shifted to the Software as a Service (SAAS) provider, allowing physicians and their clinical staff to spend fewer resources on the installation and upkeep of the server and more time with the patient.

Cloud-based EHR systems actually solve many of the issues that practices may be worried about when choosing to adopt an EHR system. In server-based EHR systems, thousands of dollars can be spent in order to install and implement a server, hardware, and software. Additionally, regular maintenance and management from a local IT department is also needed.

Cloud-based EHR systems are already established by a SAAS provider, meaning the expense of money and time diminishes dramatically. Much of the configuring, security and software is handled by the SAAS provider, thus cancelling a significant bulk of the anticipated work. And because the server is created and managed by the provider, this means that the vendor is more likely to meet HIPAA patient information confidentiality standards. This makes future expansions of a practice an easy task rather than a complete overhaul of the system. The practice does not have to worry about the capacity of the servers or any additional licensing fees.

Technology tends to advance rapidly and incrementally. Regulatory requirements also require updates to EHR systems. Cloud-based EHRs are on the rise as more independent physicians recognize that they offer the convenience, reliability, and security they need for their practice to keep up with changes and to provide quality healthcare to their patients.

Tyler Comstock
February 19, 2019

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How to choose a new EHR for an independent practice

When deciding to purchase and implement a new electronic health record (EHR) solution for an independent practice, there are a number of considerations to review. A new EHR, as with any new technology, can be a significant change for the independent physician and clinical staff. With the right information at hand, however, choosing a new EHR for independent practices can be a smooth and beneficial process.

The first question to ask is where the practice needs a new EHR or a new EMR, or electronic medical record. Many healthcare professionals use the terms interchangeably, but they are actually slightly different. The office of Health Information Technology (IT) clarifies the differences between the terms:

Electronic medical records (EMRs) are digital versions of the paper charts in clinician offices, clinics, and hospitals. EMRs contain notes and information collected by and for the clinicians in that office, clinic, or hospital and are mostly used by providers for diagnosis and treatment.

Electronic health records (EHRs) are built to go beyond standard clinical data collected in a provider’s office and are inclusive of a broader view of a patient’s care. EHRs contain information from all the clinicians involved in a patient’s care and all authorized clinicians involved in a patient’s care can access the information to provide care to that patient.

Another question to ask when choosing a new EHR is whether the system enables independent physicians and their patients to communicate with each other using seamless, secure messaging. Elation’s EHR solution provides this capability and more, to support the physician-patient relationship.

A critical question for a new EHR for independent practices is whether the system will be cloud-based or server-based. The difference between the two is quite simple: with cloud-based EHR systems, data is stored on external servers and can be accessed with any device that has an internet connection, while server-based EHR systems store data within the practice on a personal server. With cloud-based EHRs, much of the implementation and maintenance burden is shifted to the Software as a Service (SAAS) provider, allowing the doctors and the practice to spend less resources on the installation and upkeep of the server and more time with the patient.

Finally, a new EHR for independent practices must come with vendor support and minimal training requirements. With Elation’s EHR solution, training takes less than one hour. Elation is simple and intuitive – proficiency comes quickly. In addition, Elation’s support of independent practices is available 24/7, so providers can focus on their patients without interruption.

Tyler Comstock
February 6, 2019

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