4 EHR Technology Issues that Billing Services Can Help Clients With

Ron Sterling February 6th, 2012

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EHRs require a higher level of reliability and present a more complex technical challenge to your physician practice clients.  Unfortunately, many practices fail to correctly analyze their situation and design technology strategies that will support a successful EHR effort.

1.    EHR Customization

Many practices undertake efforts to customize the EHR to meet their operational and clinical needs.  However, before a practice is in a position to determine what they want to customize, the practice needs to understand what the EHR product does and the quality of the clinical information.  For example, some practices undertake expensive efforts to customize clinical information based on their paper forms that may not be the most effective structure for an EHR-based record.

In the worst cases, customization can undermine other EHR capabilities.  For example, changes to clinical content may not properly trigger calculation of the E&M code and be properly included in the EHR exam notes.

What You Can Do – Work with the practice client to fully analyze the EHR and assess the applicability of the EHR before undertaking expensive changes.  Such an analysis should answer the question about what would happen if the practice used the EHR without the change as well as the complete scope of work needed to implement the changes to completely work with the EHR.

2.    Managing Third Party EHR Components and Services

Many EHR products include third party components to supplement the basic capabilities of the EHR.  Third party products are used to manage EHR images, provide patient portal functionality, and even clinical content to support charting in various areas of medicine.

In many cases, these products are sold as a package but may be contractually set up as if the practice was buying individual products and connecting them together.  Indeed, it can be difficult to find someone who understands all of the various pieces of the products and how they work together.

This problem also manifests itself in the implementation effort, when the practice may have to separately seek help from the EHR vendor and third party vendors.  Each vendor may understand the functionality of their product and the handoff to the other product, but they rarely understand the details of their third party partner software and services.

What You Can Do –Your third party billing organization may be able to serve as the analyst to rationalize the practical aspects of working with these various products.  For example, you may be able to analyze the interface between the EHR and third party patient portal product to identify a good approach for the practice to manage the interactions with patients through the portal.  Similarly, you may be able to articulate the technical problem that is causing problems charting patient visits where the third party clinical content may record the patient treatment plan, but fail to generate the patient order for EHR tracking.

3.    Establishing Reliable System Infrastructure

In many cases, medical practices are not getting the advice they need on options to mitigate the chance of a system failure and assure adequate hardware resources.  For example,

Practices that are based on a hospital campus may be able to capitalize on the uninterruptable power service offered by the hospital and take advantage of their redundant Internet connections.  Practices in many offices need to evaluate the risk of disruption and the investment needed to assure reliable power and communications.

Practices need to evaluate their need for redundant storage devices and even servers to avoid disruption to system access.  Due to the drop in hardware costs and virtual machine structures, many practices can afford to invest in more reliable and redundant hardware for their EHR.

What You Can Do –Evaluate the costs of redundant and fail-safe computer systems and communications to avoid disruptions due to system failure or lack of system resources.  In too many cases, practices are going with bare minimum configurations which may cause performance and/or reliability problems.

4.    Protecting Patient Information

Many practices do not have the technical expertise or even understanding of their own system to conduct a Security Risk Assessment.  Security Risk Assessment is a Meaningful Use Measure needed to qualify for the Medicare EHR incentive payment.

Security Risk Assessments evaluate the administrative, physical and technology strategies used to protect patient information.  Thereby, the actual ability of the practice to meet the security requirements will depend on the design of their technology base, placement of their equipment, and access standards and procedures.

What You Can Do –Make your client aware of the key issues related to Security Risk Assessments.  You can advise your client on the hardware selection and design decisions as well as the procedures needed to implement a system that will protect patient information as well as provide a viable path to meeting the Meaningful Use Measure. 

Your physician practice clients are facing a wide range of implementation and use challenges in their effort to take advantage of EHRs.  Unfortunately, many practices are proceeding without adequately considering the technology issues that could affect EHR use for years.  Targeting your efforts to helping clients with the technical challenges of EHRs will help them protect their investment and their records.

Ronald Sterling, CPA, MBA, discusses four EHR technology issues that billing service clients need help withRon Sterling (800-967-3028, www.sterling-solutions.com) publishes the popular EHR Blog Avoid-EHR-Disasters.blogspot.com, and authored the HIMSS Book of the Year Award winning guide “Keys to EMR/EHR Success.”  He is an independent EHR consultant. Hear Ron speak in an archived webinar sponsored by Kareo: What You Need to Know About Selecting the Right EHR. Ron most recently wrote for Getting Paid on Effect of ICD-10 Codes on EHR Timelines for Medical Billing Services.

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