The EHR Life Cycle: HIM's Role in the Metamorphosis From Paper

This is a good overview on some of the challenges of implementing EMR solution.

The EHR Life Cycle: HIM's Role in the Metamorphosis From Paper

Challenges in EMR for physicians office

Reading bits and pieces of information from the internet and different viewpoints, it is quite evident that HIT implementation in a acute care hospital is not the same as implementing EMR for a physician's office.

Interestingly there are around 400 vendors( about 70 certified ones) for EMR. The average de-installation rate is close to 20%

While it is important for an EMR vendor to have a strong customer base and financial resources to keep updating features, it is important that they have the consulting skills and be able to help their clients derive business value from their IT investment. However smaller vendors have attractive pricing policy to compensate for lack of competencies.
EPIC systems for example is a product developed by the vendor internally and not put together through an acquisition plan. This gives them an advantage in terms of application lineage. It allows them to create lite version of the product to cater to a better range of customer needs.

According to Fox Group, 8 critical functions for a physicians office are
- Physician Inbasket
- Medcial Assistance Inbasket
- Patient scheduling
- Patient Check In
- Encounter documentation including workflows. CPT and DRG coding support
- Patient Check Out
- BIlling and Collections
- Patient Portal, reports etc

Moving from paper to computer is an important transition. Meaningful use increases in functionality and sophistication over period of time. Shift in incentives includes incentives payments, possible government financing. In order to have a operationally efficient EMR system and a "meaningful" the following are good steps to follow
- Observe a due diligence
- Assess operation consequences including changes in workflow
- Have a implementation plan and a team to carry it out
- Anticipate and handle disruption during implementation and conversion
- Balance between features. Dont overpurchase or be limited
- Get it right the first time is critical.

EMR - Where are we and what's in it

The Health Information Technology for Economic and Clinical Health Act has pushed the EMR agenda into reality. An interesting handshake between Walmart, eCW and Dell is worth noting (http://www.nytimes.com/2009/03/11/business/11record.html?_r=4&hp).
Walmart plans to team its Sam’s Club division with Dell for computers and eClinicalWorks. Wal-Mart says its package deal of hardware, software, installation, maintenance and training will make the technology more accessible and affordable, undercutting rival health information technology suppliers by as much as half.The Sam’s Club offering, to be made available this spring, will be under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. After the installation and training, continuing annual costs for maintenance and support will be $4,000 to $6,500 a year, the company estimates. Wal-Mart says it had explored the opportunity in health information technology long before the presidential election. About 200,000 health care providers, mostly doctors, are among Sam Club’s 47 million members.The company’s test bed for the technology it will soon offer physicians has been its own health care clinics, staffed by third-party physicians and nurses. Started in September 2006, 30 such clinics are now in stores in eight states. The clinics use the technology Wal-Mart will offer to physicians

How ready is the heatlhcare sector in terms of EMR adoption: A quick preview from HIMSSanalytics.org (The State of U.S. Hospitals Relative to Achieving Meaningful Use Measurements By Michael W. Davis Executive Vice President – HIMSS Analytics)