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Published 1/1/2007
Steven E. Fisher, MBA

AAOS launches EMR educational initiative

How much do you—or your practice manager—know about electronic medical records (EMRs)? How comfortable would you feel interviewing an EMR vendor? Would you know what questions to ask? Which EMR system would be best for your practice…and could you afford it?

To help you understand and make decisions about implementing EMRs in your practice, the AAOS Practice Management Committee has developed a major educational initiative on EMRs for 2007. The initiative kicks off with two new educational products that will be introduced at the 2007 AAOS Annual Meeting in San Diego.

The EMR Primer

The EMR Primer—developed by the Practice Management Committee under the direction of Stephen Makk, MD, MBA—is designed to provide you with information that will help you make decisions about incorporating EMRs into your practice. The Primer consists of the following 10 sections, each focusing on a specific aspect of EMRs and their purchase:

  • Introduction to Electronic Medical Records
  • Upsides and Downsides of EMR
  • Phases of EMR Implementation: Major Steps
  • List of Questions to Ask EMR Vendors
  • The “Request for Proposal” Process
  • EMR Exhibitors at the Annual Meeting
  • A Sample Evaluation Form
  • Legal and Contract Negotiation Considerations
  • Obstacles to Successful EMR Implementation
  • Glossary of Selected EMR-related Terms

Attendees at the 2007 Annual Meeting will be able to pick up a free copy at the Resource Center Bookstore, an electronic version of the document will also be available on the on-line Practice Management Center (PMC). Additional articles on the PMC and in AAOS Now throughout 2007 will expand on various segments of the Primer.

Free EMR podcast

In addition to the EMR Primer, the AAOS has developed a special podcast on electronic medical records. Because EMRs are such a hot topic, the podcast is being made available to AAOS members free of charge via the Internet. Simply go to the AAOS home page (www.aaos.org), click on “Physician Education” and then click on “Podcasts” to download the program.

Moderated by David A. Halsey, MD, an orthopaedic surgeon from Norwich, VT and the chair of the Council on Advocacy, the EMR podcast consists of a panel interview with three experts. Rosemarie Nelson, an information systems consultant, has years of experience assisting practices and healthcare institutions in implementing EMRs. Michele Zembo, MD, MBA, an orthopaedic surgeon, is currently serving on an EMR implementation committee at Louisiana State University. Marilyn Lamar is an attorney specializing in healthcare and information systems law.

What’s behind the move to EMRs?

For years, orthopaedic and other medical practices were hesitant in adopting EMRs. The reasons included lack of industry-wide functionality standards, inability of EMR systems to “interface” (communicate) with other systems, and high cost, particularly for smaller offices. Another factor was that implementing EMRs would require the development and adoption of new operational protocols and procedures, and people are naturally resistant to change.

There is now general consensus, however, that EMRs could help increase the quality of medical care provided to patients and decrease the cost of that care.

Consequently, the U.S. government—the nation’s largest health care payer—is now strongly urging healthcare institutions and physician practices to implement EMRs as quickly as possible. In August, 2006, the Department of Health and Human Services even relaxed the Anti-kickback regulations to permit hospitals to subsidize the acquisition of EMRs for physician practices.

There is also general consensus that a major potential downside of EMRs—the inappropriate disclosure of Patients’ Health Information (PHI) to third parties—can be managed. In any event, the risk of inappropriate disclosure of PHI also exists with paper charts.

What can EMRs do for you?

Not all EMR systems are created equal. At a minimum, users of an EMR system should be able to do the following tasks:

  • Document different incidents of care provided at different times in different settings by different providers
  • View information that has been documented in a structured format
  • Issue orders that healthcare services be provided by individuals inside and outside the practice
  • Send PH1 to and receive PH1 from other providers, consistent with the Privacy and Security regulations of the Health Insurance Portability and Accountability Act (HIPAA)
  • Undertake care management and follow-up analysis and reporting
  • Provide patients with clinical information and communicate with them about their care

Additionally, EMR vendors may configure their systems in different ways. Under a pure “VAR” model, the hardware and operating software are housed in the practice and patient information is stored on-site. The “ASP” model, on the other hand, stores the operating software and patient information on hardware located off-site. Still other vendors have developed hybrid products. Which model is best for your practice will depend on a number of factors, as you’ll discover as you read through the EMR Primer.

AAOS members who missed picking up a hard-copy version of the EMR Primer during the Annual Meeting can contact Marty Krawczyk, practice management program coordinator, at krawczyk@aaos.org or (847) 384-4337. To hear the EMR podcast, go to www.aaos.org, click on “Physician Education” and then click on “Pod-casts.”

Steven Fisher, MBA is manager of the practice management group and staff liaison to the Practice Management Committee. He may be reached at sfisher@aaos.org or (847) 384-4331.