Wound Supplement – Fall 2012
by Jeff Mongelli
Decisions, decisions. When it comes to electronic medical records (EMRs), the options seem to grow every day. Questions such as, “Do we get a dedicated wound product?” or, “Do we get a popular EMR that has wound care workflows developed?” and, “Do we need to have billing integrated?” are just a few of the important questions to answer before you even begin your search. Identifying your needs in detail will make your selection process much easier and will, ultimately, determine the success of your transition to EMR.
So let’s start by identifying appropriate questions. Keep in mind this is not intended to be a comprehensive needs analysis for the EMR selection process. If you need that, you can find numerous questionnaires online to aid in that process. By contrast, this article is more targeted to the types of issues specialists in general face when selecting an EMR and a few of the specific issues you face as a wound care specialist.
1. Specialty specific or general EMR tailored for wound care? I’ve spent more than 10 years in the trenches selling and implementing EMRs across numerous specialties. While I must confess I am more familiar with wound care as a patient than a provider, the documentation requirements don’t vary dramatically from a Number of other specialties. In my experience, one of the distinct differences between a general EMR and a specialty specific EMR is vendor knowledge. In the case of wound care, much like vein treatment, reimbursement requires very specific documentation, diagnosis selection, and billing modifiers. Can a generic EMR meet these needs? Sure. Can they meet those needs as adeptly as a dedicated EMR? Unlikely. Specifically, documenting multiple wounds, rapidly selecting from a refined list of diagnosis codes, and having a billing system that aids in proper coding, are all areas that require a high level of expertise on behalf of your EMR vendor. One can assume a dedicated EMR will address these issues more efficiently, so unless you have additional requirements (like other specialties being served), a wound care–specific EMR may be easier to implement and faster to use.
2. Do you want to go web based or client server? Without getting too deep into geek speak (with all respect to geeks), both options have advantages and disadvantages. Also, there is a difference between a hosted EMR and a web-based EMR. Most client-server EMRs can run with an offsite, or hosted, server. That does not mean they are web based. The distinction matters when it comes to your long-term IT costs. Think of a web-based EMR like Amazon.com. You don’t have a server you access remotely, just a website. That means no operating system or database to maintain and update, nor are you paying for a shared space on a server. It may be difficult to identify the distinction since many salespeople don’t understand it either, but It matters. Another factor in this consideration is your use of images. If you are an avid wound photographer, image management can be a factor in a web-based or remotely hosted system. Bandwidth issues, space issues, and speed issues must all be taken into consideration. Also, many companies offer a hybrid solution—web-based EMR, locally stored images. While this addresses many of the concerns, you’re also now left with paying for a local server and a hosted or web-based solution. There is no “right” answer here; the best solution can only be determined by your needs, your intended use, and your access to fast and stable Internet connectivity.
3. To bill or not to bill? Again I must state I am not a wound care expert, but I have enough experience with specialties such as vein treatment and dermatology to know that proper and efficient coding is critical to your business. Does that mean your EMR has to have this built in? No. But would it be beneficial and cost effective? Almost certainly. While there are plenty of reasons to opt for an EMR-only solution, a complete wound care system that includes billing and scheduling within the same database will improve your overall office efficiency and the accuracy of your coding. Additionally, maintaining interfaces, particularly in the face of upgrades, can be challenging and costly. Finally, it’s not uncommon for an EMR to partner with one practice-management (PM) product this year and a different one the next. I’ve seen too many practices get left in limbo when their EMR vendor changes practice management partners. It’s not pretty and it’s not a situation I would want you to experience.
4. Are you planning to meet Meaningful Use? If so, this significantly narrows your range of options within the field of dedicated wound care systems and may also open the door to considering general EMRs who have their ONC-ATCB certification. Keep in mind the cost/benefit of what will likely be a longer ramp-up period for a general EMR.
5. Do you need additional services along with the EMR? Like a number of specialties, many vendors offer a woundspecific EMR as part of a larger relationship. Providing supplies, management, treatment, and coding expertise are all additional services offered in the wound care space. Do you need it? If the answer is yes, you’ll likely pay a premium for the convenience. Does it help? Nothing is more expensive than your time wasted with improperly coded encounters—you’re literally treating patients for free. So these enhanced relationships, while driving up costs, may well prove to be a profitable alternative. One word of caution: Don’t get locked into a relationship where you can’t “break out” the components that aren’t beneficial to you and retain those that are. In other words, if you’ve signed on to a supply agreement or coding assistance and six months later you’ve hired a legendary wound care coder, be sure you can continue with the EMR without the additional services. Paying for services you don’t use or having to switch to a different EMR to get out of the arrangement are real possibilities that need to be taken into consideration and negotiated up front.
6. Do you routinely photograph you patient’s wounds? If you do, then your EMR should allow for a seamless import of those images into the patient chart. Wireless cameras can achieve this, as can a product called Eye-Fi, but your vendor needs to support it. Also, one of the great advantages of EMR for a specialty such as wound care is the ability to capture a digital image of a wound and draw on it (while still preserving the original image). If you intend to use an EMR in this manner, be sure the system is designed to accommodate the flow of those images into the patient chart and that your storage or image management solution is capable of handling the required capacity.
7. What type of outcomes analysis is available? Macro factors like pay-for-performance are making the availability and flexibility of outcomes tracking an important component of your current and future reimbursements. Additionally, outcomes tracking can assist in tailoring patient care, ensuring your methodology is as effective as currently possible. Certain wound care EMRs offer the ability to evaluate outcomes across a larger population base of users, adding the ability to benchmark your results among your peers. The goal of interoperability is to ultimately deliver these types of outcomes across the entire wound care population, but that capability is projected to be several years off. The value of generating outcomes results within your own group or spanned across numerous providers should be part of your evaluation process.
8. Do you track supplies? Well, if you don’t, you should. And it would be wise to either implement an EMR with an integrated inventory manager or use a web-based inventory service such as PogoMD®. Once again, not all Wound-specific EMRs offer inventory management nor do many general EMR systems. Is it really important to track your inventory? We’ve seen practices increase profitability into the five-figure range simply by adding inventory management. In other words, not doing it is costing you more than you realize. Another word of caution: Many inventory systems will want to lock you into their supply channel. It sounds great up front and can indeed be a good deal for you, but realize you’ll be paying a bit more for the convenience. Finally, what’s the point of paying your staff to track it if it ends up being revenue neutral?
9. Have you considered vendor viability? Many of you have likely read about, or have been directly impacted by, the acquisition of WoundExpert by Net Health Systems. Consolidation across the EMR industry is just starting to begin and the pace will pick up before the year’s end and throughout next year. In addition to consolidation we’re going to see some attrition. The number of EMR companies is not sustainable, and many haven’t aggregated enough critical mass to keep pace with the heady programming costs the industry demands. This dynamic is more prevalent with specialty specific EMRs, where market potential is smaller and market share is hotly contested. The result will be EMR companies closing their doors or getting acquired. Neither is good for you, and here’s why: A shuttered company is obviously a problem—you need to extract all of your data and select another EMR. If your vendor is acquired, the buyer will be faced with supporting two systems or “sun setting” one for the other. In addition to those changes, it’s likely your contacts and support people will be changing. Many providers who have gone through this process have ultimately opted to change to a different system since they have to make a change anyway.
10. Cost. While the list above is in no specific order, cost is listed here last for a reason. It should be last on your list also. By the way, this isn’t an endorsement to invest heavily in an EMR, but rather the result of years of experience replacing failed EMR implementations. I urge you to break cost into three components: 1) the opportunity cost of not changing to an EMR, 2) the productivity cost of the implementation, and 3) the fiscal cost short and long term of the EMR. I’ve too often witnessed the business impact of a failed EMR. If you think the cost of EMR acquisition is expensive, imagine going months with incorrect or inaccurate billings (and, in some cases, not knowing it) or decreased patient volume because the EMR is slowing you down. These are just two of the many actual costs behind the purchase price of an EMR. Physicians that have traveled the road know there is no such thing as free EMR, and there is no EMR more expensive than a failed one. In an era of downward pressure on reimbursements it’s critical to leverage down your expenses as much as possible. I would encourage you to focus more on the “fit” of an EMR to your specific uses and purposes rather than the fiscal cost. The right EMR for you will deliver improved efficiencies that will deliver a positive return on investment over time, regardless of the initial cost.
EMR selection can be a time consuming and confusing process. The wrong decision can jeopardize your reimbursement, staff well being, and your own sanity—let alone the viability of your practice. The best way to make the right decision in selecting an EMR starts with your preparation, before you ever speak to a vendor. Determining your needs as thoroughly as possible in advance of your evaluation is the most important step you can take to ensure you receive the benefits of the correct EMR for your practice.
Jeff is the CEO of Acentec, Inc., a healthcare technology company that provides products and services to medical practices nationwide.
“While there are plenty of reasons to opt for an EMR-only solution, a complete wound care system that includes billing and scheduling within the same database will improve your overall office efficiency and accuracy of your coding.”
“The number of EMR companies is not sustainable, and many haven’t aggregated enough critical mass to keep pace with the heady programming costs the industry demands. This dynamic is more prevalent with specialty specific EMRs, where market potential is smaller and market share is hotly contested.”
Published on the Wound Supplement