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The Reality of Finding Meaning in Meaningful Use — How a Hybrid EMR System Can Help Your Practice Cut Costs and Increase Efficiency
By Chris Wacker

Meaningful use. Not since the emergence of medical malpractice have two words meant so much to the healthcare industry.

One major long-term goal of the American Recovery and Reinvestment Act is to “initiate a process to computerize health records to reduce medical errors and save on healthcare costs.” To achieve this, $19 billion in federal stimulus money is available for healthcare providers who “meaningfully use” certified EMR technology.
What meaningful use means to the government, however, is still ambiguous. And the lack of a clear-cut definition has left many doctors and practice managers scratching their heads over the best type of EMR technology to select.

This confusion is evidenced by survey findings published in The New England Journal of Medicine, which showed that just 13% of 2,758 physicians had a basic EMR system in place, and a mere 4% said they had a fully functioning EMR. Some practices are deterred by the expense of traditional EMR solutions; others worry that using computers in the exam room will negatively affect patient care.

The biggest concern, however, is that a system selected today will not be viable tomorrow: It either won’t qualify for stimulus funding or the software won’t live up to the promises made by the vendor. (There are nearly 400 EMR vendors, and industry estimates of the deinstallation rates of traditional EMR systems range from 20% to 78%.)

Without a clear-cut definition of meaningful EMR use, many practices have been holding off on implementing the technology and missing out on the technology’s many benefits, including improved chart accessibility, increased record security; and enhanced staff productivity.

The Hybrid Approach to EMRs
For those who have been waiting for clarity concerning the exact definition of meaningful use, there is light at the end of the tunnel.

Health and Human Services appears to be addressing the ambiguity by simplifying what qualifies as an EMR. David Hunt, chief medical officer for the Office of the National Coordinator for Health Information Technology, said in the September 17, 2009, issue of Health Data Management that meaningful use must focus on goals that can be achieved “quickly and reasonably. … You have to be able to send data, and CMS [the Centers for Medicare & Medicaid Services] has to be able to receive it. The big thing for 2011 is that you actually acquire this equipment and start using it.”

“I think that the current road of defining meaningful use could actually encourage a modular approach,” says Brad Tritle, executive director of the Arizona Health-e Connection. “The government will start with certain functionalities in 2011, add more functionalities in 2013, and more in 2015.”

If this turns out to be the case, practices will be able to combine software components that don’t meet prior certification measures into a hybrid system that does.

Built with an open architecture, hybrid solutions offer a modular, incremental approach to installing an EMR, enabling practices to cost-effectively build their own systems using software applications such as content management, practice management, and e-prescribing.

Like traditional EMR systems, hybrid solutions improve chart accessibility, increase record security, and decrease the cost of handling and storing paper records. But with hybrid EMRs, doctors simply scan their handwritten notes into the system at the end of an appointment or business day, which requires no major changes to existing clinical workflow.

Using Hybrid EMRs
Once patient information is scanned, the hybrid system can be used for a variety of record-related tasks, including the following:

• Storing scanned records: The folder structure in the repository is organized by patient. Each patient has a folder that contains subfolders for test results, surgical procedures, x-ray information, etc. This keeps the information organized and easily accessible for authorized employees.

• Building an electronic database: Scanned documents are automatically indexed by specific identifiers such as patient name, Social Security number, illness, and age. The indexing is done automatically by dropping the patient-specific information into the fields in an electronic template designed around a practice’s specific informational needs.

• Automatically routing information: Solutions that incorporate workflow technology will automatically send test results and other important patient updates to doctors as soon as they are entered into the system. This speeds physicians’ response to patients and saves staff time.

• Facilitating compliance: Audit-tracking functionality ensures information security and simplifies regulatory compliance. Practices can use it to stay HIPAA compliant by following the flow of information, keeping track of changes, and noting what needs to be done next.

Hybrid EMRs: Not Just for Patient Records
Although traditional EMR systems are focused exclusively on patient records, hybrid solutions—with their comprehensive content management capabilities—can be used across departments such as the following:

• Billing: Retrieve encounter forms, charts, explanation of benefits forms, checks, and correspondence directly from your billing application.

• Admissions: Scan and store admissions content such as insurance cards and link the scanned content to patients’ EMRs.

• Accounting: Automatically route requisitions and link documents that must be matched or reviewed for payment.

• Back office: Automatically route documents, with e-mail notifications and time-out alerts, through verification, coding, and claim-preparation processes.

• Credentialing: Scan and organize payer applications, diplomas, licenses, résumés, and continuing medical education.

• Human Resources: Digitize paperwork in employees’ personnel files, automatically route new documents to the appropriate human resources staff member, and provide employees with secure Web access to information in their human resources records.

• Legal: Manage partnership and joint venture agreements, case files, business and employment contracts, compliance records, and correspondence.

What Hybrid EMRs Can’t Do
Although hybrid systems cost-effectively provide many of the benefits of traditional EMRs, at present they fall short of key Certification Commission for Health Information Technology standards and federal measures such as diagnostics. Hybrid solutions do not offer preliminary diagnostics to guide a physician’s ultimate diagnosis nor do they offer advanced diagnostics such as lab tests, CT scans, MRIs, and stress tests.

This could mean that if the government does not end up taking a modular, incremental approach to EMR certification, practices will not receive stimulus money to defray the cost of hybrid EMRs. Due to the difference in implementation and maintenance fees, however, many practices are willing to forego the incentive money in favor of implementing an affordable system that moves them away from the inefficiencies of relying on paper records.

How to Evaluate a Hybrid System
Hybrid EMR systems deliver significant benefits, including decreased paper-handling and storage costs, safer and more accessible records, and increased staff efficiency. While researching EMR systems, be sure to keep the following questions in mind:

• Is the system easy to install and easy to use? Hybrid solutions are designed to be simpler to use than traditional EMRs. They should not take months to install, need much user training, or require significant adjustments to existing clinical workflow. If the system you are evaluating doesn’t seem intuitive, stay away.

• Is it flexible? Most doctors like making their own decisions, and they don’t like being told what to do. Your doctors should not have to adapt the way they work to the new technology; rather, the system should be flexible enough to adapt to your doctors’ processes.

• Do you trust your vendor? Remember that you’re not just buying software; you’re also buying a long-term relationship with a software vendor. Ask how long the vendor has been in business, whether it is committed to keeping up with the latest standards and regulatory requirements, and whether it may be acquired by a larger company. Learn as much as you can about the reputation of the vendors and products you’re assessing: Talk to your colleagues, read industry reviews, and be sure to ask vendors for customer references.

Multiple stakeholders from across the practice should be involved in answering these questions and identifying the business problems that the technology must address. Practice managers, physicians, and office staff should work together to ensure acceptance not only from the people who will implement the system but also from those who will use it every day.

With a clear-cut definition of what meaningful use means within the context of your practice, you may find that as a path to digitizing records, cutting costs, and increasing efficiency, a hybrid EMR is exactly what the doctor ordered. — Chris Wacker is executive vice president at Laserfiche.