Electronic Medical Records and Clinical Management Systems
We categorized the questions that physicians and their staff ask us most often. If you have questions that are not answered here, please call 800-267-ABEL (2235) and press 1 to reach our Sales department.
Confidentiality, Security and Privacy
All access to electronic patient charts is controlled through individual user passwords. The added benefit of this password access is that staff and physicians can have different levels of access to the chart assigned to them as determined by the physician. For example, receptionists may have no access to patient medical information, whereas nurses and lab technicians may have access to vital signs, laboratory and diagnosis information.
The Electronic Medical Records systems are designed to prevent unauthorized users and hackers from gaining access to patient records. Several safeguards such as firewalls and physical security measures prevent most incursions into EMRs. Overall, EMRs are more secure than paper. In addition, there are mechanisms in place to prevent writing over the patient record after you have signed off on the chart. This is to prevent alteration of records after the fact. The EMR also has audit trails that indicate when certain facts were recorded into the chart and when addenda or changes were made.
Keeping patient information secure also involves making provisions for backups and disaster recovery of data. Each practice needs to backup their system as a normal part of daily workflow. To ensure that all data is backed up, it is important to schedule backups to run at a time when no one is using the software, i.e. early morning, lunch or after hours. Label backup media for use each day of the week and use them in sequence. Once a week, take a backup copy off site and replace it with an additional set. Rotate the off site backups at the end of each working week. The off site backups provide additional protection against loss through fire, robbery, water damage and vandalism.
Current legal practice allows all physician records to be subpoenaed into court. Even private and confidential files such as those you might have when doing psychotherapy are not exempt from this rule. You will have to develop your own code for recording confidential information that you would not want to bring to court.
Cost of a system
The dollar cost varies with each system. Here are some of the main factors that determine the total investment required for a particular practice:
The number of physicians and FTE nurse practitioners that will be using the software.
The number of workstations that the software will be used on concurrently.
Physicians, and FTE nurse practitioners and other staff usually require training on how to use the system and incorporate EMRs into their practice workflow. We will work with you to develop an implementation plan to maximize the benefits of training for the lowest possible cost.
Offices that are just becoming computerized may need a practice management consultant to plan the implementation of the computer system. We can help with an implementation plan as well.
Fee for Service physicians, using the Electronic Data Transfer and Overnight Verification of Health card numbers, will see an immediate improvement in cash flow, which can lead to significant savings to the practice over time. In addition, there are tax advantages to using a system such as this. If you were to lease the system, this would be considered a business expense and you would be able to deduct it directly from your income on your tax return. If you were to buy the system, the cost of the hardware could be depreciated over a five-year period.
As you and your staff become proficient at using the EMR system, you will find that there are less charts to be pulled from the shelf, less filing to be done and fewer lab reports getting lost. This will lead to significant savings in time and energy chasing lost charts and lost lab results. You will also find that patient education and some other clinical activities can be done faster and more efficiently. For example, repeating a long list of prescriptions will take a couple of clicks of your mouse and 20 seconds for the printout to come out. These sorts of efficiencies can add up to significant timesavings for charting.
In addition, there are some routine charting tasks, such as those for common acute illnesses, such as URIs, UTIs, conjunctivitis, etc. Templates for these encounters can be customized to expedite speed of charting.
Some physicians are quite excited about such a system in their practice. These physicians participate in large-scale community clinical trials that pay them for their participation. This system would allow you to quickly and easily find all the patients in your practice that might be eligible for entry into a clinical trial. This would make it easy to demonstrate that you could actually recruit the number of patients required and would allow you to easily find those patients when it came time to recruit them.
Space used by the system
Space is certainly a premium in many physicians offices. We will work with you to find the optimal arrangement for your office. Some examples include putting the computer tower under the desk or putting the monitor on a bracket that hangs off the wall. There are also Tablet PC options available that don't require large amounts of desk space. Remember that as you start using the system more, you will require less room for your paper charts. Over time, this will free up valuable space in your front office and filing rooms.
Number of PCs in the office
We will work with you to determine your computer needs and try to put together a package that works best for you.If you require more PCs than average, you will be able to purchase them at the excellent prices we have negotiated with our hardware supplier.
Again, we will work with you to determine your computer needs and try to put together the optimal package for your particular situation.
Training requirements
ABEL will work with you to train and support your staff to use our software. We can also arrange for Windows training at a very reasonable cost. Most physicians find that their staff adapt well to using computers and are quite happy with the results of computerizing their practices.
This is an important consideration. We are currently developing methods and policies to deal with this issue. However, since we are dealing with human beings, each situation will be unique.We hope to have several different options so that you will have a solution for your particular situation.
For example, you may be faced with a locum who is computer phobic and does not wish to learn how to chart using computers. How will you handle this? We will help you plan a method to make sure that vital information is incorporated into your EMR without having to do large-scale data entry.
If you have a locum who doesn't mind learning to use computers, we will help train them so that your records are maintained at the level you are used to.
Managing the transition
Practice Management Consulting firms and ABELMed Inc. can help physicians manage the change that results from the introduction of computers into their practice. Practice Management Consulting firms and ABELMed Inc. can work with you and your staff before the computer system is introduced into your practice to make sure that you are ready and that the system will create the minimum possible down time.
Today's EMR technology is not quite at the point where a truly paperless office is possible for small clinics. For larger clinics, it is feasible to hire somebody to scan paper records into the EMR. Most smaller clinics would find it inconvenient and difficult to scan large numbers of records.Many offices have consultant notes, lab reports, hospital discharge summaries and radiology reports on paper and have the patient's medical history on EMR. This is quite workable. In the future, this information will be downloaded electronically. For example, downloading lab reports directly from the laboratory. Since this is the bulk of information that comes in on paper, it should make a large dent in the paper burden.
As we go into the future, we will be exploring options such as scanning and Optical Character Recognition (OCR) for getting paper records into the EMR. We will also look at getting radiology information, discharge summaries from hospitals, etc sent in electronically.
Charting the encounter: time savings, time costs and quality
Many physicians find that they can save quite a bit of time in charting their patient information electronically. EMRs can save physicians considerable time on routine procedures such as repeat prescriptions and in recording visits that were similar to previous visits. A repeat or follow-up visit is easy to record simply by replicating the previous visit note and making the small changes necessary.
Using EMR can help you improve patient care by giving you the tools to spend more time with patients and less time doing paperwork. In addition, most patients perceive physicians that use computers in their practice to be up-to-date and more professional.
Most physicians who have used an EMR find that it takes about 3-6 months to get used to using a system in their practice. Usually, they start out slowly, charting a few patients a day until they are able to chart most patients easily. Most physicians feel quite comfortable with charting patient information electronically once they become familiar with the process. Most feel that they would not want to go back to paper charts.
The EMR has several features that will help you improve your care of patients. You will be able to find charts faster without ever leaving the exam room. Cumulative Patient Profiles are maintained automatically, allowing easier and faster review of patient information.
You will be able to detect drug-drug, drug-allergy, and drug-disease interactions when you enter in a prescription. This will save you significant time and the hassle of having to speak to the pharmacist to make changes in medications.
Many physicians fear that EMRs may cause them to practice cookbook medicine. The reality is that your clinical judgment will still be required for good patient care. The current level of technology simply allows physicians to chart their patient encounters electronically. EMRs serve as a tool to help you chart and to practice medicine better. For example, the templates used to chart information may remind physicians to record information that they sometimes forget to write down or may remind them to perform a procedure or do a physical examination that they have forgotten to do. EMRs will not hinder your satisfaction with caring for patients since you can continue practicing medicine the way you like best.
ABELMed EHR - EMR / PM has the facility for you to ask for a picture of a body part or a homonculus. You can easily draw pathology that you have elicited or noted onto the picture.
Reliability of system
With any technology, the greatest risk and disruption is caused when it becomes unavailable for any reason. The system we have chosen will have an uninterruptible power supply and has been found to be stable in many physician offices over long periods of time. Most systems will have automatic backup every evening and can even be programmed to do a backup twice a day.
More important than reliable equipment is having a reliable network. We have tested the configuration of hardware and software that will be implemented in your practice. We will also provide recommendations on how to use the system to ensure minimal breakdowns of equipment.
A system is as reliable as the support you can get for it. We offer 24/7/365 Telephone Support to help you solve any system problems that arise.
Obsolescence of technology
This is a real concern for any system that uses state-of-the-art technology, which is improving so fast. One solution is to lease the equipment. This means that you will be able to get new equipment periodically, at a reasonable rate.