What comes first Process or Software?

An important element of a medical practice workflow is Order Tracking. 

When Providers order labs, radiology etc, a practice must followup at least twice to ensure that results are received or there is some followup action taken. 

In a technology solution that drives a practice, I frequently see questions related to the ability to 'task' someone of a responsibility to take some action. 

This is where process versus technology debate comes in.

When you 'task' or message someone to do something, that is like walking over to your staff and saying, 'can you take care of this'?

Let me illustrate this. There may be a eFax queue where lab results come in; or they come in electronically via lab connection. Someone needs to look at these results. Someone needs to determine if doctor should be looking at these or they are normal. Next comes the determination of calling or informing the patient and whether or not patient must be called in for a visit. And finally, any comments must be entered to close out the test.


How Reliable are EMR Reviews are anyway?

All Doctors, Office Managers, Practice Manager looking for EMR systems should read this blog - Courtesy The Healthcare Blog.

It will open your eyes; at least make you think - and take all the online reviews with a pinch of salt. How influenced and flavored are these reviews?

Having worked with many vendors, I will say that most sites do not allow vendors to post reviews directly. However, they may certainly be influenced. Read past the 'blandly positive' reviews as the writer of the blog says, and focus on those that appear original. If possible, find and try to talk to the provider or practice that wrote this review. 

Buying a Car or EMR - Similarities

Generally speaking we buy cars with emotion, not logic. If logic alone prevailed we would buy the cheapest and safest transportation to get us from point A to point B.

We evaluate - 

  • Convenience
  • Looks
  • Safety
  • Value
  • Something that matches our Status (and more)
  • Comfort of passengers

There are two important similarities I want to highlight.

  1. When you get an EMR, don't just look at your comfort and convenience. Don't evaluate just from a clinical charting perspective. Involve 'passengers' - your staff. In fact, they will be driving more than you.
  2. The old adage - you get what you pay for holds even for EMR systems just as cars. Look at your value, convenience, and overall workflow benefits. Buying the cheapest is not always a good idea.

And as with anything else, look at recommendations from peer and third parties.

Benefits of a True EMR + PM Integrated System

A lot has been written about the benefits if an integrated system versus 'best of breed' as some vendors like to call it. Best of Breed is really a lose term for 'we don't have other components, so we've partnered with another company'.

Interfaced System

Integrated System does not mean 'interfaced' system. Applications  may be owned and  perhaps developed by the same company. But if they were developed as standalone applications, they may be connected by interfaces or bridges. Applications may not share a single database or development platform. 

To an end-user, the workflow and process may appear seamless because the vendors passes data from one application to another behind the scenes automatically and the user does not have to do anything.

Integrated System

Systems and applications designed to and developed from ground up on a single database are considered true integrated systems.

Which is Better?

From an end user perspective, it should not matter; at least theoretically. Vendors on both sides of the fence have written about the benefits of each.

Consultants have always favored the Integrated system approach. However, they have not successfully been able to convince me from an end user perspective. From a software and database integrity point of view I agree it makes absolute sense.

Benefit of Integrated System

I was sitting with a Doctor friend at his office. His biller walked in and said, 'Doc, you just saw patient Jones and I think you under-coded. I saw the note, I believe this would be a 214 level coding.'

The doctor just opened that patient's visit note in his EMR and updated the chart. 

The biller saw that the claim updated with the new code. 

I suddenly realized something and asked the biller, how did you you know or see the visit note? Do you have access to the EMR system? 

My friend said we have an 'integrated' system, so she can view my notes on the same screen where she creates and views the claim. She does not have to go to another 'app' or module or software. It is all in the same system and database.

Now it suddenly came together - Single database Integrated system. This is also the reason why when Doctor updated his note with the new code, the claim was immediately updated.

It took a real world example to be finally convinced of what consultants have been saying all along.


No Upfront Fee EMR

Lot of companies are waiving upfront fees, because there is so much pricing pressure. I know owners of several EMR companies, most of them have their support and training staff offshore. That is not necessarily bad, but then you don't get the quality of training you deserve.

Plus, so many studies have shown that successful implementation has to do with the level of training and support. 

Rather than zero upfront costs, what you should be asking for is - 

  • One day of Onsite Training during 'Go-Live'.
  • Unlimited Remote Training
  • Dedicated Phone support number for you.

Rather than compromise on a bit of upfront cost, it is imperative that you focus on making your practice more efficient and profitable. 

This is not a Trivial System you are going for - EHR and Health IT has business implications. If not done right, it can slow you down, create chaos and you end up suffering. 

If cashflow is really a concern, work out creative ways to spread it out. I'm sure your vendor will work with you.

If you think you can train yourself and your staff (assuming you have a lot of time on your hand), and setup the system yourself, why not go with the Free software Practice Fusion. Of course, if you add up your time and cost of time, you will conclude very soon that free system was actually more expensive.

Rise and Fall of Google Health

I was going through some notes from 2008. Eric Schmidt of Google announced Google Health at HIMSS 2008. Google pulled the plug in 2011. What happened?

In the Google implementation, your personal health information will not be given to anyone without their explicit permission, which is not true completely for HIPAA-compliant systems. If we get a subpoena, we always check our judgment as to whether the subpoena is narrow enough. If we think it’s a fishing expedition, we will fight it in court. That has worked well for us so far.

At that time, Google Health and Microsoft's HealthVault were the two PHRs that decided to fight it out. Google quit, HealthVault still chugs along.

Among several reason why Google Health did not work out:

  • It did not involve Physicians (and EMR systems).
  • Google found it tough to partner with Insurance companies - Insurances companies tend to be a walled garden.
  • Poor Marketing and Poor support for users. Even an EMR pioneer like me struggled to use it.
  • Perceived waste of time by users. Young people did not care to enter data themselves, and to those that PHR mattered most just couldn't do it. It was too cumbersome.
  • Google could not find a way to popularize it, or figure out a way to bring in partners to monetize somewhere.

I think HealthVault will probably go down the same route as Google Health.

The main reason is that EHR systems now have sophisticated Patient Portals built in. Secondly, with MU2 and beyond, interoperability will eventually become a reality, making true secure data exchange possible, irrespective of PHR platform.

What does it mean to be ICD-10 Ready for a Small Practice?

Transition to ICD-10 is not about being Compliant. It is an ongoing Transformation. Everyone is affected - Payers, Providers and Vendors. But physicians would be on the losing end because they are the ones submitting claims. If not submitted accurately, physicians don't get paid, plain and simple.

Getting Ready for ICD-10 means two things:

  • Planning
  • Training

Your vendors, can only help by providing the right tools to help plan and eventually submit claims but ultimately you are responsible. If claims are not done right, you don't get paid which means you lose 100%.

A lot has been written about ICD-10, it's complications etc. so I will not harp on it here.

Some simple steps you should take are:

  • Start off with your existing superbill.
  • Map out the relevant ICD-9 to ICD-10 codes. Your technology partner - EHR/Billing platform should help with that.
  • At the very minimum, your biller should be formally trained. I recommend the entire staff, including physicians should attend training.
  • For a small practice, your Biller or Office Manager should spearhead the transition effort and guide the rest of the staff, coordinate with vendors and clearinghouse.
  • Explore possible boost in overall revenue. Overall, ICD-10 has the potential to boost revenue.
  • Testing - work with your technology partner and clearinghouse to send test claims.
  • Most important, budget for the transition cost including cost of training so that you don't get caught with unplanned expenses.

Healthcare Change - Done to us vs. Things we choose - SMD factor

Seth Godin was on the mark in this blog 'Done to us vs. things we do'. There are changes that we withstand, that are beyond our control as Seth says, like Malaria, the atomic bomb, the McCarthy hearings, television's ubiquity, the decay of the industrial base--these are mammoth changes, changes that came from all around us, changes we had to withstand.

Yet, thinking about today and all the changes in just a few short years from the inception of cellular phones to smart phones, from Internet to facebook and from Paper charts to EMR. No one forces us. We think we are forced but we choose to accept most of these.

Sure there are cultural pressures that indirectly force us to accept change because we want social acceptance but that is a different kind of pressure - not a gun held to hour heads.

EMR adoption is going from Carrot to Stick. Initially there was the incentive and now it is shifting to penalty. Most providers somehow think of it as a forced or thrust change rather than a welcome change to improve and get better.

SMD - Slow Me Down - Factor

The fundamental shift in thinking comes because we can't accept change. The most common statement I hear as a resistance to this change is 'it slows me down'. The problem is that 'it' does not slow you down, the attitude slows you down.

Instead of looking for EMR to help you overcome SMD, think about your current workflow (see my recent article on this here), method of working, and use of various available technologies within and outside of EMR to help you overcome SMD factor.

A good partner - vendor, reseller, or consultant will help you find what works for you and your way of working, your comfort level.

Change is never easy, but as the cliche goes, it is inevitable. In many ways, choice makes change ever more difficult, doesn't it?

The future isn't so much about absorbing or tolerating change, it's about making change.

"Workflow" becomes a problem when it neither works nor flows.

Someone recently wrote this on Twitter and it caught my attention. It caught my attention because everyone seems to be talking about Practice Workflow and how to optimize it. It is also being talked about in the context of EMR / EHR Software Systems. Yet majority of small practices struggle with the concept of Workflow precisely for this reason - it neither works nor flows as they expect it to. We may think it does, but it meanders, particularly for inefficient workflows. We know that a straight line should take a mile, but the inefficient meandering workflow may take 2 miles to get there. These workflows work eventually though and flow ultimately, because at the end of the day, somehow, things do seem to get done.

In a fantastic book edited by Ronda G. Hughes, PhD, published by NCBI (NIH) in 2008 titled - "Patient Safety and Quality", there is a Chapter on Organizational Workflow and its Impact on Work Quality that I think everyone should read. I have extracted some important elements here.

Some Workflows are designed, while others evolve and happen organically over time. Most often, when workflow processes are looked at in isolation, they appear quite logical (and even efficient) in acting to accomplish the end goal. It is in the interaction among these processes that complexities arise. Some of these interactions hide conflicts in the priorities of different roles in an organization, for example, what the staff is accountable to versus the physician(s) and their schedule. Practices also adapt workflows to suit the evolving environment.

Over time, reflecting on workflows may show that some processes are no longer necessary, or can be updated and optimized.

Today, the need to think about workflow re-design is important due to several factors, including:

  • Introduction of new technologies like EMR/EHR Software Systems
  • New treatment methodologies
  • Cost and efficiency pressures to improve patient flow
  • Initiatives to ensure patient safety
  • Implementation of changes to make the care team more patient-focused

Perhaps the most important reason that workflow is of pressing concern for today's clinicians is the introduction of healthcare information technology (healthcare IT). While EMR software promises benefits, it can be disruptive to existing workflows in a practice.

EMR software systems assume a workflow structure in the way their screens and steps are organized. Practices that are thoughtful about workflow design are more likely to be successful in adapting to EMR Software Systems and being successful.

Do you think just by installing a good EMR you can accomplish this?  That will depend on the kind of workflow.

Poor Workflow

Practices rely on good information. Valuable information can be lost when poor workflows impede communication and coordination or increase interruptions.

A poorly functioning workflow includes:

  • Unnecessary pauses and rework
  • Delays
  • Established 'workarounds'
  • Gaps where steps are often omitted.
  • A process that participants feel is illogical.

Good Workflow

The design of good practice workflow is not simply about improving efficiency. Workflow processes are maps that direct the team (front office, clinicians and back office) how to accomplish a goal. A good workflow will help accomplish those goals in a timely manner, leading to care that is delivered more consistently, reliably, safely, and in compliance with standards of practice.

An excellent process can accommodate variations that inevitably arise in healthcare through interaction with other workflow processes, as well as factors such as workloads, staff schedules and patient load.

Impedance and Hurdles in the way of a Good Workflow

5 primary instances why EMR Software Systems can disrupt practice workflow:

  1. Instead of using EMR Software implementation as an opportunity to re-design practice workflow, practice owners that just throw technology into the mix of an existing workflow is more likely to cause the process to become even more inefficient than before.
  2. Treating EMR Software system as a 'necessary evil' that has to be done. This thinking prevents proactive initiatives to re-design workflow.
  3. Acquiring EMR Software as if it was a 'commodity' and Shopping solely on pricing, look-and-feel etc.
  4. Not involving the entire staff in decision-making.
  5. Not being prepared to re-design your Workflow


In addition to looking for an EMR system that has the necessary features at a reasonable price, one should not compromise on practice workflow re-design. Most systems today have most of the features that a practice needs and industry competition has leveled the playing field where pricing differences are minimal.

Workflow re-design and optimization can be accomplished in two ways.

  1. Find a Vendor / Re-seller that knows how to do this and has experience doing so.
  2. Find a Consultant that can help.

Either way, EMR Software is anything but a Commodity.

EMR is Just a Tool - Use it only if ...

I was visiting a Client in Los Angeles. He started up a new practice. He wanted to start with an EMR software that was a complete system to help him get started in the right way. When we first talked last year, my first thought was that just like many others, he would want a system that can do everything without having to pay anything.

I was surprised when he emphasized that he had two objectives.

  1. A system that was powerful enough to help him with clinical documentation and manage the business of a medical practice.
  2. Someone that can be a 'partner' to help optimize the practice workflow and bring in efficiency.

What was missing here in the goals was - 'how much'. He did not talk about pricing at all. Out of the four packages that were offered, he chose number 3 that had more value services, unlimited training and immediate phone support when he needed it. He ended up paying a couple hundred dollars a month more than what he would have paid otherwise, but what he ended up getting was far more valuable.

During my time at this clinic last week I found that he had been able to setup an extremely smooth workflow, and his staff was trained and happy. They knew that EMR Software was a tool that they needed to use optimally.

I did not see any of the standard negatives I see at other practices struggling with EMR Software implementation. I have seen some practices with the same software struggle. Part of the problem was that there were compromises made in the level of training they purchased.

In a nutshell, here are some things we did together:

  1. Optimized Templates that would take care of 80-90% patients within 90 seconds or less.
  2. Front Desk optimized patient registration, scheduling process.
  3. Empowering Patients to help with intake data to reduce their paperwork and staff's time doing data entry.
  4. Creating Notes such that billing is error free with minimal rejection.
  5. Setting up Management Reports to help practice owners and providers stay on top of Practice Finances by spending less than 5 minutes per week.

In short, if you like the EMR System you are looking at, make sure you get adequate training and services. EMR Software should be a tool to help re-engineer your Practice and optimize workflow.

How much for your EMR? Commoditization of EMR

In Economics, a commodity (wikipedia) is a marketable item produced to satisfy wants or needs. Commoditization occurs as a goods or services market loses differentiation across its supply base, often by the diffusion of the intellectual capital necessary to acquire or produce it efficiently. So, has the EMR software market now effectively been commoditized?

The answer will depend on who you ask.

Let's look at it from a Provider's (Small Practice) perspective. It will also depend on why someone is considering EMR software. There are two classes of buyers:

  1. Those that have used an EMR software and want to switch because they are not happy.
  2. Those that are considering EMR softare for the first time.

Providers buying EMR software for the first time don't see subtle differences in technology, value and effectiveness. They don't see the differences between vendors. 'All EMR are the same' - I've heard this phrase so many times it is not even funny. For this group, EMR software is a commodity.

On the other hand, Providers that want to switch because they are not happy. They know exactly what to look for, what works, what does not and how to differentiate between vendors. They are looking for unique attributes that produce better value.

Even if the systems you evaluate seem to have similar 'features', each system handles workflow differently.

  • Will a system help you create a better workflow for your practice and become more efficient?
  • Will your vendor help you implement the system for efficiency? If vendors won't, perhaps their re-sellers will.

There is unfortunately so much pricing pressure that vendors can't afford to give lots of extra services. Vendors are going for 'volumes' of practices.

Re-sellers build their business on the Services Model. They want your business and they want that you will recommend them to your peers and colleagues. This is what creates a true win-win situation. Get into the spirit of 'partnership' with Re-seller.

What about pricing?

I know pricing can be an important factor. But step back for a minute - is it really that much of a factor? The difference between the system you want and the other EMR is perhaps $200 per month maximum. This is less than $10 a day. If a system makes you slog for 15 minutes more every day, you've just lost more than $10. In the bigger scheme of things, that $200 in higher fees will give you multiples back in return.

Bottom Line

Buy EMR software on value, not pricing. You should try to get more value, support and services rather than negotiate pricing, unless it is absolutely ridiculously priced.

2 Secrets to Successful EMR Implementation

In my informal survey of Successful EMR Software implementations, I have found 2 very important factors that make EMR Software implementation and Adoption successful. I have used two words:

  • EMR Implementation
  • EMR Adoption

Let me distinguish between the two.

EMR Implementation is just about usage of the system. It implies that you are putting a layer on top of your practice workflow, trying to automate and speed up some of the tasks everyone does. It does not talk about improving practice and workflow efficiency. In other words, you are just doing things better. If your practice workflow is inefficient, with technology, you just make that inefficiency better.

EMR Adoption indicates that your practice uses and depends on the EMR system to help you become better and more efficient. It forces you to examine your processes and weed out inefficiencies.

What are the Two Secrets of Successful EMR Implementation?

  1. Continuous Training
  2. Focus on Adoption versus Implementation - Focus on Processes

Continuous Training

There must be a good plan for training with the right trainers. Sometimes training is done by IT people and that is ok, they know the application, and can show you what buttons to press, but they don't always understand the practice workflow. It is always better to be trained by clinicians that know the system or by consultants that are experts in practice workflow. It is not important to learn every trick in the book, every intricate aspect of the EMR software to prepare for every possible workflow scenario.

Good training enforces, over time, simulations of workflows, 'what-if' situations.

Another important aspect of training is Continuous training and reinforcement training - not to different in philosophies from CME.

Too many practices and provides underestimate the importance of training. In the process, they over estimate their (and their staff's) ability to learn the EMR system, however easy it may seem. Part of it is driven by the motivation to try to reduce costs.

Training is precisely the Wrong place to cut costs. It actually costs you more in the long run to cut training costs. I wrote an article in February 2013 about this.

EMR Software Adoption - Process 're-engineering'

After EMR software implementation, one mistake practices make is to assume that everything will stay the same day-to-day. You are investing in EMR technology to become better and more efficient. You should not just assume that by 'implementing' and 'installing' EMR Software, it is going to solve all your problems.

Again, distinguish between Implementation and Adoption. Strive to examine your workflows and how EMR software can help improve them - re-engineer them.


Once EMR Software is implemented and Adopted, it is a process of continuous improvement. It must be a sustained effort to stay on top with changes - staff turnover, software updates, regulatory updates (MU, ICD-10), etc. It takes continual effort to constantly strive for improvement to get results of increased efficiency.

Get Your Medical Practice Ready for 2014: Review These Three Areas | Physicians Practice

Get Your Medical Practice Ready for 2014: Review These Three Areas | Physicians Practice. Pay particular attention to the third one.

Marketing Plan

Marketing does not necessarily mean only new patient recruitment. It also means keeping your patients happy and informed. It means keeping your patients 'in the loop' regarding their health and letting them know about your practice and what's going on in your practice.

One area that is not mentioned is that of Patient Engagement promulgated by Meaningful Use of EMR. There are new requirements in Meaningful Use II that mandate a certain percentage of your patients use your Patient Portal. Newsletters are an excellent way of creating awareness.

And, of course, happy 'customers' spread the word for you and will recommend you to their friends and relatives.

What do you think? Email me/call me.

Doctors - Think outside the 'Box' of your 'Clinic' - Add Coffee Shop, Apple Store and Fitness Center

Healthcare landscape is changing rapidly. We moved from the age of Physicians visiting patients' homes, to corner clinics to group practices to ACO's and Hospitals. Now what? Is the Small Private Practice a relic of the past? Here is some research:

Jury is still out. What is clear however is things are changing and the American ingenuity will reinvent the Small Practice - again.

I should not be surprised when I read and article in FastCompany Magazine of all places, related to healthcare paradigm shift. I would urge everyone of you to read this article.

The Doctor's Office Of The Future: Coffeeshop, Apple Store, And Fitness Center

Patient - us - are also consumers. As the article says, 'As Americans try to figure out what changes the Affordable Care Act will bring to their lives and pocketbooks (and politicians continue wrangling over the rollout), here's one that probably missed everyone's radar: the new experience that could be waiting for people in their primary care doctor's waiting room.'

Starbucks became a 'destination' rather than just a coffee shop. It became a place for us to relax, congregate, read, whatever we connected with. We know we want to stay healthy, but dread going to the lowly 'waiting room' of a doctor's office. It is dreary, it is downright depressing in most cases.

If my Physician's office was designed as the Article says, it would certainly become a 'destination' for me, it would actually motivate me to stay healthy.

System for Targeting Advertisements based on Patient Electronic Medical Record Data

A US Patent application has been filed for a 'System for Targeting Advertisements based on Patient Electronic Medical Record Data'. This is so Wrong on so many levels.

I have written about EMR Data sales in the past as also how some free EMR models work. There are also some downright illegal activities like this one involving Prozac.

This particular Patent application is about 'a patient specific informational material distribution system, that comprises of at least one repository or informational material items associated with corresponding particular medical conditions and an individual item is associated with at least one medical condition.'

Where is this going?

On one extreme why not allow a doctor to give full access to the practice's patient database to a pharma company? I can see people saying, this will not happen, there are regulations in place. But, we all know how it starts. One isolated instance, then another and another. People start discussing mainstream, and then it just happens.

As EMR adoption increases, hospitals and academia start focusing on big data in the name of better analysis for greater good. The downside effect is bound to happen. I do expect such things to happen. While people say there is no good system to match offers and demand in healthcare,  with increasing adoption of EMR, it is just a matter of time.

I do not know what the real intent of this patent filing was but at least for now, there are regulatory responsibilities to ensure everything is legal.

Is it certainly something I will be watching with a keen eye in the months/years to come.

Patient Centric Medical Record and Patient Centric EHR

So much is now being written about the need for EHR systems to be patient centric. At the very onset, it implies that current EHR systems are not patient centric. As I think more about it, read more about it, I also find that definitions of the words 'patient centric' also varies. The interesting thing is, a lot of people writing these blogs are either providers (physicians and clinicians) or health care consultants. But of course, patients don't blog and no one bothers asking patients.

What if Patients were responsible for keeping and maintaining their own medical records? What if the doctors and providers, clinics and hospitals were not required to keep these records (other than legal necessity)?

What and How would Patients maintain their records?

About 8 years ago I decided to 'organize' my father's medical records. He was of course, more organized than me. He had all his records meticulously organized on paper with proper folders and files. I thought I could do better.

I started using the now defunct Google Health (don't even get me started with that). After a lot of effort meticulously scanning and digitizing paper records, entering discrete data, linking up to pharmacies, I was quite pleased. Not everything was there, but I was pleased.

This is where it started going downhill. Maintaining updated records was a nightmare. Not being able to 'automatically' populate the Digital Health records from hospitals and Dad's personal physicians meant that I had to continue scanning all paper, entering data by hand. It was too much work. In one instance, it took me 5 phone calls, 2 visits, and 27 days before I could get two visit records from a local hospital, and they wanted to charge me $75.

So, slowly but surely, we slipped back to paper, and it worked!

Has anything changed now?

I don't think so. Will it change in future? Maybe it will, but trust me, it will take a long time.

In the mean time we would be happy to go to any of our doctors and ask for an old record and get it instantly, without her having to dig through piles of paper, pull out the right chart, copy it, mail it to me. And, hope and pray that I can read her handwriting.

So, EMR software is the first step in the right direction towards 'patient centric EMR/EHR'. At least, I will have 'access' to my records.

Web based EMR and EHR - Same Features, Similar Pricing, But...

Show me one Web EMR that is so dramatically different that you will scream - "Wow - I've never seen that anywhere before". I'm not talking about bells and whistles or small features, I'm talking about game changing solution. Do this - make a list of 'features' of these Web EMR systems. Write them all out in Column A of an excel spreadsheet. In columns B, C, D, ... write the names of vendors/products.

blank excel
blank excel

I guarantee most Web EMR systems will have most of the features you list out.

How do I Choose the EMR System?

So here are some basic do's and don'ts. First thing - Don't focus on features, unless there are one or two features that you believe are critical to you, but then that can be done in 2 minutes, or during the presentation you can ask that the vendor show you.

Show Me

Here's how to determine if a system is good for you and if you can see yourself using it.

Make a list of routine activities and desired outcome. For example, a provider's desired outcome can be -

  1. A good final note that is not bloated with unwanted information so that you don't have to sift through paragraphs of text to find the real assessment and details of an exam including abnormals.
  2. How to chart during the encounter in front of the patient and what will it do to the patient perception?
  3. What does it take to 'finish' the encounter after the visit? Can you finish portions of the encounter afterwards and if so, what are the exact steps involved?

A front desk person's desired outcomes can be -

  1. How quickly can you check-in a patient.
  2. How to handle interruptions; someone calls for an appointment when you are talking to a patient that just walked in for an appointment?
  3. How to handle co-pays, as well as past payments due from a patient that just walked in?

A back office or billing person's desired outcomes can be -

  1. What are the actual steps for working an aging report?
  2. How to address claim rejections?
  3. How to create claims and reconcile with provider's notes and superbill?

Don't just ask 'can you do this', ask 'How' and 'Show Me'.

Again, before you are able to ask the appropriate questions, you should do your home work. Step back and look at your day to day tasks and try to write them down along with your desired outcome.

This will help you find a system that you will want to live with for a long time.

Is your EMR Ready for ICD-10? Are you Ready for ICD-10?

Understanding the two questions is extremely important. Let me repeat:

  • Is your EMR Ready for ICD-10?
  • Are you Ready for ICD-10?

In order to succeed, both must be ready and work in unison. If either one is not, you are set for failure.

Popular misconception is, 'my vendor is ready for ICD-10, so I don't have to do anything.'

In a recent article in the Medical Economics, 'ICD-10 Countdown: How your practice can get ready', Michael F. Arrigo, CPHIT, CPEMR managing partner of No World Borders, a healthcare management and information technology consulting firm advises practices to view their EHR vendor as a partner, but not to assume the vendor alone will make them ICD-10 compliant.

“They can’t do it automatically by just upgrading your software and, in the end, they are not responsible for the healthcare providers’ compliance with ICD-10, the provider is,” he says. “At its core, ICD-10 is really about documenting the patient’s condition properly and the physician is the only professional licensed to diagnose, so they have to do a really good job documenting.”

Steps at the Practice

Not just the billing staff, every employee of the clinic must be trained, with the billing staff taking a leadership role. Ideally, everyone should take some formal courses. American Academy of Professional Coders (AAPC), the American Health Information Management Association (AHIMA) and the American Medical Association offer such courses.

From the billing and coding perspective, your challenge is going to be working with insurance companies. I read a very good interview of Dr. Scott W. Tranhaile, MD about his clinic's preparation. That may be an extreme case but shows you cannot take education and preparation lightly.

What about EMR?

EMR Vendor has two parts to their responsibility at the very minimum.

  1. They must be ready to submit ICD-10 codes to the clearing house and that testing must start if it has not started already to ensure everything would transmit correctly.
  2. It must allow easy modification to your templates and superbills.

A good System must make the overall workflow of the Practice as smooth as possible for you to document the patient encounter efficiently.

Can an EMR automate ICD-10 for you?

I recently read an interview of a new vendor that claims they can 'read' your notes and recommend appropriate ICD-10 codes. Really? I do not think technology has the level of 'artificial intelligence' to do that. And even if it did, do you really want to trust software to do coding for you?

Every practice must go through this educational process. What would happen if you get audited? An educated practice can breeze through such audits, versus saying, 'my software picked the codes'.


Great Customer Experiences are hard to find

I was at a Michelin Star Restaurant in Manhattan yesterday with my family. We wanted to go to this place since one year, something or the other prevented us from making it happen. Lots of expectations were built up. For me, I just found the food mediocre. My expectations were not met. It is not the first time this has happened. I've gone to places with great expectation, simply to be let down.

Big Promises - Unmet Expectations

Sometimes, Big promises can lead to mediocre, if not poor experiences. Big promises by who? The restaurant did not make that promise to me explicitly, but it was my mind that made the promise to myself.

This Expectation was a culmination of it's 'rating' by a respected body (Michelin, in this case), my friends, peer, online reviews etc. built up that expectation. This expectation changes the way we experience a product and/or service.

So, Big expected promises can sometimes fall short leading to experiences that are not up to mark, even if in our own minds. If the company does not live up to that expectation we tend not to trust that Company quickly and broken trusts are hard to mend.

Companies will therefore be afraid of laying out grandiose expectation and promises. It is obvious - if we make these promises, we are afraid of owning them and then afraid of the 'what-if we fail in delivering'? When we create our own Big Goals in life, we sometimes keep them to ourselves afraid that if we fail, we don't want our loved ones to perceive us as a failure.

Expect Better - Experience Better

On the flip side,  We have better experiences when we expect to have better experiences.

An expensive wine tastes better because we paid a lot for it. That's just how our mind works. Classic Coke just tasted better because we wanted it to taste better.

So, it would be unwise for companies to hold back from laying out high levels of standards and expectations. The expectations don't have to be pretentious. You don't need to make huge statements and buffer them with fine print. Experiences are just those small things - one step at a time. How you are greeted and treated by your salesperson, by every employee of a company, the way a customer service representative answers the phone, or even the look and feel of an email you receive from the company.

Customer Delight

Finally, customer service is not a 'milestone', it is an ongoing experience. Once you get started on a relationship and journey with your client it must get better with every encounter. Even if it does not get better, at the very least it must not deteriorate. Customer experience must continue to delight and sometimes even surprise. Only then you will have your client do the 'selling' for you by using social media to spread the word for you and build a level of expectation for your next prospect.

Easier said than done, this is the hardest act to follow for a company, but worth every penny and drop of sweat. Effort well worth spending on.