EMR | EHR

New EMR/burnout study: Can your practice benefit from its findings?

A new PAMF (Palo Alto Medical Foundation) study on the connection between EMR and physician burnout is getting a lot of attention. The study has limitations (e.g., it focuses on one organization, one EMR and set of workflows, and it aims to infer much from a single question). But despite the need for caveats, the study is valuable because it confirms what intuition suggests about EMRs and physicians' stress. What's more, the authors tested workflow modifications and found they helped alleviate EMR-related burnout at PAMF. You can read about the study here. To summarize it, the study validated that when EMRs encourage message overload, they significantly increase physician stress. The study found that about half of all messages the physicians in the PAMF study received were EMR-generated--i.e., things like health maintenance alerts and medication reminders that the system generates automatically. The researchers found that many of these messages could be handled, or at least triaged, by other members of the care team. For example, medication messages could be routed first to a pharmacist, who would involve the physician only if needed. Nurses and MAs could also handle much of the automated message volume, such as follow-up appointment reminders. Not surprisingly, when PAMF experimented with diverting these lower-complexity messages to others, the burden (and stress) on physicians decreased substantially. Can PAMF's solution work in your practice? PAMF is a large, integrated healthcare organization. Healthcare Dive reported that PAMF launched an initiative called MIST--Multi-Disciplinary Inbox Support Team--to test the idea of sharing the message workload. One year in, MIST seems to have helped reduce physician message loads (and stress) substantially. But what if your practice is not a huge organization with IT and workflow experts or pharmacists on staff? In our consulting work, we often recommend practices involve staff in more meaningful work. To enable physicians to focus as much as possible on tasks that only they can do (working at the top of their licenses), everyone else needs to do as much as they can. Expanding the roles of staff -- within their skills and scope, of course -- can help

By Laurie Morgan|2022-01-01T22:51:44-08:00July 7th, 2019|

Technology for patients: Think good, not perfect

(c) Barclays PLC* A few days ago, the ATM turned 50. The first ATM in the world debuted in London in 1967; we got our first one in the US in 1969. Wow! I bet that the ATM has been around longer than many of you reading this. It's hard to imagine a time when this technology wasn't on every street corner. Yet when the ATM was first introduced, it was slow to catch on. In fact, it took about 30 of those 50 years for the ATM to be used by 2/3 of consumers -- and even as recently as 2013, more than 10% of consumers still had yet to pick up the ATM habit. The ATM's slow-but-steady path to everyday use got me thinking about technology in the medical practice. Technologies to connect patients and practices, especially on the administrative side, have emerged at a fantastic pace in the past few years. But many practices we've worked with have hesitated to implement them, for fear that the majority of their patients won't use them. Some practices that have implemented, say, a patient portal or online scheduling, have been disappointed because only a portion of patients seem excited to use it. "Laurie," they say, "we tried that. Only 20% of our patients used it. It was a failure, so we abandoned it." But when the ATM was first introduced, the adoption rate was much slower even than a 10% or 20% utilization your practice might see on its new payment portal or online schedule. So why didn't the banks give up? After all, implementing an ATM network is a massive, risky, very costly undertaking. So why were the banks undeterred by their meager initial results? And what can we learn from it for our own technology initiatives? The key is to focus less on the people who don't try the technology, and more on the people who do. For every one of those few customers who used the ATM in those early days, the bank could declare a victory. The consumer who wanted to use an ATM

By Laurie Morgan|2022-01-01T22:51:48-08:00July 4th, 2017|

The power of managing details

I'm working on an ebook right now about medical practice staffing. More specifically, it's about how the instinct to cut staff, to be as leanly staffed as possible, can backfire*. There are dozens of little details that any practice can explore to improve profitability. These small changes can be made with much less risk than eliminating a job or cutting staff hours. And because they improve the profitability of your processes, they are a gift that keeps on giving, making your bottom line a little bit bigger every day. Here are just a few of the possibilities I explore in the ebook. Are you taking full advantage of these opportunities to improve your bottom line? Reduce no-shows: Take a quantitative look at your no-show rate. Are you tracking both true no-shows and last minute cancelled slots that can't be refilled? Audit your reminder process and results. Is your timing right? Experiment with reminding further ahead or closer to the appointment. Remind people using the technology they prefer. Capture email and cell info: Being able to reach people electronically opens the door to multiple efficiency improvements, including more effective reminders and better collections. And your patients that want to be emailed or texted, not called, will appreciate the option. Win-win! Train patients on portals: Too many practices make portal adoption a low priority, or abandon the effort altogether, because they find it hard to get patients engaged. It is hard! But it's still very worthwhile. As more patients use your portals, you have more ways to reach them for marketing. Portals make other key tasks more profitable, too. Notice I said "portals," plural? If you don't have the ability to collect payments through your EHR portal, investigate the option to set up a payment portal with your PMS vendor. Patients want to help themselves -- and they want to pay without having to write a check or find a stamp. They'll reward you by paying faster and more reliably. If you cut staff before checking out all the possibilities to improve your operations, you may not have the people you need

By Laurie Morgan|2022-01-01T22:51:56-08:00May 8th, 2016|

Transitioning to a new EHR? A few tips to consider

Are you transitioning to a new EHR? It's exciting to imagine the benefits you'll enjoy when your new system is finally in place -- but it can be a little nerve-racking to consider the process of getting there. (If you've already done it once, you know that unexpected things can go wrong -- and that your practice productivity can take a hit while you try to resolve surprise snags.) Your best defense: planning. To paraphrase President Eisenhower's famous quote, plans may ultimately be useless in preparing for battle, because surprise problems are almost inevitable, but the experience of planning is indispensable. Setting aside enough time for planning allows your entire team to understand the scope of what you're undertaking. It puts the challenge into a realistic frame, to help head off frustration when things don't proceed perfectly. It helps you recognize the pieces of your implementation that will cause the biggest headaches if they fail, so you can prioritize better. And, while the point of Eisenhower's quote is that it's impossible for any plan to predict everything that could go wrong, planning does give you the opportunity to prevent some problems before you get started. The process of planning may feel like wasted time, but nothing could be further from the truth. Rushing in without allowing enough time for planning increases the likelihood of a difficult problem that isn't easily solved while you're up and running. It's much harder to repair the automobile while you're rolling down the freeway. If you've got an EHR transition coming up, I hope you'll join my upcoming webinar (free), "Five Tips for an Optimal EHR Transition," on March 15 at 11AM Pacific.

By Laurie Morgan|2022-01-01T22:51:56-08:00March 8th, 2016|

Get the right EHR this time! Join my webinar 1/20 for ideas

If you are among the many, many practices that are considering an EHR switch in 2016, you won't want to miss my webinar this Wednesday, 1/20/16, at 11 Pacific/2 Eastern. It's a short, sweet, 30-minute presentation with 7 steps you can take to organize your search and decision-making. The webinar is free, courtesy of sponsor Care360. And it's the first of a two-part mini-series on choosing and implementing a new EHR for satisfaction and success. Sign up for free, and you'll have access to the recording (in case you can't be there at the live presentation), and also get an automatic reminder of the second presentation. (But I hope that you'll join us live so that you can share any questions or comments.) Here is the signup link. Hope to see you online on 1/20 at 11AM Pacific.

By Laurie Morgan|2016-03-04T11:23:52-08:00January 18th, 2016|

Resolved to switch EHRs in 2016? Seven steps to satisfaction

Is New Year, new EHR your practice's resolution? You're not alone. Software Advice analyzed requests for EHR recommendations through its system, and they found that the number of buyers replacing an existing EHR increased 59% in 2015 versus 2014, and that 60% of their total buyer population was switchers. Practices as a whole are more experienced with EHRs, and therefore better able to prioritize what they want from a system. Systems have also steadily improved in recent years, becoming more responsive to physician and practice management needs. And the cloud has allowed for much faster roll-out of improvements, while keeping costs in line. It all adds up to make switching a much more attractive option than in the past -- and it makes sticking with a system that's unsatisfactory a lot less tolerable than it used to be. If you're looking to switch, your biggest concern is probably to ensure you're making an upgrade -- and not jumping out of the frying pan and into the fire. Because even though switching has gotten easier, and better systems have helped lower the risk, an EHR change is still a considerable undertaking, and will likely come with significant learning and conversion costs (even if the software itself is no more expensive). I'll be sharing some best practices for making an EHR change in a free webinar on January 20th, sponsored by Care360, entitled, "Seven Steps to Choosing an EHR." It's a 30-minute presentation (so you'll still have time for everything else you'll need to get done, and maybe time to grab a sandwich!). It's at 11 Pacific/2 Eastern, and I hope you'll join me. This webinar is Part 1 of a two-part mini-series entitled, "Choose Wisely, Implement Well for EHR Success and Satisfaction." Sign up for "Seven Steps," and you'll automatically receive a reminder about Part 2 -- plus you will have access to a recorded version of the presentation in the event you can't attend live. Please join us if you can -- it's always a pleasure to answer questions and hear your feedback live!

By Laurie Morgan|2022-01-01T22:51:57-08:00January 14th, 2016|

Eat your vegetables: make carrot cake! (Or, learn to love your EHR)

Photo of carrot cake (c) Fotolia.com Joe and I recently presented a webinar called "Finding the ROI in Your EHR" with Kareo. Joe remarked after that it might have been more appropriate to call it, "Learn to Love Your EHR." This is because one of the main points of our talk was that even though you might have initially purchased your EHR strictly to comply with government programs, you still can find benefit that are important to you beyond what those government programs. Based on our experiences working with medical practices, we believe that many administrators and physicians don't think about this at all. They don't ever look beyond the avoidance of Medicare penalties or earning of Meaningful Use incentives when considering the value of their EHR. They simply don't think of their EHRs the way they look at other significant purchases, because ROI didn't factor into the decision in the first place. But even though you bought the EHR because you felt that the government required it, that doesn't mean you can't derive benefits from it beyond what the government had in mind. The government may have urged you to buy vegetables -- but that doesn't mean you can't turn carrots into carrot cake! Most EMR/EHR systems have many excellent features that can really only be maximized once you've got a fair bit of experience with them. So if you've been using yours for a while -- even for several years -- it's not too late to think about how to get more value. In fact, being really comfortable with the basics of the system is essential to digging deeper. One of the most valuable opportunities your EHR offers is the ability to create lists of different populations from your patient base. (Remember that trick from Meaningful Use? It's a measure that is actually something you can use for other purposes, too.) For example, if you're a primary care practice, you can use the list feature to identify patients who are overdue for preventive visits. This is a great thing to do whenever cash flow or physician

By Laurie Morgan|2022-01-01T22:52:01-08:00March 9th, 2015|

Reminder: EHR ROI webinar this week (2/19)

Please join Joe Capko and me as we present "Finding the ROI in Your EHR," a free webinar hosted by Kareo. Joe and I will be discussing many different ways your EHR can help your practice become more profitable and serve your patients better. We hope you'll take part on Thursday, February 19 (10AM Pacific/1PM Eastern) -- to sign up, visit this link. It's free, and we'll have time for Q&A, too!

By Laurie Morgan|2022-01-01T22:52:01-08:00February 16th, 2015|

EHR: the right thing for the wrong reasons? (Get ROI, not just MU incentives!)

Did your practice adopt an EHR primarily (or solely) because of Meaningful Use (MU) incentives? And is MU your main focus when it comes to using your EHR? If you adopted EHR technology mainly to meet MU, you may not be expecting to gain anything from it beyond government incentives (or penalties avoided). But, more likely than not, there are benefits built into your system that can help your practice -- benefits that offer untapped ROI. Joe and I will be discussing many different ways your EHR can do more for your practice at an upcoming (free!) webinar hosted by Kareo on Thursday, February 19 -- to sign up, visit this link. In the meantime, here's one quick tip we always like to share with all of our practice clients. Used properly, the workflow tools in your EHR can provide immediate insight into your patient flow processes -- it can tell you at what stages patients are waiting, giving you the data you need to optimize staffing (e.g., add MAs), scheduling (e.g., stagger new patient and established visits), or technology (e.g., enable patients to enter their own history and chief complaint). If you're entering your workflow in/out data accurately, you can get a quick view of the bottlenecks and wait times in your system that is a gold mine for maximizing patient throughput while keeping patients happier than ever -- but the key is entering information accurately. More on that in our webinar -- please join us!

By Laurie Morgan|2022-01-01T22:52:02-08:00February 2nd, 2015|

Your smart phone’s lurking dangers

The iPhone, Android or other cell phone you depend on for everything – besides texts and calls your phone is likely keeping you busy with games; productive with email, to-do lists and calendars; in touch with Facebook, LinkedIn and Twitter; and convenienced with applications as straightforward as a simple flashlight. But how much do you really know about this rapidly growing library of applications? How well do you read the obligatory user-agreement before you install the application? Well, of those “free applications” that most of us have installed more than a few represent some potentially serious risks, especially if you have HIPAA data on your phone. Most free applications can access your contacts, calendar and other data on your phone – and for purposes of convenience, there are perfectly legitimate reasons for this, but can you be sure the publisher will only use this data for legitimate reasons? One shocking example came from a flashlight application for Android that, once installed, had access to nearly all the data on the phone. The potential threat from applications, malware and viruses is very complex within a BYOD environment – even the basics of keeping device system software current can be a nightmare when one is facing a multitude of different hardware and operating system platforms. Naturally, risks of this sort should be thoroughly defined in your HIPAA risk assessment that is a requirement of meaningful use. Regularly updating and refining your risk assessment alone could become overly burdensome very quickly. Accordingly, it's worthwhile, given the complexity and ever-changing nature of technologies, to consider a very conservative approach – we recommend practices own and manage all devices accessing patient and other critical data.

By Joe Capko|2015-01-26T16:54:09-08:00January 26th, 2015|

Thinking portals and Meaningful Use Stage 2? Join my free webinar

Does Meaningful Use Stage 2 have you thinking (perhaps worrying) about offering a patient portal to your EMR? Or do you have a portal, but wonder if it's getting the use that it should -- and whether it's really helping to engage your patients? Next Wednesday, 4/16/14, I present a free webinar on successfully implementing your portal as part of Kareo's webinar program. I'll take a look at: Why patient engagement matters -- and how portals fit in Keys for a successful portal roll-out Tips for promoting your portal to patients How portals satisfy Meaningful Use -- and why it's not just about Meaningful Use! Please join me on 4/16 to explore this important and exciting topic. Click to sign up for the free webinar on Patient Engagement, Patient Portals and Meaningful Use

By Laurie Morgan|2016-03-04T11:54:55-08:00April 10th, 2014|

Still time (but not much!) to avoid a PQRS penalty in 2015

There is still time for providers to avoid the PQRS penalty for 2013 reporting, which will mean a 1.5% deduction from Medicare reimbursements in 2015 (ouch!). The following two methods still apply for individual providers: -Submit via a qualified EHR vendor -- if your EHR is provided by a vendor that has been permitted by the CMS to submit directly, submitting data could be much easier than you think. Be sure to contact your vendor to find out what their capabilities are. Even if not qualified to submit directly, your vendor may be able to help you submit via a registry -- the second method available to not just avoid the 1.5% penalty in 2015, but also earn a .5% incentive for 2013. -Submit a single, valid measure via a single claim. You can do this! This approach will not permit you to earn an incentive this year, but you will avoid the penalty in 2015 -- and you'll have gotten your feet wet for more comprehensive compliance in 2014. (Do it now -- don't delay -- to be sure your claim is accepted and qualifies.)

By Laurie Morgan|2013-11-24T17:46:46-08:00November 24th, 2013|

Beneath recent KLAS small practice EHR rankings lies more than one story
Gallery
Beneath recent KLAS small practice EHR rankings lies more than one story

EHR, EMR | EHR, technology

Beneath recent KLAS small practice EHR rankings lies more than one story

Medscape's story last week about new KLAS research ranking EHRs for practices of 1-10 physicians had some helpful insights. The top system, Athenahealth, was praised for its high level of service and continuous improvement of the product -- despite getting dinged by some respondents for its "high cost." (Specific product improvements or features that were most appreciated were not mentioned, but I have to wonder if Athena's tight integration of EHR and PMS was one reason its clients were happier. As I've posted before, I think this integration is a huge factor in getting the most from billing technology -- and will only become more apparent with the ICD-10 conversion.) Athena wins, even though it is the high cost provider -- does that mean low cost solutions can't satisfy? Not necessarily, according to the survey: PracticeFusion, the famously free EHR, came in third -- and its score of 86.3 was not far off from Athena's 86.9. Like Athena, it got points for ongoing development, but did get a few criticisms, though, for missing features. We have often suggested that practices check out PracticeFusion if cost is their primary concern, but to be prepared to evaluate if it fits their specialty; this data seems to bear out the idea that PracticeFusion can be a great solution for many practices, but there's no substitute for actually trying it out for your own to be sure it fits your specialty, meets your functionality expectations and can be efficiently integrated into your patient flow. Unfortunately, while I don't want to call out any particular offenders, suffice to say that many of the EHRs on the bottom of the pile have been troublesome for practices we've worked with. In some -- but not all -- cases, this is at least partly because the vendors have historically been much more focused on (and effective with?) larger networks and hospitals. Perhaps the most interesting aspect of this story from our point-of-view is that churn in the EHR market continues -- and it's a good thing. When more practices feel free to switch from an unsatisfactory EHR, we'll see more benefit from these (painful)

By Laurie Morgan|2022-01-01T22:52:15-08:00October 9th, 2013|

ICD-10: The only thing to fear is fear itself
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ICD-10: The only thing to fear is fear itself

billing and practice management software (PMS), coding, EMR | EHR, finances, medical practice business, technology

ICD-10: The only thing to fear is fear itself

Did any of you catch the ICD-10 TweetChat Kareo hosted on Tuesday? I participated representing our team(@capkoandcompany); three other panelists from different segments of the medical management world joined in as well (@brad_justus, @modmed_EMA, @hitconsultant). Kareo does a wonderful job reaching out to its clients and the entire practice management community with events like these -- and we were delighted to have the opportunity to participate! (Kareo published a summary on its blog -- and you can also search all the tweets using #kareochat .) As expected, there were many smart, informed comments -- and some really good questions by the Kareo folks in particular. But, I was struck by the relative silence from people who weren't from the billing/practice management/technology expert community (i.e., from actual billers, coders and practice managers) -- especially because one of the themes that emerged from our chat was the sense that small and medium private practices (in particular) have been holding off dealing with ICD-10. Did the audience that could benefit the most shy away from the chat altogether? The drumbeat of journalists, bloggers and other experts about the need to deal with ICD-10 NOW (or face likely disaster!!) has gotten louder and louder in recent months, and I sometimes wonder if it sometimes has some negative unintended consequences. In our zest to create helpful urgency (and dispel the dream that ICD-10 will be delayed again), are we pushing people towards fear-induced denial and procrastination? Seemingly every week, we work with medical practices that have not begun to prepare for ICD-10 at all -- and they're scared. But while their foot-dragging has not been ideal by any means, it's also not a guarantee of disaster. Converting to ICD-10 is not going to be easy, but it's also not something that's beyond the reach of any practice to manage -- especially because so much help will be available from vendors and payers (provided you ask!). It seems from our vantage point that too many practice administrators, billers and coders have already decided -- without even really getting started -- that ICD-1o will be an unavoidable

By Laurie Morgan|2022-01-01T22:52:16-08:00September 13th, 2013|

The Time is Now for ICD-10 Planning

Regulatory requirements that affect the medical practice are changing rapidly. While the primary focus may seem to be on EHR systems and meaningful use to obtain those stimulus funds, there are other mandatory system changes that need to be addressed now, starting with the conversion to ICD -10 code set. The new code set represents an important advancement in diagnostic coding and conversion to it is required. Limitations of ICD-9 include limited descriptive reporting and inability to adapt to advances in medical procedures and technology. The new system promises more flexibility and descriptive capacity. As a result, more accurate healthcare data reporting is expected. Due to the significant structural differences between the existing ICD-9 diagnostic coding system and ICD-10 coding system, the transition to ICD-10 code set is one of the critical areas of change for physicians in the near future. Medical practices will be required to adopt the use of the ICD-10-CM code set by October 2013. Since the new system is relatively complex, you’ll want to make sure your entire staff receives the training they need as early as possible. One potential benefit for doctors that “under code” is that more precise diagnosis and procedure codes will enable more accurate reimbursement. Additional benefits include an improved ability to measure health care services, reduce coding errors, a decreased for supporting documentation with claims, and the ability to use administrative data to evaluate medical processes and outcomes. October 2013 may seem a long way off, but given the magnitude of this conversion it is important to address this change now in order to avoid severe work disruption and delayed or lost payments. The first step in planning for the conversion to ICD-10 is to assess the organization’s readiness for adapting the new codes and understanding the impact of the change on your practice. Practice leaders should meet with billing system IT representatives and develop an implementation strategy, time-line and budget to accomplish the conversion. The timeline should include adequate time for testing the system and it should contain a plan for providing essential education and training for the team members.

By Joe Capko|2011-10-27T16:54:55-08:00September 9th, 2011|

New Post on Kareo.com: ACOs Around the Bend

We just published a new article on Kareo's blog about ACOs. Everyone's talking about them, but we wonder if all the anxiety's warranted. We anticipate there will be a lot of waiting-and-seeing, since the scale requirements (5,000 Medicare patients for main program, 15,000 for the Pioneer program), technology standards (well beyond meaningful use -- intense reporting and analysis of outcomes and savings), and uncertain upside potential should signal caution to all but the most prepared, well-funded and established groups. But, what do you think? Read the full post at Kareo.com.

By Laurie Morgan|2022-01-01T22:52:55-08:00June 7th, 2011|

More on EHR government funding

How EHR Stimulus Funds Are DistributedLast week's blog was a brief primer on what you should know about electronic health records including some information about how the government is beginning the process of defining meaningful use of EHR application that is essential to qualify for stimulus funds available through the American Recovery and Reinvestment Act, ARRA, of 2009. Here is a schedule of how the stimulus funds will be made available to physicians that meet the government's criteria based on what year you implement EHR meeting the criteria.1st year funds and funds each consecutive year that follow2011: $18,000, $12,000, $8,000, $4,000, $2000 = Total: $44,0002012: $18,000, $12,000, $8,000, $4,000, $2,000 = Total: $44,0002013: $15,000, $12,000, $8,000, $4,000 - Total: $39,0002014: $12,000 $8,000, $4,000 = Total: $24,0002015: Total = $0Source: US Department of Health and Human ResourcesThis provides a snapshot revealing that implementing EHR before 2013 provides the greatest amount of stimulus funds. It's not too early to start researching implementing EHR into your practice, but keep a watchful eye on how the proposed legislation published in the Federal Register on January 13, 2010 is revised before it is finalized to make sure your EHR decision is in sync with government minimum standard requirements.The devil is in the detail! Judy Capko is one of America's leading practice management and marketing consultants. e mail judy@capko.com. zz

By Judy Capko|2022-01-01T22:52:59-08:00April 25th, 2010|