Electronic medical records can boost bottom line

Chicago-The question of whether electronic medical records (EMRs) are cost effective in single or multiple offices is answered with a resounding "yes" by J. Gregory Rosenthal, MD, who outlined various reasons.

"If a physician chooses a good EMR system and uses it, it is beyond cost effective and can legitimately add $50,000 or more to his or her bottom line, depending on the degree of utilization. It can make a practice nearly audit-proof, can eliminate dropped charges, make ophthalmologists ready for the upcoming pay-for-performance program of physician assessment, and save a great deal of time," Dr. Rosenthal said at the retina subspecialty day at the American Academy of Ophthalmology annual meeting.

He said he believes so strongly in incorporating this technology into a medical practice that he referred to it as "a financial imperative."

The cost-savings can be significant because for the first time the documentation can fully support the coding, there can be an auto-auditing capability, and there are no more lost charges. In fact, the EMR can be used to do transcription, which for the average retina specialist can cost about $12,000 a year. These advantages can immediately offset the cost of most systems, said Dr. Rosenthal, a partner at Vision Associates Inc., and an informatics consultant with Systemedics Inc., Toledo, OH.

"In our first year using an EMR system, it cost our practice about $10,000 per physician in amortized expense and added about three times that amount per doctor to our bottom line," Dr. Rosenthal explained.

With regard to evaluation and management (E/M) coding alone, the EMR system provides much better documentation that allows physicians to achieve better documentation and legitimately and honestly achieve a higher E/M code with much less fear of an audit.

He recounted the unexpected arrival of a commercial payer who planned to audit the practice charts over the course of 1 week. The auditor left, satisfied after 20 minutes of chart review, according to Dr. Rosenthal.

Eliminating "time leaks" is another extremely important advantage of integrating an EMR into a medical practice.

"If a physician can save 10 seconds here and 20 seconds there, this efficiency can translate into 20 to 30 minutes at the end of a 40-patient day," he said. "Our system creates the chart note and the letter as we work, thus eliminating the normal 45 minutes of dictation at the end of the day. In my experience the EMR saves me about 1 hour a day."

This time-savings enables the physician to see about 20% more patients in the same time.

The enhanced efficiency reduces stress, Dr. Rosenthal said. Since it is flexible, using it is an enjoyable experience. There are, he added, imperatives for maximum value that allow a better, cost-effective experience.

"In my opinion, it is absolutely essential to have a true, searchable, nonproprietary database that allows the physician to have minimal dependence on the vendor," Dr. Rosenthal advised. "The physician should have complete and easy control of the template and be able to change it based on the needs of the practice without incurring vendor costs. It is also imperative to have the billing system and the EMR system connected to each other."

The status of the vendor is a factor that may be overlooked. The vendor must be financially stable.

Strive for live interfaces

Another key feature is to have good interfaces, especially to imaging systems. Dr. Rosenthal prefers live interfaces.

"This is very possible to accomplish and better than having static images," he said. "Physicians should have a photo archiving and communications system (PACS) not only to collate different types of imaging data but also to communicate with colleagues."

Managing charts for satellite office(s) in a paper environment can be a clerical and overhead nightmare, according to Dr. Rosenthal. Either the satellite office(s) must have a separate charting system or the charts must be moved back and forth among offices.

"With a good EMR, managing charts in a satellite office should be no different from being in the home office," he stated.