(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
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.
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.
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!
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!
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.
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
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)
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.
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.
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 email@example.com. zz