EMR’s or ‘Electronic Medical Records’ are steadily becoming the norm, but for medical professionals and Practice Managers, there is still a lot of uncertainty. We sat down with the Head of Clinical Product at Healthbridge, Jared Krain, for a Q&A session covering doctors’ most frequently asked EMR questions.
To kick off the discussion, tell us – what is an EMR?
We already know that EMR stands for ‘electronic medical record’ but in practice, an EMR is essentially an electronic version of anything you would typically find in a yellow paper file. It’s a digital representation of that clinical information you have on your patient.
And what would you say is the purpose of an EMR?
The purpose of an EMR is to have all the right patient information available and accessible quickly and reliably, from any location. An EMR facilitates this by easily summarising patient data to highlight important information (such as allergies and conditions) and clinical trends. In summary, the purpose of an EMR is to improve patient care by giving the treating doctor – or doctors – relevant data, in a structured manner that will enhance their care decisions.
You’ve touched on improved patient care as a benefit of EMRs. What are some of the other main benefits?
So, in addition to doctors having access to clinical information wherever he or she is, some of the other benefits include the fact that nothing gets lost and you have a more complete picture of the patient’s health. You don’t have to scroll or page through reams of information – it’s organised in such a way that if there’s anything of critical importance it will stand out immediately. And the structure of that data stays the same, regardless of the doctor who contributed to it. Continuity of care is improved because everyone in a multidisciplinary team has access to the same information.
What are some of the main pitfalls of implementing an EMR?
One of the main pitfalls is trying to do everything on day one. It needs to be a digital journey and every practice is different. If a solution you’re considering is saying you can go digital immediately, it should raise alarm bells.
The second pitfall is not including the admin side of the business in that digital journey. So, we talk about the storing and organising of clinical information for the doctor, but there needs to be a seamless workflow integration of the admin side of your business. By including that into your criteria for going digital – you save a lot of time and administrative burden for yourself and your staff. An EMR that’s designed for both clinical and admin workflow will mean you know instantly who’s in your waiting room, why they’re there, where to access their folder – there are no missing files or misplaced documents – how to bill them and more. You don’t want to implement an EMR that doesn’t include the admin process – admin is part of the clinical process.
Another pitfall is when practices adopt an EMR system that only works in one way and tries to shoehorn you into the technology’s workflow, rather than making your workflow (and practice) more efficient and effective.
The last of the major pitfalls is implementing a system that claims to do everything. The best products do the essential things really well rather than everything. EMRs that have lots of features are also usually very complicated. What you want is a system that is easy to use and enables the doctor-patient engagement because it’s about the patient, not the system itself.
How long is it likely to take to be up and running on an EMR?
The time it takes to get up and running depends on the practice. If you’re a brand-new practice, you can be using the system on day one. If you are an older practice with existing paper-based patient records or legacy systems and processes, you should give yourself more time to fully implement the system. It’s best not to put too much emphasis on how long it’s going to take, but rather focus on having a good, seamless experience with both the system and your technology partner.
Given that there are so many EMR options available to doctors in private practice, how do you go about purchasing one?
I think it’s always best to look for a solution that has been designed specifically for your speciality. We focus on General Practitioners (GPs) first to make sure that the system delivers what GPs in private practice need. A lot of general EMRs don’t cater for how a GP’s practice would typically run.
Ideally, look for a local solution. International solutions have features and even healthcare terminologies that we don’t use or need in South Africa and it just adds clutter and complexity to the system or a medical practice.
As we talked about earlier, look for a system that integrates the admin and billing side of your practice. You want to be sure that your clinical information can be converted to billing information without duplicating effort or needing to sign in and out of systems to manage patients and your practice. And bear in mind that a good EMR brings benefit to the admin person too – not just the doctor.
Lastly, don’t get caught up in trying to compare lists of features. Figure out what exactly your practice needs and make sure that the EMR can meet those needs.
How do I convert my paper-based patient files to electronic medical records?
A key feature of an EMR is how it allows you to scan historic files and make them readily available in your electronic record. So, you can have a combination of the data you’ve captured electronically and your historical paper files. That has got to be incredibly easy and straightforward to do otherwise you will end up with a messy hybrid solution of your paper and digital systems. Essentially that means, take a picture or scan and upload the documents into the patients’ digital folder and it’s something that admin staff can do, not just the doctor.
When deciding your upload strategy use the size of your practice, how many patient files you have, the make up of chronic vs acute patients, etc. as guidance as to how you should be going about transferring files from paper to digital. This is something you should be able to engage with your solution partner to make it as easy as possible.
How safe is my data on an EMR?
Digital security is actually a lot safer than physical security. For example, there’s no way of knowing when a paper file goes missing, unless maybe when you need it and can’t find it. That doesn’t happen with electronic records. It’s similar to internet banking – initially it was met with caution and uncertainty, but I think most people would agree that it’s safer to pay for something electronically than to manually draw and carry cash from an ATM.
So how safe is your data? It’s actually safer than having it on paper. And as a doctor, it reduces your risk that are the result of misplaced files, unauthorised access, missing information, incomplete or incorrect information.
How do I know if an EMR is POPI compliant?
The most direct route is to ask the solution provider the question but it’s actually more than a simple yes or no. Some good questions to ask are: what steps are you taking to remain POPI compliant? How are you staying abreast and ahead of the latest security challenges and risks? Bearing in mind that security goes much broader than POPI compliance.
What happens when a doctor retires? How long do they have access to the notes, for example, for legal reasons?
A good question to ask when choosing a system is what happens if I want to leave the practice? A good EMR, who has the patient and doctor’s best interests at heart and the legalities around storing patient files, should allow that doctor to access those records for the stipulated amount of time, at least.
Can you customise EMRs?
Some EMRs can be customised, and others not. You should look for an EMR that doesn’t just turn features on and off, but can actually be tailored to your typical workflow. More than being tailored– you want to be able to be able to configure it for the way your practice works and your unique needs.
Are EMRs integrated with medical aid schemes?
The good ones are. An EMR that is integrated and can immediately send a claim through and will save a practice a lot of time and effort. So, if it can convert the clinical encounter into a claim and give practices the option of submitting it straight to the medical schemes, you have a better chance of collecting payment before the patient leaves the practice.
How do EMRs help with Telehealth appointments?
Again, a good EMR will have telehealth functionality built into it that will allow doctors to capture patient information while conducting the consult at the same time. It’s more than being integrated but the components actually work together – so a doctor is able to do everything without having to switch between tabs or solutions or devices or browsers. An EMR that truly enables telehealth will also alert doctors to when a patient has arrived for their consult, and help you manage the waiting times so you don’t have any delays or wasted time waiting for patients to log on, etc. A good EMR will also notify the patient with reminders about their appointment and how to access it.
And lastly, an EMR that understands the value and disruption that telehealth will likely bring to doctors’ visits as we know it will consider the legal aspects of a telehealth consultation. A good EMR will have an audit of what took place in the consultation, whether there were clinical notes captured, how long the consultation was. It essentially helps you with terms and conditions, patient consent, security, the patient journey, and the legal side – not purely just a video call.
Any closing thoughts on EMRs?
Only that a good EMR is the foundation for a thriving practice. It really should be the enabler to allow you to pivot or innovate to the current climate, as we’ve just seen with the impact of COVID-19. For everything from delivering better quality patient care, to improving your practices finances to reducing admin and errors, a good EMR in the right hands can help you realise the best practice you can imagine for yourself.
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