March/April 2009 |

MedEsthetics

By Cheryl Whitman

“Change does not necessarily assure progress, but progress implacably requires change,” according to noted historian Henry
Steele Commager. If you’ve struggled to integrate “timesaving” technologies into your life, you’ve likely experienced this phenomenon. Transferring data and implementing new devices require both time and money, but once you navigate the initial learning curve the dividends can be well worth the investment. This is certainly true in the case of electronic medical records(EMR).

“We started using EMR from the day we opened our doors,” says Rachel Gordon Lichten, office manager of Central Ohio Plastic Surgery, Lancaster, Ohio. “The system we selected is an integrated software system for plastic surgeons, and the scheduler is linked to the EMR, which is linked to the billing module. I find having an integrated system to be invaluable. All of the information for each patient is in one place, and it’s easy to navigate between the modules. This improves our organization and, by extension, our ability to provide excellent patient care.”

EMR Defined

EMR systems allow you to prescribe medications, order tests, report test results and record patient notes in a digital format. New EMR systems also include additional modules for billing, scheduling, inventory management and other administrative functions. EMR software can help you to integrate medical information from multiple sources, capture data at the point of service and support the decision-making process. The primary difference in operations for you and your staff is that with EMR, all of the information that would normally be written on a paper chart is entered into the computer software. You can access your files, which reside on a central server, via your PC, laptop, Tablet PC or PDA. With such a system in place, your patient coordinator can track patients from the initial phone call through consultation, treatment and recovery. Users can view the tasks and procedures connected with each type of service your practice provides and stay on track throughout the patient’s treatment course.

Benefits of Using EMR

You can avoid a lot of frustration and costly upgrades to your electronic medical record system by taking a moment to thoroughly evaluate your needs prior to contacting vendors and meeting with sales representatives. To help you get started we’ve compiled a web-based questionnaire that will help you identify your practice’s specific needs and narrow down the best EMR options for your office.

To view the questionnaire log onto medestheticsmagazine.com.

Systems developed for medical aesthetic practices offer templates for specific procedures, like this one from NexTech detailing
injectable treatments.

“By having a portable EMR program on my laptop, I can seamlessly update patient charts regardless of the location they are
seen and readily access this information in subsequent visits,” says Ulysses H. Scarpidis, MD, plastic surgeon, New York , New York. “I don’t rely on each hospitals’ medical records department to update my files. In addition, my NexTech EMR allows me to renew prescriptions, follow up with patient care issues from any office or hospital location, and communicate with hospital staff and other physicians more effectively regarding patient care.”

EMR systems are designed to provide a variety of benefits to both your patients and your business. Transitioning to an EMR system could allow you to:

Increase productivity by simplifying chart management. You and your staff can
save valuable time through faster chart pulls and reduced transcription. End-ofday reporting goes from hours to seconds
since system programs can run the numbers for you, and legible and complete prescriptions can be sent in real time to
the pharmacy.

Boost revenue. EMR software can help increase patient retention and revenue by alerting you to patients who
missed follow-up procedures. They can also help you target advertising by identifying your most popular procedures and complementary procedures and/or treatments that patients are most likely to choose. Further, once you have transferred all of your paper records, you will have extra space that can be used to generate profits in the form of a new treatment or consultation
room, not to mention a reduction in spending on paper goods.

Improve documentation processes. Additional billing modules allow you to pre-validate insurance claims; process claims faster and more accurately; decrease accounts receivable by building in electronic billing; apply payments using e-remittance; and access templates that prompt questions you may forget to ask. When it comes to converting existing paper files to EMR, the easiest and least expensive approach is to start with a “day forward” system.

Maintain compliance. Updated software helps you stay up to date on all state and federal laws regarding compliance. You can use it to document clinical and/or accredited training. Most important, patient records are password protected to prevent unauthorized access and backed up to prevent loss due to theft, fire or water damage.

Save time. EMR systems update patient information in real time and allow multiple users to search patient databases simultaneously. You can record patient history information with a click; export reports; inventory products; and reduce time and money spent on transcription services.

Enhance patient care. By supplying accurate charting and immediate access to records, you can review allergy/ drug interaction warnings; generate a quote; identify complementary services for individual patients; provide pre-op and post-op lists; track treatments; and alert patients to special promotions. The digital database also allows you to personalize marketing campaigns for different patient groups. “EMR programs that generate and combine established subjective and objective exam templates focused on the individual patient’s areas of concern can significantly decrease time spent on data entry and eliminate collecting
duplicate information,” says Dr. Scarpidis. “Equally important, these plug-andplay templates allow you to start using the EMR program on day one. Some programs also allow you to customize templates depending on your patient population, accustomed practices and individualized needs.”

Choosing the Right System

Investigating EMR options can be a daunting task. There are a growing number of companies offering EMR software and services. Determining which program is right for your practice and
which system offers the best protection in terms of patient confidentiality requires some research. To help physicians narrow their options, the Certification Commission for Healthcare Information Technology (cchit.org), a nonprofit group funded by the United
States Department of Health and Human Services, certifies vendors who meet CCHIT standards for EMR. In addition to HIPAA concerns, you want to think about what your individual needs are before you start evaluating systems. Some EMR programs are customized to the individual practice, while others are pre-designed based on practice size— small, medium or large—and specific specialties. You can also find systems for practices with one physician or multiple physicians. Buying a template designed specifically for a medium-sized, two-location, one-physician dermatology practice, for instance, may save you money on customization as you implement your system.

Once you have narrowed your choices, ask for the names of satisfied users in your area. Take key staff members with you to visit other businesses that use the systems you are considering. Ask about the training they received—was it done by the vendor directly or through vendor-supplied materials? Ask about financing and/or leasing options available through the vendor. An EMR system is a significant capital investment, but current economic concerns may be a benefit in this regard. Many vendors may be more flexible with pricing and/ or product packages for some of the latest
technologies available. Client financing is often available through approved third-party financing companies.

“The cost of starting up new, or switching from your current software is highly variable,” says Hesham Butty, MD of NexTech Systems. “We base our rates on the modules selected and the number of system users. Additional modules can be added as requirements change and the business grows. It is essential to assess the individual business needs and tailor a package specifically designed to meet those needs at the most economical price possible.”

Not all systems are created equal, and while you will find many that are exceptional, you will still have to seek the right fit. “I would look at several different systems before investing in one,” says Lichten. “We went for a more expensive system and found it to be well worth the investment. I know other offices that opted for less expensive systems and are now upgrading because they don’t have all of the features they need.”

Lichten recommends that you look closely at how often the system is updated, both to reflect new technology and to ensure that the program is able to evolve as your office expands. Also, examine the degree of technical support available. Even two to three years after purchase, it is likely you will still rely heavily on your vendor’s technical support.

Transition and Implementation

Adding an EMR system offers process improvements for your practice, as well as a positive effect on the quality of care you can provide to your patients. However, be prepared: The process of acquiring new skills can be difficult and even frustrating at times. Take time to build enthusiasm and assign a lead staffer who is excited and can champion the upcoming change. Prepare for the change by scaling back on appointments during your training interval to give your staff time to learn the new system without the pressures of a full client schedule. In addition, be prepared not only to weed out old processes, but also to change some of your business behaviors.

“We are currently converting the Institute to EMR,” says Steve Watson, president/CEO of The MIAMI Institute for Age Management & Intervention, Miami. “With more than 15,000 patient charts, we have a big task of scanning and associating paper files to the new EMR record. Since the Institute has many specialties (wellness, surgery, dermatology, dental, medical spa and lasers), the integration of a single system for our patients across multiple specialties is the driving factor for incorporating EMR. This will allow the patient to flow to each service in the proper order without conflicting treatment plans and timing.”

When it comes to converting existing paper files to EMR, the easiest and least expensive approach is to start with a “day forward” system. From the first day of implementation forward, put new patients into the system immediately. As established patients come in for appointments, scan their files and add the new information from their visit. When business is slow, staff members can scan old files in batches. In no time, you will have all of your patients’ information exactly where you need it at the touch of a button.

“Locating a misfiled chart can cause several hours of lost productivity. Also, pulling records and putting them away at the end of the day is very time-consuming,” says Suzanne Gil, MD, of Calla Slimspa, Winter Park, Florida. “We’ve been using mSpa by Mack Software for years. The transition [to EMR] was painless and has proven to be one of the best decisions we’ve made. There’s no risk of a chart being misfiled, and all of the patients’ information is just a few keystrokes away. Even though there is a bit of an upfront investment, we plan to save quite a bit of money on staff time and paper costs.”

There is no question that converting your files and operations to EMR will require an initial investment of time and money, as well as a change in your operations. But if you opt to meet the challenge of change these new systems represent, progress in the form of process efficiencies, improved patient care and even enhanced revenue can follow, taking your practice to the next level.