Dermatologists struggle with electronic health record implementation

An article by Bob Gatty documents some of the acute obstacles that small dermatology practices must overcome when implementing EMR. “We must strike the right balance between modernizing the practice of medicine, delivering high quality care and protecting patient care,” says dermatologist Sasha Kramer, M.D. in the article.

EHR implementation pitfalls can be costly

Another good article from modernmedicine.com explores the technical difficulties that physicians often face when implementing EHR. Brett Krasner, M.D., a dermatologist, explains the shortcomings of his EHR system. Some of the issues he encountered: poor training, a “useless” and expensive server, and coding that “lumped all skin-related activities into a single exam item.” Despite this, Dr. Krasner says if he had to implement an EHR again, he would “absolutely” do it, just on a cost basis.

Electronic health records conversion of my 20 year old medical practice

Dermatologist Cynthia Bailey MD shares her fears of converting a 13,000 patient dermatology practice from paper to EHR. “I had no idea how hard this would be,” she writes, “and it has to be done in just 5 days!  It’s the EHR-conversion, mix-master vortex nightmare…..”

Dermatology Electronic Health Record Manual (dEHRm)

On aad.org, you can download the current Dermatology Electronic Health Record Manual, which is designed to guide you through the adoption of EHR. The Academy says it’s a comprehensive toolkit that can help you assess the needs of your practice and your readiness, using worksheets, tables, checklists and other resources.

The Electronic Medical Record in Dermatology

This article appeared one year ago in Archives of Dermatology. The abstract, available online, reads: “Governmental incentives to stimulate the ‘meaningful use’ of electronic medical records and future disincentives for Medicaid and Medicare provide an impetus for dermatologists to consider adding this technology to their clinical practice.” The authors go on to cite “scientific and economic data” that can help dermatologists make an informed choice about EMR.

Because medical services are increasingly going online for convenience, we should expect doctors and other medical professionals to use this kind of technology. Whether it’s for the initial consultation or an after-hours consult, a virtual option is definitely becoming more viable.

However, these new methods of communication mean that medical professionals need to closely monitor their online activities for HIPAA compliance.

Apple gear (including iPad) is HIPAA compliant when using WPA2 Enterprise security, explains Jason D. O’Grady, in a recent ZDNet blog post. According to representatives O’Grady contacted at Apple, “WPA2 Enterprise uses 128-bit AES encryption, giving users the highest level of assurance that their data will remain protected when they send and receive communications over a Wi-Fi network connection.”

The rep also explained the FaceTime feature of “end to end” encryption with unique session keys and a unique FaceTime ID for every user.

Ensuring HIPAA Compliance

To ensure HIPAA compliance when using FaceTime, be sure to connect to a secure wireless network that is encrypted with WPA2 Enterprise security.

Resources:

• About Apple FaceTime
• ZDNet: FaceTime calls are encrypted; and HIPAA compliant when using proper encryption
• HHS.gov: Understanding HIPAA

“Digital Assent’s partnership with PatientNOW will significantly improve a patient’s experience from the moment they walk through their physician’s door,” said Tim Collins, CTO and co-founder of Digital Assent. “Everything is electronic and automated, which decreases time spent filling out paperwork or a doctor shuffling through paper for health information. Physicians will also benefit from reduced clerical errors and transcription costs.”

The PatientPad is a wireless touch-screen solution that automates the patient check-in process and delivers targeted health information and advertising to interested patients while they sit in their healthcare provider’s waiting room, exam room or treatment room. Since the beginning of the year, the PatientPad has enjoyed rapid adoption by physician practices in more than 30 states.

Along with a comprehensive and certified EMR solution, PatientNOW offers fully integrated marketing, customer contact and patient process tracking tools to increase efficiency and revenue creation for each practice.  This unified EMR and practice management solution is tailor-made for the aesthetic medical provider market, including plastic and cosmetic surgeons, dermatologists and medical spas.

“Aligning ourselves with Digital Assent and the PatientPad is a natural fit for both companies, which are two of the pioneers leading the conversion from paper to electronic health records,” said Jerry Jacobson, president and co-founder of PatientNOW.  ”Capturing data electronically from the patient and pushing it automatically to the PatientNOW EMR system is a tremendous value and time saver for every one of our practices.”

The first office to go live with the integrated solution was The Skin Spa of Newnan Dermatology, located a few miles south of metro Atlanta in Newnan, Ga. “Now that PatientPad integrates with PatientNOW, our front-office staff no longer have to waste time and energy manually entering patient data,” said Trisha Kennedy, Director of The Skin Spa.

This partnership follows on the heels of Digital Assent’s recent $7.5 million Series B equity funding, which the company is using to more rapidly grow its market share and product footprint.  Earlier this year, the company received a $2 million Series A round of funding to expand its leadership team and launch a national sales campaign.

In October 2010, only 25% of plastic surgeons reported office use of EHR. Listed among the bottom specialities at the time were psychiatry, plastic surgery, osteopathic manipulation, baritatrics and holistic medicine.

Within one year, plastic surgeons evidently adopted EHR at a rate that lifted them out of this bottom five, while the other specialties remained. Primary care physicians are believed to be leading the way in EHR adoption.

SK&A has a federal contract to measure EHR adoption. You can view the report document in PDF here: Physician Office Usage of Electronic Health Records Software

A study published last month in Health Affairs looked at 163 physicians in Massachusetts who were part of a pilot program organized by the state’s eHealth Collaborative.

Beginning in 2006, the group funded and set up EHR systems in different physicians offices in three towns: Brockton, Newburyport, and North Adams. They handled technical aspects and redesign of the physicians’ workflow.

In 2005, before the EHR was implemented, doctors were surveyed about creation of patient registries. Four years later, they were surveyed again.

Respondents showed a significant change in their ability to sort patients by specific factors. Although they could already sort by diagnosis, different registries became useful after EHR was implemented.

A quote from the abstract on HealthAffairs.org

Physicians who participated in the program increased their ability to generate some types of registries—specifically, for laboratory results and medication use. Our analysis also suggested that physicians who used their electronic health records more intensively were more likely to use registries, particularly in caring for patients with diabetes, compared to physicians reporting less avid use of electronic health records.

From 2005 to 2009, the participants’ ability to generate a registry based on lab results jumped from 44 percent to 78 percent. During the same period, registries for medications increased 33 percent to 83 percent.

According to Business Wire, patients concerns include:

• Stolen personal information by hackers (about 80%)
• Lost, damaged, corrupted records (64 percent)
• Misuse of their information (62 percent)

If you’re using an EMR already, it’s wise to reassure your patients about security of their records. It may help to explain how paper records have their own security disadvantages: they can be damaged, lost or stolen more easily than electronic information.

EMR or EHR: What is the difference?

With EMRs, only the provider has access. EHRs (electronic health record), on the other hand, are electronically shared with other providers. Both systems have their benefits. Many countries are working to adopt the EHR method on a national scale for tracking their citizens’ health care.

An EMR, on the other hand, can be of great benefit to a specialist because generally only one diagnosis or treatment is tracked. Many consider the EMR a transition phase to the more optimal EHR, though this topic is a subject of disagreement.

The EHR allows for a more comprehensive account of a patient’s health because it retrieves medical information from multiple systems. This accessibility supports clinical decision-making and keeps all providers on the same page concerning a patient’s health maintenance needs. With this system, patients are also able to view their records.

With specialized software, providers can access and keep track of their patient medical records, including:

• Prescriptions
• X-rays
• Blood work requests
• Lab results

The information entered is stored automatically on a server. The physician uses a laptop or desktop during the patient’s visit to pull up their patient’s charts and record notes and courses of action rather than hassle with the old clipboard. Some EMR software also transfers procedural codes and diagnoses in coordination with the medical billing software being used to accelerate the billing process.

Advantages of the EMR Over Paper Medical Records

There are several benefits for providers who elect to transfer from the paper-based system to  an electronic method for tracking patients’ progress. Paper records are easily lost, misfiled, damaged, and they can be difficult to read. With EMR, providers are able to integrate otherwise discrete pieces of medical records including laboratory ordering and results, referrals, monitoring, and prescriptions.

Furthermore, switching to the EMR allows providers to streamline their workflow. They are able to save on administrative resources and time when looking for files and updating them.

Benefits outlined in the article include:

• Doctors can check patient’s medical history for potentially harmful drug interactions
• Reduced risk of medication errors caused by illegible handwriting or failure to spot drug allergies, etc.
• System can confirm the prescription benefits
• Refills are complete with the touch of a button
• Affordable medications can be selected more easily
• Integration with EMR allows easy access to vital patient information

Overall, the article shows that e-prescribing technology is improving the efficiency of medical practices – especially those writing many prescriptions.

“Despite a vigorous campaign by the federal government and some large health-care providers to move the nation’s patient records from the Jurassic Age of paper to the Electronic Age of digital communication, most physicians and clinics have been slow to embrace the transfer.”

Among the impediments to EMR acceptance among doctors, he cites patient privacy concerns and lack of uniformity between medical record systems.

Read more on Technorati

“If you have a practice that you want to transition to someone or perhaps sell, EHR is actually a very smart investment because you’ve essentially established a foundation for a modern practice,” says consultant Bruce Kleaveland.

Cost is the reason that most physicians hesitate to implement electronic health records, according to Miami physician Dr. Arnold Oper, who has been in practice for about 53 years. “They can’t see the jump of cost-effectiveness” says Dr. Oper.