EMR Implementation: Boon or Bane

Surprisingly, most facilities experienced significant drop in productivity with a new EMR.

The Health Information Technology for Economic and Clinical Health (HITECH) outlines the government’s idea to boost medical care while minimizing cost using technology such as Electronic Medical Records (EMRs). As a provider, you can see the benefits of an EMR since it helps you know everything that took place during the encounter in an easy-to-read typed format.

Downside: But not every EMR works that way — at least not right away as many healthcare practice management professionals will know. Perennial complaints about these records are that they lead to more documentation errors than they fix. Moreover, they are long and tedious and make it hard to find the information required for coding the chart, resulting in significant loss of productivity.

Get advice to transition seamlessly

Normally most coders are used to a templated charting system, and it may not be easy for them to transition to an EMR that may run well over 10 pages. If you are held to a production schedule of a certain number of charts per hour, it can be a daunting task to hunt through multiple pages to locate the required documentation.

Advantage: EMR captures much more content as compared to the traditional system. And every test and order will not be missing in the documentation record in an EMR.

Help or more work

It’s surprising to know that most facilities witnessed a big drop in productivity when they introduced a new EMR. According a study in the Journal of the American Informatics Association, physician order entry took double the time than usual — mainly due to the ramp up time required to learn the system and as well as the need to be present at the workstation to enter details. This is why there is a spurt in the use of scribes. Even using scribes has its own compliance concerns, they do help create a more detailed and accurate account of what actually happened during the patient encounter.

Normally it’s observed that most facilities do bounce back after six months of using the EMR as per as productivity is concerned.

Watch out for payer audits for cloned documentation

One of the biggest areas for audits is scrutinizing cloned documentation. Even though it’s quite acceptable to expect the chart notes of many providers examining the same patient to be alike, the credibility of the doctor’s documentation comes under scanner if they are exactly the same due to cloned documentation.

Macros? Again, EMRs facilitate the use of macros as it can be beneficial to documentation when using these systems. But the OIG Work Plan for 2011 indicated that Medicare contractors witnessed an increase in medical records with identical documentation across services.

The OIG therefore reviews multiple E/M services for the same providers to detect EHR documentation practices linked to potentially improper payments. But this does not mean that you should not use macros at all. CMS reiterates that it is perfectly fine to use a macro — it’s just that the provider must provide personalized info that’s enough to support medical necessity determination.

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