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EHR implementation pitfalls can be costly

Dr. Krasner
National report — Potential problems that can arise with electronic health record (EHR) implementations range from technical difficulties to legal wrangling over responsibility for the necessary hardware, software and data, say two dermatologists and a lawyer.

A major reason for implementing EHRs is to avoid penalties that will be assessed starting in 2015 under the American Recovery and Reinvestment Act, says Maithily A. Nandedkar, M.D., a dermatologist in private practice in Reston, Va. "But when I started five years ago, I did it just to be efficient," and she says the system she chose has met this goal.

"One of the best capabilities I've found with my EHR system is that I can access all my charts from home," Dr. Nandedkar says. "If a patient calls, I can document that immediately," and notify a staff member who may need to answer the patient's question. "Some malpractice carriers are offering a discount for being able to e-prescribe and document with electronic medical records (EMRs)," she says.

Dr. Nandedkar says her practice has had these capabilities for more than five years, although her malpractice carrier does not discount for them. The e-prescribing program even alerts her to potential medication interactions. "As soon as I see a patient," she says, "I document and bill the encounter, so my cash flow stays consistent."

Dr. Nandedkar says she finds EHRs more efficient than paper. "But if you feel more comfortable implementing e-prescribing first, then do so," she says.

The same goes for dermatologists who want to use an EHR system separate from their practice management system. "There's no rule that makes one thing better than another," she says. "It's just whatever works for you."

Dr. Nandedkar's implementation tips include the following:

  • When scanning in patient charts, "Just scan the charts of patients you're seeing now. Don't scan all your old charts in. It's too cumbersome and inefficient," she says.
  • When initially implementing EHRs, "Don't see as many patients. See one or two patients per hour for the first week. You're going to have to bite the bullet and lose money, but it's a means to an end. It doesn't take forever to learn Microsoft Word, and it won't take forever to learn your system."
  • When interfacing with a lab or other vendor, "Make sure they're paying for the interface, not you. They're benefiting financially from you sending patients to their lab."
  • Regardless of what type of mobile computers one chooses, "I definitely recommend Wi-Fi. Don't use a big hardwired computer in the exam room." For Health Insurance Portability and Accountability Act (HIPAA) purposes, "It's better just to close the laptop and walk out of the room," she says.
  • Before signing a maintenance agreement, "Find out what it's going to cost you if the system goes down." When her EHR system crashed the day after Thanksgiving, Dr. Nandedkar paid nothing extra because a provision to have her service transferred to an alternate server was in her contract.

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