When did EHRs begin?

The electronic health record (EHR) dates to the 1960s, when computer systems were first being developed and honed for practical use. Paper medical files continued to be used for some time (and are actually still being used in some medical practices today), but the computer revolution added significantly to the evolution of the medical record. So when was the EHR first implemented?

The earliest known predecessor to today’s EHR was the Problem-Oriented Medical Record (POMR) developed by Dr. Lawrence Weed “so that medical students and practitioners could function in a structured, rigorous way more like that of workers in the scientific community.”

As noted by the American Health Information Management Association (AHIMA), “From the moment technological advances moved data entry from punch cards to keyboards, and data display from printed results to video display terminals, innovative physician tinkerers around the country have seized on the opportunity to improve healthcare delivery.”

The AHIMA, in its HIM Body of Knowledge, identifies several of the earliest efforts to implement EHRs, known by various names in the 1960s and 1970s, including electronic medical records, computerized medical records, longitudinal patient records, and electronic charts. Those “more well-known efforts include:

  • Lockheed Corporation, in 1971, created a system for El Camino Hospital, featuring computerized physician order entry (CPOE) and allowing multiple, simultaneous users.
  • In the early 1970s, the University of Utah, 3M, and Latter Day Saints Hospital deployed the Health Evaluation through Logical Processing system.
  • Researchers at Massachusetts General Hospital launched the Computer Stored Ambulatory Record project in 1968, which had modular design and accommodated flexible clinical vocabularies through vocabulary mapping.
  • The Regenstrief Institute in Indianapolis created the Regenstrief Medical Record System in 1972, incorporating then nascent object-oriented programming principles to automate integration of structured, electronic clinical data from their sources, such as laboratories and pharmacies.
  • The Veterans Administration (now known as the Department of Veterans’ Affairs) began work on the Decentralized Hospital Computer Program, the progenitor of the Veterans Health Information Systems and Technology Architecture, which innovated an enterprise-wide EHR system spanning hundreds of clinical settings across the country.”

Tyler Comstock
January 28, 2019


How well-conceived EHRs could make things easier for independent physicians

The ideal electronic health records (EHRs) solution will enable physicians to operate more efficiently and effectively, providing higher quality care to their patients. Maintaining patient records on paper, kept in files on a shelf, was not only time-consuming but increased the possibility of errors when handwriting could not be deciphered or papers were lost. The EHR provides the opportunity to input patient data during the visit and to easily access it before and after the visit.

Physicians have been challenged by the transition to EHRs, in part because their system may not have been designed to truly make things easier for them. The ideal electronic health records (EHRs) solution, such as Elation’s Clinical First EHR, keeps in mind the specific needs of very busy doctors who want to spend more time caring for their patients than interacting with technology.

A white paper published recently by Stanford Medicine cites the results of an online survey conducted in March 2018, of 521 primary care physicians in the fields of Family Practice, General Practice, and Internal Medicine. Asked how EHRs affected them and their practice, almost three-fourths of the survey respondents said that “the first order of business should be improving the user interface of EHRs to enhance efficiency and reduce screen time.”

Suggestions ranged from shifting data entry to clinical support staff to including a “highly accurate voice recording technology that would act as a scribe during patient visits.” Additionally, almost half of the primary care physicians participating in the survey noted that ideal electronic health records will be “transformed into a powerful tool that helps with clinical care, predictive analysis to support disease diagnosis and prevention, and population health management.”

Interoperability was the top concern for the primary care physicians. The Stanford Medicine white paper cites “the need to make patient data available easily and readily to professionals from all parts of the health care system for the benefit of the patient.”

Elation Health understands that well-conceived EHRs will make things easier for doctors by enabling them to access patient data easily and securely, coordinating with other healthcare providers for the patient’s care. Elation’s EHR solution provides physicians the ability to spend less screen time and more face time with their patients, as they chart, e-prescribe, and order lab tests all from the same screen. The Cockpit View eliminates back-and-forth linear workflows, letting doctors click less and do more for their patients.

Tyler Comstock
January 22, 2019


How to take advantage of 2019 tax benefits from medical expenses as an independent physicians

Tax laws are changing over the next few years. Some of those more significant changes have to do with eligible deductions for medical expenses. Independent physicians should be aware of the 2019 tax benefits from medical expenses, for themselves and for their patients.

The tax changes include an increase in the standard deduction as well as a lower threshold for medical expenses for those who do itemize. In the 2018 tax year, medical expenses that exceed 7.5 percent of a person’s gross income can be written off. However, with the 2019 tax year that number reverts back to 10 percent of gross income.

AARP reports that eligible medical expenses include:

  • Out-of-pocket fees to doctors, dentists, chiropractors, psychiatrists, psychologists, podiatrists and other medical professionals that are not covered by Medicare or other health insurance
  • Health insurance premiums — as long as they weren’t paid with pretax dollars, as most employer-based health benefits are. You can deduct Medicare Part B premiums and any premiums you pay for a Medigap policy, Medicare Advantage plan or a Part D Prescription drug plan.
  • Premiums for long-term care insurance and payments to nursing homes and other long-term care facilities
  • Inpatient alcohol and drug treatment programs
  • Wheelchair ramps and other modifications you make to your home for medical reasons
  • Transportation to and from doctor and other medical appointments — including taxi or bus fares, or out-of-pocket costs for using your personal car, including parking.
  • Copays for prescription drugs
  • Copays for physical or occupational therapists
  • Payments for dentures, prescription eyeglasses or readers, hearing aids, crutches, wheelchairs or other durable medical equipment
  • Payments for smoking-cessation programs and weight-loss programs related to a specific disease diagnosed by a doctor, including obesity

According to AARP, Medicare beneficiaries spend an average of $5,680 on medical expenses each year. The current threshold of 7.5 percent will help those patients as they tend to have lower incomes. In fact, AARP states that 49 percent of those taking advantage of the medical expense deductions have earnings of less than $50,000 per year.

In other tax-related news, the House Ways and Means Committee introduced a tax package on December 10, 2018, that “includes a five-year moratorium on the medical device tax; a two-year delay for the so-called Cadillac tax on high-cost employer plans, which won’t expire until the end of 2021; a two-year delay of the health insurance tax; and a full repeal of the tax on indoor tanning,” according to Modern Healthcare. However, that tax package is not expected to pass in the Senate.

Tyler Comstock
January 9, 2019


Former independent physician goes back to becoming independent doctor

Although the percentage of physicians in independent practices has fluctuated in recent years, at least one doctor has decided to return to her roots as an independent physician after practicing for 30 years. Erica Swegler, M.D., a member of the AAFP Board of Directors, explains in an article recently published by AAFP why she is returning to a solo practice, where she started her career as a physician just after her residency.

So why return to independent practice? It’s not all about the money, obviously. Dr. Swegler cites the lower rates of burnout among independent physicians as one positive aspect of working in an independent practice. In fact, a recent survey of 235 health care professionals in 174 small independent primary care practices in New York City found their burnout rate to be only 13.5 percent.

Dr. Swegler enjoys the autonomy in her practice, in particular the ability to focus on her patients’ needs and not the needs of the organization. As she says, “I have the satisfaction of taking care of my patients by placing their needs first…. I can practice to the highest level of my license and ensure that my patients have only the right, appropriate care they need.”

Tyler Comstock
December 14, 2018


EHR tips for solo primary care physicians

Independent physicians must run an efficient practice, to be financially solvent and to provide quality healthcare to their patients. The right electronic health record (EHR) system can help do just that, but some providers may find that their EHR system is challenging or actually requires more of their time than they are able to give it. The right technology solutions offer an EHR for solo primary care physician practices that benefit both provider and patient.

Salvatore S. Volpe, MD, a New York-based solo primary care physician, spoke with Health Leaders in 2016, to offer tips for using an EHR for solo primary care physician practices in an efficient, effective manner. At the time, Volpe had been using an EHR for his practice for eight years. He also belongs to the board of directors of the New York eHealth Collaborative and serves as chair of the health information technology committee for his state medical society.

Volpe’s tips on optimizing an EHR for solo primary care physician practices include:

Take a team approach. Independent physicians with a small staff should involve that staff in the EHR process. Training each team member on the features of the EHR system can help the provider significantly when it comes time to input or retrieve patient information. Medical assistants and other clinical staff can take the time to pull up relevant screens and even add certain patient notes, so the provider has more time to spend with that patient during the visit.

Invest in prep time. Volpe advises that reviewing patient data, including test results, prior to the patient visit can better prepare the provider for the visit as well as reduce the time needed to review that information while the patient is in the room.

Ask for help. Independent physicians can ask for help within their practices, from their team members, as well as from the EHR provider. At Elation Health, we understand there will be questions about the EHR system. With our extraordinary 24/7 support, providers and their staff get the help they need from our team of dedicated user success specialists within 30 minutes or less – 365 days a year.

Tyler Comstock
December 10, 2018


A primer on PHI and what’s illegal to disclose for independent physicians

Patient data must be protected by independent physicians, whether that information is contained in paper files or in electronic health records (EHRs). However, it can be confusing to both patient and provider as to exactly what constitutes protected patient data. HIPAA, the Health Insurance Portability and Accountability Act, is a federal law that governs health-related transactions and procedures to protect patient health information and patient privacy.

What information is protected and who is responsible for protecting it?

The HIPAA law refers to “covered entities” as those responsible for protecting patient data. Health and Human Services (HHS) states that “every health care provider, regardless of size, who electronically transmits health information in connection with certain transactions, is a covered entity.” Further, HHS defines “health care providers” as all “providers of services (e.g., institutional providers such as hospitals) and providers of medical or health services (e.g., non-institutional providers such as physicians, dentists and other practitioners) as defined by Medicare, and any other person or organization that furnishes, bills, or is paid for health care.”

Protected health information (PHI) is essentially identifiable patient information. Anything that can identify the specific patient on paper, in an EHR, or when discussed verbally, is illegal for the independent physician to disclose without the patient’s explicit permission. HIPAA’s Privacy Rule “protects all ‘individually identifiable health information’ held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral.”

Specifically, the individually identifiable health information that is considered PHI includes information that identifies:

• the individual’s past, present or future physical or mental health or condition,
• the provision of health care to the individual, or
• the past, present, or future payment for the provision of health care to the individual.

Individually identifiable health information also includes many common identifiers such as the patient’s name, address, birth date, and Social Security Number that are illegal for the independent physician to disclose.

Tyler Comstock
December 3, 2018


What are value based care and pay for performance strategies for independent physicians?

The independent physician plays a key role in a patient’s health, but the independent practice often runs on a tight profit margin. Providing quality, value-based care while maintaining financial stability can be challenging for some smaller practices. The Centers for Medicare & Medicaid Services (CMS) encourages and rewards the move toward value-based care, but reimbursement can sometimes put a small, independent practice in a bind while waiting for that pay for performance.

CMS has recognized the value in the independent practice and wants to encourage smaller practice to remain independent. In fact, recent studies have shown that “small, physician-owned practices, while providing a greater level of personalization and responsiveness to patient needs, have lower average cost per patient, fewer preventable hospital admissions, and lower readmission rates than larger, independent- and hospital-owned practices.”

Independent physicians have several strategies available to them for providing value-based care and participating in pay for performance plans. Value-based care generally requires time beyond the office visit to manage chronic conditions or to follow up on care plans. Independent physicians may find that they are spending additional time communicating with patients or with other providers. This time is typically not covered by traditional billing codes.

However, CMS recently added ongoing care codes to reimburse independent physicians for that extra time. For example, code 99487 is assigned for treating medically complex patients with an increased reimbursement rate of $93.67. Population health management can add to the efficiency of treating patients with complex or chronic conditions.

Another strategy for the independent physician is to join an Accountable Care Organization (ACO). While the physician retains independence, joining the ACO enables the practice to take advantage of the power of the group. Independent physicians in ACOs may be able to participate in Medicare’s Shared Savings Programs, in addition to enjoying cost savings and collaboration with other members of the group.

CMS also recently launched the Small, Underserved, and Rural Support initiative to “provide free, customized technical assistance to clinicians in small practices.” The program offers program level support and practice level support for practices of 15 or fewer physicians, with priority given to those practices located in a rural area, in designated health professional shortage areas (HPSAs), or in designated medically underserved areas (MUAs).

Tyler Comstock
November 14, 2018


What are the advantages of cloud-based EHRs for small and independent practices?

When accessing a patient’s medical record, it is critical for the independent physician to be able to rely on the security and availability of the patient data. Electronic health records (EHRs) or, electronic medical records (EMRs) as some prefer to call them, can provide that convenience and security. The question for a small and independent practice is whether to use a cloud-based EHR or a server-based EHR.

Cloud-based EHR systems, or cloud-based EMR systems, offer many advantages. The small and independent practice will enjoy savings on installation and maintenance both for the system and the IT department. The independent physician can be assured of automatic updates that allow for security compliance. Cloud-based EHR systems, or cloud-based EMR systems, also offer seamless features that make it easy for practices to expand and provide wide access for all users within the practice.

With a cloud-based EHR, data is stored on external servers and can be accessed with any device that has an internet connection. Tight security is integrated into the cloud-based system, to protect the patient’s electronic protected health information (ePHI). Many describe the security of cloud-based servers as “achieving HIPAA compliance with bank-level security and high-level encryption methods.”

Cloud-based EHR systems, or cloud-based EMR systems, 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 may be spent on installing and implementing a server, hardware, and software. Regular maintenance and management from a local IT department is also needed. However, cloud-based systems are already established by a software-as-a-service (SAAS) provider, meaning the expense of money and time diminishes dramatically.

Today’s cloud-based EHR systems are “much more affordable and easier to install and maintain” for the independent physician. The costs of the cloud-based system are “much more attractive to smaller and independent medical practices not only because of lower upfront costs but due to a lack of IT staff and expertise in smaller practices.”

Tyler Comstock
November 12, 2018


5 attributes that independent physicians share with successful entrepreneurs

Independent physicians are primarily focused on the healthcare outcomes of their patients. However, they also need to focus on running their practice as a business. Just as an entrepreneur must plan and manage a business effectively to be independent and self-sustaining, there are many smart business decisions for physicians to make as they successfully grow their practice. Fortunately, independent physicians share a number of attributes with those successful entrepreneurs.

A recent post in Passive Income MD outlined five attributes common to independent physicians and entrepreneurs:

Problem solving skills. In an independent practice, there are many smart business decisions for physicians to make to ensure their practice continues to be financially solvent. Entrepreneurs must continuously solve their daily business problems to be successful. Independent physicians, of course, must also use those entrepreneurial problem solving skills when diagnosing and treating their patients’ medical conditions.

Ability to stay calm and focused under pressure. Successful entrepreneurs do not panic under pressure; rather they remain calm and focus on the problem to determine the solution. Independent physicians face this same situation with each new diagnosis and each new medical crisis. They must also apply these skills to their financial strategies, remaining calm and focusing on the success of their practice.

Critical and abstract thinking skills. Being able to see the “big picture,” as well as the critical details of a situation, whether that be a patient’s medical condition or the business needs of the practice, is a trait shared by independent physicians and entrepreneurs.

Self-discipline. When working for an employer, rules are generally set for the employee. Start time, breaks, project deadlines, and priorities are all predetermined. Entrepreneurs must have the self-discipline to run a successful business while balancing the many distractions and temptations around them, depending only on themselves to focus on the needs of the business. The same is true for independent physicians, who must have the discipline to focus on the needs of their patients and their practice.

Knowledge acquisition, research, and a healthy understanding of risk. For an entrepreneurial venture to grow, the business person must stay on top of the latest information and maintain a knowledge base of relevant topics in the chosen field. The independent physician must remain current on the latest medical research, including procedures, diagnoses, and treatment. To thrive in a successful independent practice, the physician must also balance the risk and rewards of each medical and business decision.

Greg Miller
November 5, 2018


Physician burnout rates lower for small, independent practices

Physicians who are overwhelmed with their workload and who do not enjoy a healthy work/life balance may soon burn out from the stress involved in practicing medicine. However, most independent physicians who have control over their workload, who take advantage of electronic health records (EHRs) for their independent primary care practice, and who run their own practices autonomously appear to have much lower burnout rates than those physicians who work as an employee for a larger organization.

A recent study published by the Journal of the American Board of Family Medicine (JABFM), funded through the Agency for Health Care and Quality’s EvidenceNOW initiative, and approved by the New York University School of Medicine Institutional Review Board, found a “remarkably low burnout rate (13.5%) among providers practicing in SIPs (small independent primary care practices) in NYC compared with the burnout rate among physicians in previous studies.”

The study involved 235 providers practicing in 174 small independent primary care practices in New York City. Most (66.9%) SIPs were solo provider practices and 46.5% were recognized as Primary Care Medical Homes (PCMHs).

Authors of the study speculated that small independent primary care practices “may have deeper relationships with their patients, which may lead to greater job satisfaction and less burnout among providers.” Other studies have shown physician burnout to be a major problem for larger organizations such as hospitals and other healthcare facilities. In fact, an NEJM Catalyst survey recently found that “83% of respondents — who are clinicians, clinical leaders, and health care executives — call physician burnout a ‘serious’ or ‘moderate’ problem in their organizations.”

Lower physician burnout in small, independent practices is most likely attributed to the autonomy those physicians enjoy in regard to their workload and work hours. The JABFM research study authors indicated that one explanation for their finding of the low burnout rate “could be the autonomy (ie, control of work environment) associated with owning one’s own practice as opposed to working in an integrated health system or Federally Qualified Health Center where providers are subject to greater administrative regulations.”

Nick Dealtry
October 31, 2018