The best first step towards a painless implementation of electronic medical records

Many medical facilities are contemplating the implementation of an Electronic Medical Record (EMR) system as a way to consolidate medical information into one easy-access repository.

An EMR is a storage system for clinical documentation used to treat and care for patients. EMRs, which are populated via user input from a variety of interfaces, aggregate this discrete information into one, easy-to-use repository. Although medical administrators might think that purchasing an EMR is the best first step in the successful implementation of their clinical information repository, there are alternatives. Implementing an EMR is a significant undertaking from a time, cost and manpower perspective. It introduces a new process to the workplace that generally affects employee comfort, morale and productivity. Instead, adopting a new method of electronic transcription can be a wise introductory step towards the implementation of an EMR at healthcare facilities of any size.

Implementing EMRs

An EMR is not just a repository of information and records, it is also a new operational process for storing information affecting both clinicians and staff. EMR vendors often promise a “fix all” solution that will increase productivity, decrease cost and improve overall healthcare. Many medical facilities buy into this promise, only to struggle to overcome disappointing results when the solution is implemented. Although some EMR vendors are willing to resolve implementation issues after a sale is complete, it still leaves administrators at the mercy of the vendor. It can also be costly as administrators are forced to throw good money after bad to justify their original purchasing decision.

When considering the implementation of an EMR, healthcare facilities should evaluate:

1. The real dollar cost or savings the system offers;
2. The challenge of building buy-in from physicians and staff alike;
3. The effect on workflow;
4. The relationship between transcription costs and EMR usage.

These four concerns are most likely to culminate in negative results if an EMR is implemented all at once.
Staff must interface with an EMR daily, requiring training, adjustment to their daily tasks, and often redefinition of responsibilities. Because EMRs change the way that clinicians and other staff members interact with patients, it may require doctors to spend less time with patients, cutting into productivity and profitability. This is similar to a new coach being introduced in the middle of a game – players have to spend time learning how to work with the new coach instead of executing plays.

But just like a team owner that selects a superstar player, only to be disappointed when the player is on the field with the rest of the team, administrators must visualize how the greater picture will be affected by an EMR. Specifically, they need to understand how an EMR affects operations.

In much the same way as the football “Hail Mary” pass, an all-at-once implementation is a risky, all-or-nothing endeavor that rarely leads to a successful execution. It takes planning and incremental steps to achieve forward momentum. With gradual and carefully planned implementation, the transition to EMRs can easily be managed with positive results.

Easing into an EMR

The transition to EMR will be easier if existing operations are in order and prepared to go paperless. Establish a method to gather patient information that’s necessary to create a complete medical record. Ideally, this should be done without infringing upon your doctors’ and staffs’ daily operations. Adapting an electronic dictation system can make gentle yet productive strides towards the implementation of an EMR — staff can continue business as usual and maintain productivity, EMR data can be compiled and waiting for a future EMR implementation, and transcription costs can decrease.

Fundamental #1: Keep ‘em dictating

A large portion - approximately 70% - of today’s paper medical record is made up of information sourced from dictation and transcription. Physicians favor this process because it allows them to quickly and accurately document patient encounters. They have more time to provide patient care, increasing their productivity.

Administrators, however, see transcription as an expensive and vulnerable process that can be changed to increase administrative productivity and efficiency. EMR vendors suggest that eliminating transcription will decrease expenses. They assert that the savings on transcription alone can provide a positive return on investment, quickly and easily.

Most EMR’s replace transcription with ridged templates. A template system, however, can be more labor-intensive and cut into the amount of time a physician, clinician or staff members spends with patients. With transcription, a doctor who sees 25 patients per day takes two minutes to dictate per patient. With an EMR template, instead of two minutes, it takes five minutes to enter patient information. At this rate, a physician adds one hour and 15 minutes to an already long day. Consequently, implementing an EMR that doesn’t consider clinician preference and efficiency results in a loss of thousands of dollars in revenue, all in an effort to try to reduce hundreds of dollars of cost.

By contrast, some of the more advanced transcription solutions available today enable medical practices to retain the preferred clinician methodology -- dictation and transcription – while reducing costs and bringing a facility closer to the realization of a fully functional EMR. A system that enables clinicians and staff to conduct business as usual truly decreases costs.

Fundamental #2: Tweak your transcription process

Instead of a total overhaul, simply reform and upgrade the dictation and transcription process. If you use paper records like most healthcare providers today, your dictation and transcription process can easily be converted to electronic records.
Achieving this is easier than you may think. Many vendors in the market today offer software solutions with their transcription services that provide healthcare facilities with the conventional paper method they use today, but also stores the paper electronically in a format that compliments data stored in an EMR.

Why is this important? Imagine using an electronic system for two years prior to implementing an EMR. This type of electronic system would provide two years worth of patient history that can discretely populate an EMR. Because a transcript can account for as much as 70% of the patient medical record, capturing this information through an advanced transcription system in a format that supports discrete data (history, plan, medications, allergies, etc.), allows future EMR records to contain a significant amount of information in one easy and painless step.

If a healthcare facility with paper records were to implement an EMR immediately, they would lack data to populate a patient record. The practice would be dependant upon old paper files while migrating to new technology.

Additionally, clinicians would lack incentive to use the system since patient information isn’t available. Administrators can also rest assured that such software solutions won’t negatively impact their budgets: the systems are either included as part of the transcription expense or reduce the cost of transcription, compensating for the upfront investment.

Some systems, often those built on an ASP (Application Service Provider) model, do not necessitate any capital expenditures or monthly operating costs and therefore enable electronic patient documentation using dictation and transcription with reduced operating expenses. Additionally, with electronically formatted files containing discrete data elements, facilities can continue to use an existing paper records system while building a wealth of information for their future EMR. This is possible because most transcriptions are nothing more than a text document with hidden identification tags “attached” to each piece of relevant information (history information is tagged “history”, medication information is tagged “medication”, etc). This hidden tagging means that a printed version looks just like your traditional transcription, but the electronic version is a transcription that will populate each field required within an EMR. A paper file and EMR-friendly electronic version of a transcription is possible today without purchasing an EMR and without additional out-of-pocket expenses. Additionally, such a system slowly builds clinician buy-in as they discover the benefits of online clinical documentation.

Fundamental #3: Streamline the transcription document for cost savings

Recurring lines in a transcription -- letterhead information, addresses, closings, clinician titles, relevant dates and phone numbers -- can account for up to 70% of a transcription’s costs when a transcriptionist charges by line count. Additionally, the inconsistency of line counts based on either character or “return” keystrokes, can unknowingly squander thousands of dollars. An electronic transcription system with clinician-specific templates automatically generates information that is repeated throughout a transcription – without a transcriptionist typing – and therefore don’t add to the line count cost of a transcription. Additionally, an electronic system mandates “line count” consistency, forcing all transcripts to be measured by the same measuring stick.

Fundamental #4: Find a software solution that is transcription company independent

Usually, a transcription service provider offers proprietary software with their services, meaning that if a healthcare provider wants to change transcription services, they also have to change software. With healthcare providers switching transcription companies an average of every 18 months, staff must learn new software regularly – a significant operational cost and labor expenditure.

By reversing the traditional business model and searching for a software solution that works with a variety of transcription companies, a practice can change transcription companies without changing software and without changing a clinician’s process. Choice in transcription service providers also allows healthcare provider to find transcription companies with specific skills, such as understanding doctors with foreign accents. Find a software solution that allows flexibility in selecting transcription services, in order to reap all the benefits of an electronic based dictation and transcription software solution.

Preparation is half the battle

With electronic transcription, it is possible for a practice to gradually achieve the benefits of an EMR even before the EMR is up and running. A practice will improve operations in the following ways:

• Maintain the optimal, popular dictation interface
• Migrate 70% of all medical information to a digitized, EMR-ready format
• Install solutions with little or no upfront costs
• Create a document sharing system among multiple locations
• Reduce transcription expenditures by significantly reducing the number of lines transcribed
• Maintain control over the transcription process, with freedom to choose among a variety of transcribers
• Store all data in formats ready to populate any EMR

For some healthcare providers, this solution may even be enough, while for others it presents the option of proceeding to an EMR installation at its own convenience, completely equipped to upgrade in a seamless, pain-free transition. Best of all, regardless of whether now or later, most transcription software solutions can integrate with an EMR, ensuring that healthcare providers never lose the benefit of one of medicine’s most effective and efficient recording tools: the doctor dictation.

Emdat is a suite of web-based applications that completely automates the preparation, routing and delivery of the entire dictation, transcription and documentation process. Emdat begins with the proven foundation of traditional dictation and adds web-based cost-saving features to give clients a fully integrated solution that improves workflow, reduces cost, and saves time. Because there's very little change to the dictation process, Emdat is easily and quickly adopted by any dictating clinician. Emdat automatically routes dictation and transcriptions to the proper person for transcribing, review, authentication, printing and chart placement all with no capital expenditure, no maintenance costs and no contract.