Before you decide, consider these issues

Howard Mevis

Although many orthopaedic practices have not yet fully adopted an electronic medical records (EMR) system, some early adopters have realized that their very expensive investment is not working out. A recent report from KLAS Research found that more than half of the medical practices polled indicated that they were giving some consideration to replacing their EMR system.

Orthopaedic practices need a “sustainable” EMR system to meet meaningful use requirements as implementation moves from Stage 1 to Stage 2 and later to Stages 3, 4, and 5. Stage 1 meaningful use requirements set standards for data collection. Stage 2 focuses on the exchange of standardized data to improve care and performance and introduces the idea of measuring process improvement. Stage 3 meaningful use requirements, with implementation set for 2016, seek to achieve improvements in both healthcare systems and overall community health status.

Your EMR system should be able to support these developments. If you are not sure whether it does, ask your vendor. If software updates are needed, ask the vendor for a release date schedule. These meaningful use standards will have an impact on patient care, the collection of clinical outcome metrics, and your revenue stream.

The problems with current systems
Several factors may contribute to a practice’s decision to replace its EMR. For some practices, integration costs, especially for data sharing with hospitals, facilities, imaging centers or other physicians, lead to a decision to replace the system. For others, the lack of technical support and software updates and upgrades may prompt a change. In making the shift from Stage 1 to Stage 2, many practices have found that their EMR system was built to handle clinical transactions but does not focus on the clinical care process.

“EMR systems fail because the technology is poorly designed and the system doesn’t effectively integrate with the office’s practice management and picture archiving and communications systems, or with similar systems operated by related entities such as labs and imaging centers,” noted Jonathan Schaffer, MD, a member of the Academy’s EMR Project Team.

Usability becomes an issue mostly due to poor work flow. For improved practice efficiency, EMR end users must devote significant time and effort to developing work flows that support use of the EMR.

“It’s important to evaluate work flow and make necessary changes before you implement an EMR system” said Dr. Schaffer. The AAOS has two primers on electronic medical records that detail methods for evaluating work flow and developing implementation plans.

Additional issues include poor or limited training prior to and after system implementation, practice finances, and integration with older systems. “Older systems may not be able to handle the complexities of current and future billing requirements and payment systems,” said Dr. Schaffer. “If your base practice management system was originally purchased 20 years ago, future billing and payment requirements will render it useless, despite any software updates and upgrades.”

Should you replace your system?
Several factors should be taken into consideration when deciding to replace an EMR system, including the following:

Regulatory changes—During the next 2 to 4 years, orthopaedic practices will be required to implement ICD-10 coding, meet additional meaningful use criteria, and report data on clinical outcomes and other aspects of the practice.

Integrated searching—The ability to query both clinical and financial data with one integrated search will be needed as payment systems move from volume to value.

System integration—New relationships and new affiliations may lead to mergers that require system integration.

Data transfer security—Practices will need a secure patient portal and secure email exchange to avoid violating the privacy and security regulations under the Health Insurance Portability and Accountability Act. Data transfers to allied health professionals, imaging centers, lab facilities, hospitals, and other facilities such as skilled nursing or rehabilitation facilities, and within residency programs with trainees must also be secure.

Trust and confidence—A lack of confidence in your present EMR system or in the vendor’s ability to respond to changes may be sufficient to trigger a change.

Next steps
Before making the decision to change EMR systems, orthopaedic practices should first take the following actions:

1. Critically assess why the first EMR system is not working out. Is the problem with the system or with work flow?
2. Identify the specific problems with the current EMR system. This becomes the basis for a gap analysis that assesses the current capabilities, future capabilities needed, and steps to move toward the future.
3. Review the existing EMR system agreement, paying particular attention to termination clauses.
4. Determine the cost of data conversion to a new system. This analysis will be time consuming and may affect productivity.
5. Evaluate three aspects of the original implementation plan—leadership, communication, and accountability—as well as any EMR performance reviews. If these are part of the problem, simply changing systems will not result in improved productivity, patient safety, or clinical outcomes.
6. Consider present and future data exchange requirements.
7. Recognize the need for a secure patient portal and email system. Patients will demand these features, regardless of the EMR system used.

Make the commitment
In most cases, practices should avoid changing their EMR systems. Change is not only expensive, it may not solve the real problem. But making the commitment to meeting meaningful use standards is important, according to Thomas C. Barber, MD, chair of the EMR Project Team.

“Practices that have met the requirements can attest to the value of getting that incentive payment. Addressing this issue now will enable practices to qualify for the current incentives and avoid future penalties,” he said.

Dr. Schaffer agrees. “If you depend on payers to provide you with data, you put your revenue stream at risk. Your data, collected within your practice by your EMR system, are not only important for contract negotiations and reporting outcomes to accountable care organizations and payers who employ value-based purchasing strategies, they’re also important for clinical decision support and patient engagement.”

Howard Mevis is director of the department of electronic media, evaluations, course operations, and practice management. He can be reached at mevis@aaos.org

Additional Information:
EMR Resources
EMR Primer #1
EMR Primer #2
Meaningful use toolkit