Practice Management Alert

Also, expect some staff to be uncomfortable with e-records initially

Smooth your practice's transition to electronic health records (EHR) by anticipating several key problem areas. 

Medical offices that implement EHR systems will eventually be more efficient, but be patient, say billers who have made the switch from paper records to EHR.

Careless EHR Errors Can Happen

Check out this testimony from a biller about her office's transition to EHR:

-We have had EHR for three  years. I have to say coming from an office that used paper charts, this is the best thing for a medical office,- says Lee Ann Byers-Tomlinson, office manager at Stone City OB-GYN in Bedford, Ind. -It cuts down on personnel time looking for paper charts and allows more than one person access at a time to the chart. Also, EHR is a lot more legible,- she says.

However, EHR does present its own unique set of challenges, Byers-Tomlinson says. One issue with e-records is that -sometimes, it's easy to just click away at the templates and make a simple error,- she says.

Example: Entering a CPT code as -99214- on a claim when you really meant -99212.- A payer would see this simple mistake as an overcode, which could garner your office unwanted attention.

Further, -lab entry has to be watched when using EHR--a decimal point manually entered in the wrong place can make the lab value mean something totally different,- Byers-Tomlinson says. -Lab entries were harder to get wrong with paper records, because you could always check the paper record to make sure your entry was correct.-

But the biggest challenge in EHR implementation in Byers-Tomlinson's office was the tedious transformation of all patient information. -Insurance information and patient data all have to be loaded into the system before the physician is even able to start charting a patient. If you are an extremely busy office, this can cause lag time for the physician, as well as the patient,-  Byers-Tomlinson says.

Another issue with e-records is physician training. If the doctor is not trained to use EHR properly, the office could be in for a painful transition marked by an uncomfortable audit or two.

During physician audits, -one of the most common problems we are seeing is that the documentation contains conflicting data,- says Shannon O. Smith, CRTT, CPC, CMSCS, of DoctorsManagement in Knoxville, Tenn. 

Example: Within the history of present illness (HPI) portion of the note, the physician states the patient has some shortness of breath, -but the review of systems (ROS) is templated to state -Respiratory: No wheezing, no shortness of breath,- and this information does not get changed on the note,- Smith says.

-Even though the physician really did perform an ROS of the respiratory system, now we have conflicting data within the documentation,- Smith says.

Audit alert: Smith says that this type of -conflicting data makes an auditor wonder if the data was really obtained or just marked for a higher level of service.-
 
Shop Around Before Buying E-Records System

Make sure all employees that will be using your EHR have input in the EHR decision-making process. Try to find out what each person in the office needs from an EHR system before undertaking this costly venture.

Factors to consider: Before deciding on the best EHR system, Byers-Tomlinson says that her office -looked at several systems before making a commitment to one. We looked at not only the EHR but also the type of support offered and the cost factor.-