How a practice becomes a hostage to its EMR

When an ENT doctor wants to buy an EMR, electronic medical record, they usually check with their colleagues in the world of Otolaryngology. This practice makes sense, to an extent. But how many purchases or decisions that you make stick with you for most of your life? And how many of those did you make without testing and trying for yourself?

Put it another way, would you buy a $50,000 car without driving it first? Would you buy it just on a recommendation? Would you buy it based solely on what it looks like in the show room or because you saw someone drive it down the street?

Most software companies offer a free version or a trial version to see if it meets your needs. EMR companies generally do not. They have valid reasons for these restrictions, but surely they can figure out a way to make things happen.

My gut tells me that EMR companies are generally afraid. Its fairly well known that many practices who launch an EMR project will abort or end up using limited aspects of the EMR. Sometimes a great implementation falls short because the users figure out that the program doesn’t quite satisfy their needs. I would like to see an EMR company be bold. Is there an EMR company that is confident enough in their product that they would let a practice try it for free for a span of several weeks?

There are some who say that playing it safe would be to buy an EMR from the biggest company. Big does not make it better. A few urology groups I know have gone several BIG EMR vendors. Each of these vendors talked about how many urologists are using their products. So these urology groups signed up and spent a fortune. After implementation, they wanted to add some features that were common to the practice of urology. The EMR vendors patted them on the back and said here they are for an extra $30,000 (and for a larger urology group $100,000).
Once you have put in a lot of time and money, the BIG vendors can sometimes hold you hostage.
Ok. Anyone can hold you hostage. A small fry EMR company can custom make an ooberEMR that works so well…except that it doesn’t interface with anything. Or the 1 programmer that built the whole thing gets burned out and switches career paths.

Its not only the EMR companies that hold you hostage. Once you have an EMR, your employees suddenly become more valuable. If one of them quits, it takes time and money to get the next employee trained. Doctors who have become very dependent on their few employees have acquiesced to cost of living adjustments. Now several years into an EMR practice, the employees are making 30% more than what they made before. All the return on investment goes POOF!

Look for IT training when hiring medical assistants

By Patty Enrado, Contributing Editor
09/24/08


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WASHINGTON - A shortage of healthcare professionals across the board is spiking employer interest in hiring medical assistants. Demand for medical assistants with specific training in computer applications such as practice management software, scheduling, billing and electronic health records is making the category one of the fastest-growing professions through the 2006-2016 decade, according to the U.S. Department of Labor .

Approximately 62 percent of medical assistants work in physician offices, 12 percent are employed by public and private hospitals, including inpatient and outpatient facilities, and 11 percent work in offices of other health practitioners, according to the U.S. Department of Labor . Most of the remainder works in other healthcare settings, including outpatient care centers and nursing and residential care facilities.
According to Judy Jondahl , director of accreditation for the American Association of Medical Assistants (AAMA ), associate degree programs are putting a bigger focus on information technology skills and requiring IT competency as part of the their curriculum. AAMA recently approved of new standards and requirements for its medical assistant curriculum.

“Multi-skilled medical assistants can be very advantageous to a practice," Jondahl said, noting that many physician practices are scrambling to hire anyone with applicable information technology skills right now. She said medical assistants already are being required to develop expertise in data management of electronic health records and electronic medical records, including hardware and software skills to maintain EHRs, EMRs and anything Internet-related to the medical office.

In the front office, medical assistants need to administer and management patient admission through computerized office billing systems. While in the back office, IT skills play a big role in data gathering of lab samples and basic vital signs.

IT competencies have become more common among large practices, she said.

Here are three things to look for when contemplating upcoming staffing moves:

· Work with local medical assistant programs to identify strong candidates with IT skills

· While certification isn't necessary, choosing certificated medical assistants ensures competency on basic IT systems

· While experienced CMAs can earn, on, average, $38,000 -- about $10,000 more than an entry level CMA -- it may be worth the effort to land a candidate with the skills and knowledge to get to work on Day One. That employee can be come a key trainer and leader when it comes to IT adoption.

ENT EMR CCHIT, The skinny on Otolaryngology Software

EMR, electronic medical records, have been a constant at the American Academy of Otolaryngology Annual Meetings since I was a resident. The AAO-HNS has an OTO-Expo (its trade show) at the annual meetings. The OTO-EXPO has seen the number of EMR vendors start with just 1 vendor and climb up to, I believe, a peak of 13. AllMeds EMR has held the consistency spot being there every year for the last decade. NextGen, AllScripts, Greenway, MiSys, and a few others have joined the scene.

AllMeds, Greenway, and Misys have progressed from being small startups to now being sponsors of major events. The AOA, Association of Otolaryngology Administrators, now lists AllMeds as a platinum sponsor, Greenway as a gold sponsor, and Misys as a silver sponsor. The AOA and the AAO-HNSF do not endorse one EMR over the other.

The AAO-HNS has multiple lectures and seminars on practice management systems and electronic medical records. Dr. Tom Upchurch, an otolaryngologist and co-founder of AllMeds, has been a perennial speaker at these events. To his credit, he has maintained his objectivity during these presentations. The first time I heard him talk about EMRs, I realized the pain that we would all be going through. Tom is a visionary and is a mentor to me. He has an interest in what we are trying to build out.

I expect the crowd at AAO-HNS conference in San Diego scheduled for Oct 4 through Oct 7 to be bigger than ever despite the economy. With the stimulus package encouraging IT expenditures, ENTs who have been sitting on the fence will come out in force. Having recently listened to Karen Zupko at a conference extolling the potential government money to be had, and watching the fall in PC prices, the return on investment is so much faster than when we bought ours.

Karen Zupko and her firm Karen Zupko & Associates, KZA for short, have presented at the last several AllMeds user conferences. At each conference she has shown the improving rates of return with EMRs. When she first started advising ENT surgeons, the software choices for Otolaryngologists were minimal. Now there is a plethora and the gaps between them are closing. But every single one of them still has the same problem….the people at small offices like yours and mine who have to run them.

So which EMR did we choose and how did we pick it? We started our review of EMRs in 2002. Having looked over AllMeds, Greenway, Misys, and a dozen others, we picked AllMeds. At that time, AllMeds had the greatest number of ENT users. If I am biased towards AllMeds, it would be out of familiarity. I would love to be able to have all the EMRs available to me on a regular basis to test them out and try them. I called all the software providers to see if they would be willing to provide a fully functioning product for me to keep on our test servers. Only AllMeds, GE, and AllScripts called back. AllMeds was kind enough to give me a second software package to put on teaching/training servers. GE will participate in the Fall. All you other EMR Companies….still waiting for the software to test.

What makes comparisons between EMRs frustrating is that testing is not done in the same fashion that cars are tested. It is easier to spend $50,000 on a luxury vehicle than on an EMR. Test-driving it at a convention floor or even in your own office for 15 minutes does not really tell you how it would work in your daily grind. AllMeds has made it easy for me to let you do a test drive. Contact me and we can make this happen.

Say CCHIT three times fast. As acronyms go, this does not bode well when trying to make a sale. In the early days, EMR users did see sh*t. The software was not robust or interoperable and the hardware was expensive. CCHIT stands for: Certification Commission for Healthcare Information Technology. CCHIT has been a blessing and curse to the EMR world. It has forced EMR vendors to improve aspects of their software, but also raised some onerous demands. CCHIT inhibits and promotes natural selection of EMR companies. If you are an EMR designer with a very novel approach, you may find yourself running up against a wall of standardization. But overall, the goal of CCHIT is to provide buyers/users some degree of security and interoperability. The CCHIT website goes into detail and has volunteering opportunities.

Email me about your EMR purchasing decisions and if you have changed your EMR. AllMeds claims to have a 94% retention rate. We are in our fifth year of using their software. AllMeds nor their competitors have given us reason to change. So I need to hear from those of you with different systems. While this blog is directed toward the ENT community at large, I welcome feedback from doctors of all stripes. Please include any industry affiliations. Lets get the skinny on EMR for otolaryngologists.