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It’s time for the next installment in my series of posts looking at the long list of EHR benefits . Eliminate Staff The idea of eliminating staff is a really hard one to talk about. Often the staff in a medical office becomes a family and so it’s really hard to think about losing a staff member in order to pay for the EMR. In fact, it’s incredibly common for staff in a clinic to fear an EMR implementation because they’re afraid that their job is in jeopardy. From my experience, it’s incredibly rare for any existing staff to lose their job during an EMR implementation. There are two main reasons why it’s unlikely that someone will lose their job because of an EMR implementation. The first is that most healthcare organizations have a natural employee attrition. When this happens the organization can just choose to not replace the departing employee. This is one way to save money on staff without having to actually fire any employees. The second reason that people don’t lose their job to the EMR is that those people get reassigned to new jobs. For some people this can be nearly as bad as losing a job, but for many it’s basically a shift in job responsibilities. This shift can often be welcome since the EMR implementation can free them up to do work that they always wanted to do and never were able to do before. The areas of healthcare that I’ve seen most affected by an EMR implementation is medical records, transcription, billing, and the front desk. We’ve already written previously about transcription and EMR . The front desk and billing can be affected, but generally stays close to the same from what I’ve seen. A lot of this depends a lot on what type of staffing you had before the EMR. I have seen some organizations implement an EMR and save money on front desk and billing staff. Medical records (or HIM if you prefer) is usually the most impacted. Certainly they still have an important place in the office for things like release of records and other records management functions. They also have to continue to deal with the legacy paper charts. However, their days of finding, organizing and filing charts are over when an EMR is put in place. In some cases the chart organizing and finding gets replaced with things like scanning into the EMR. In other cases, there isn’t as many medical records staff needed. Many who are reading this post are probably balking at the idea of eliminating staff being a benefit of an EMR implementation. They’d no doubt point to the EHR backlash that we see from many doctors who complain that an EMR makes them much slower and takes up too much time. This is an important item to consider when evaluating the benefits of an EMR in your organization. It’s not much of a benefit to save other staff cost if the doctor spends twice as much time per patient. However, on the other side of the coin is those doctors who swear by the efficiency their EMR provides them. I’ll never forget this older OB/GYN I met who told me he would NEVER use an EMR. Two years later that same OB/GYN was proclaiming his love of EMR. He described how he wouldn’t be able to see nearly as many patients as he did each day without the EMR. He acknowledged the slow down that occurred when they first implemented the EMR, but once they adapted to the EMR workflow they were able to see most patients. No doubt Eliminating Staff can be a mixed EMR benefit basket depending on your unique situation. Although, this is true with almost every EMR benefit we’ll cover in this series. This can be a tremendous benefit of EMR or it can also be an expense as you find you need to hire more staff. Related Whitepaper: Getting Lean with Your Practice: Five Tips for Improving Provider Productivity with an EHR One of the major reasons that health care providers resist implementing an electronic health record (EHR) system is the belief that using it will slow them down, reducing the number of patients they can see and therefore reducing practice revenue. In fact, an EHR that is designed around an efficient workflow can enable providers to work faster and more efficiently. “Lean” methodologies, originally introduced by Toyota, have recently been used by health care providers such as Massachusetts General Hospital, ThedaCare, and Beth Israel Hospital (Boston) to streamline patient workflow. By understanding and measuring the workflow, health care providers can determine best practices, which will ultimately enable them to achieve the level of efficiency they desire. Download Whitepaper or see More EMR and Health IT Whitepapers Related Posts EHR Benefit – Space Savings EHR Benefit – Accessibility of Charts EHR Benefit – Legibility of Notes

Recently I was asked if SaaS/Cloud computing is appropriate for small practice EHR hosting. I responded “SaaS in general is good. However, most SaaS is neither private nor secure. Current regulatory and compliance mandates require that you find a cloud hosting firm which will indemnify you against privacy breeches caused by security issues in the SaaS hosting facility. Also, SaaS is only as good as the internet connections of the client sites.   We’ve had a great deal of experience with ‘last mile’ issues” To add further detail, Bill Gillis, the CIO of the Beth Israel Deaconess Care Organization (BIDCO) responded “We built, manage & maintain our own private cloud in a Co-location facility.  Our EHR cloud is served to the practice via public internet over SSL. One challenge we struggle with is ISP availability and service level/stability.  In Metro Boston one would expect a robust internet infrastructure.  We’ve found heterogeneous public internet capabilities and quality of service.  We’ve found that getting a good ping response is not truly an indicator of meeting application performance requirements.  Many cloud hosted applications are sensitive to latency, packet loss, fragmentation & jitter. In the first year of our project deployment we struggled because the ISP connectivity did not appear to be the culprit.  A practice would have 10+ megabit connections with ping returns under 25ms.  Yet the practice would experience application freezing, crashes or very poor/slow response time.  From the public ISP’s perspective ‘the lights were green’ and they would take no further action.  After engaging third party network sniffing firm, we discovered the real culprit impacting performance – network latency.  We were able to take the data from that engagement back to the ISP to illustrate the problems with the packets in transit. Implementing network sniffing engagement was time consuming and costly.  Doing this for the 100+ practice locations we were supporting is not sustainable.  Luckily we found a company in Boston called Apparent Networks (now called Appneta ).  Appneta makes a small, low cost black box application that provides deep and detailed network data back to a secure cloud.  We place a device in a practice that communicates back to a device we keep in our hosted/central site.  The devices continually communicate with each other and log all of the various degrees of network performance up to the cloud.  The best part is we preconfigure the devices and mail them to the practices reporting issues.  All the practice staff need to do is provide power and plug it into an open Ethernet port.  This saves us from deploying a technician on-site.  Since we first deployed these devices we’ve been able to get to the root cause of performance issues and resolve them rapidly.  We’ve been able to identify everything from an ISP charging for a certain level of bandwidth while only providing 1/2 that speed to staff streaming media during high volume hours saturating the local router.  The performance data is stored in the cloud indefinitely.  This give us a longitudinal view of the network/internet connectivity for a specific practice.  Recently we were able to avoid a potential issue by noticing that a practice’s connection stability was slowly degrading over the past year.  We were able to work with the ISP to discover they had an issue with a local Central Office/substation.  The reality is most ISP’s are not that willing to work with us until we show them the data.  Once we have the smoking gun, they tend to dig deeper and work with us to resolve the problems.  For all the high-tech equipment we’ve leveraged for our private cloud, this device was the real swiss army knife of the project.” I’ve described Cloud Computing as “your mess run by someone else”.   It can be done successfully, but SaaS is only as good as the privacy protections you purchase or build yourself.   Performance is only as good as your network connection. I hope this is helpful.

Beth Israel Deaconess Medical Center (BIDMC), a teaching hospital of Harvard Medical School, has deployed software from Oceanport, N.J.-based CommVault Simpana for improved patient care through increased data protection, simplified HIPAA compliance, and expedited access to vital medical records. Beth Israel Deaconess Medical Center (BIDMC), a teaching hospital of Harvard Medical School, has deployed software from Oceanport, N.J.-based CommVault Simpana for improved patient care through increased data protection, simplified HIPAA compliance, and expedited access to vital medical records. read more

Today’s EHR and HIT news includes news from Advanced Data Systems on their latest Black Book Rankings, customer news from CommVault and TriMed Technologies as well as ‘go live’ news from Advantas . Black Book Rankings Names Advanced Data Systems the 2013 Leading EHR Vendor in Pain Management Black Book Rankings has named Advanced Data Systems (ADS) as the 2013 Leading EHR Vendor in Pain Management. ADS scored an impressive 9.61 rating of an overall best possible rating of 10

Every day CIOs are inundated with buzzword-compliant products – BYOD, Cloud, Instant Messaging,  Software as a Service, and Social Networking.

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