Electronic medical record systems will not reduce all claims denials

June 1, 2011

I am a total proponent of the use of technology. As the owner of two single-specialty billing services, I know the value of using the latest technology to save time, optimize the use of human resources, increase efficiency, reduce errors and redundancy and keep the planet "green." But I want providers to have realistic expectations of what an EMR can offer with respect to billing for services rendered and getting paid by insurance carriers.

Key Points

In the medical practice, failure to utilize the latest technology can cost the practice lost revenue, increase staffing costs and give the practice an outdated, behind-the-times reputation. Patient portals, websites, electronic funds transfer, e-prescribing and automatic remittance are just a few of the options providers can use in their practices.

Right now, the big buzzword is EMR (electronic medical record), also known as the electronic health record (EHR). I prefer to use EMR because when I key in EHR, the computer always autocorrects it to "HER."

First, let's cover a few of the "must haves" that should be part of the EMR you are purchasing for your practice:

Dermatology specificity - You do not want to purchase a system that was designed for family practice and then "revamped" to fit dermatology. Dermatology is a unique specialty that requires a unique EMR.

The guts must be in it - Just like Ragu spaghetti sauce, everything you need in the form of templates, forms, formatting, macros, etc., to generate a progress, procedure or operative note must be an inherent part of the software you purchase. If you have to spend months developing the guts before you can start using it, forget it and move on to another company.

It should be fast - Seconds count in charting ... whether by hand or electronically.

No screen jumping - If you have to switch screens in order to move from one type of documentation to another (for example, documenting an E/M visit that includes an excision), that is not good. It takes time, and time is money.

Minimal typing - The best EMR is one that allows you to generate a medical chart note without having to write or type. Touchscreen technology is the only way to go.

A concise note - After you have clicked and tapped, you should end up with a chart note that makes sense, is easy to read and is formatted as if you had generated a handwritten chart note. If every chart note ends up with four pages of text for a normal dermatology encounter, move on to the next demo.

Flexibility and uniqueness - If every chart note ends up looking exactly the same as the one before, you are looking at potential issues with fraud and over-utilization triggering audits. The system you use should allow you to generate a note unique to that patient and the problems that patient presents. No two charts should ever look the same.

Too many defaults - The system should have a minimal amount of defaults with respect to charting - especially with the generation of E/M visits. For example, the system should not assume what body areas you reviewed by merely clicking on "full body exam." You must click on each area examined during the visit without any defaults. These types of defaults have a high potential for fraud and overutilization, as well as the auditors questioning the integrity of the chart note.