TURNING DATA INTO
INTELLIGENCE WITH ELECTRONIC INFORMATION SYSTEMS OR THE EMR
You are listening ReachMD XM157, the channel for medical
professionals. Welcome to GI Insights where we cover the latest clinical
issues, trends, and technologies in gastroenterological practice. GI Insights
is brought to you by AGA Institute and sponsored by Takeda Pharmaceuticals
North America.
Your host for GI Insights is Professor of Medicine and
Director of the Digestive Disease Center at the Medical University of South
Carolina, Dr. Mark Delegge.
DR. MARK DELEGGE:
For a variety of reasons, physicians have been slow to
adapt the electronic medical records system or the EMR, for instance, I think
it is currently estimated that less than 15% of gastroenterologists have
actually implemented an electronic medical record system with even fewer of
those actually having fully implemented these systems. Joining us to discuss
this, turning data into intelligence with electronic information systems is Dr.
Larry Kosinski, Managing Partner of Alegent Gastroenterology that’s an eighth
positioned single specialty GI practice in the Northwest Suburbs of beautiful
Chicago. Dr. Kosinski is also a Member of the AGA Practice Management in
Economics Committee.
Welcome Larry.
DR. LARRY KOSINSKI:
Well, thank you for having me.
DR. MARK DELEGGE:
Larry, it seems like we are stuck on the pen and paper
here. First of all, just to get started, what is EMR, what does that mean,
what’s an electronic medical record?
DR. LARRY KOSINSKI:
Well, your electronic medical record is basically the
transformation of what is traditionally the patient's chart into an electronic format.
So, it consists of the doctor's notes as well as the notes of phone messages,
there are also all the laboratory results, the imaging results, procedure
results, all the things that would usually be maintained in a patient's paper
record is what winds up being the electronic medical record.
DR. MARK DELEGGE:
Is there just one EMR, I mean is there something just called
the EMR or is this something that’s commercially available from a number of
vendors.
DR. LARRY KOSINSKI:
The EMR industry is markedly fragmented. There are
currently over 300 different companies that are making some form of an
electronic medical record. There are very large companies that dominate the
market, but it is a very significantly fragmented industry and we expect that over
the next few years, this is going to continue to consolidate until we have a
much, much smaller number of vendors.
DR. MARK DELEGGE:
Larry, as a gastroenterologist, I do have some concerns,
patient's safety is one, but the other one is actually compliance and billing.
So, does the EMR actually help me with that, to stay compliant with say when I
am charging for a consultation or a new visit or perhaps even a procedure.
DR. LARRY KOSINSKI:
Probably one of the earliest pieces of the EMR that was
digitalized was what we called Charge Capture or capture of the essential
elements of your patient's visit, the patient name, the date, the location of
the service, the physician's name, the referral doctor, the CPT code which is
actually what you perform, and one or more ICD9s, which are the diagnoses.
This encounter data was probably one of the earliest things that was ever
incorporated into digital systems and it became part of our practice management
systems. Unfortunately, for many, many years, until recently, physician's
still submitted their bills on paper to their billing staff and the billing
staff would then digitalize it by entering into practice management systems.
Today, we have the opportunity to work with software that allows you to take
your encounter data and maximize how it is implemented into a digital format.
For instance, we perform services that fall under 2 categories: Evaluation and
management services, which are outpatient visits, and procedural services.
Evaluation and management services have to be coded in the system, it’s quite
complex. Most physicians are very uncomfortable in dealing with this, but
there today are many systems available to us, which can assist us in obtaining
the correct code for the service we are performing, and in many cases, this
winds up increasing the level of code and thereby the reimbursement you
receive.
DR. MARK DELEGGE:
Now Larry, I see in front a billing sheet and I am wondering
whether it’s a level 3 or level 4 or level 5, sounds like this takes the guess
work out of it.
DR. LARRY KOSINSKI:
The better systems do specifically the medical decision
making. We all basically have the ability to perform a history and a physical
examination that conforms to the systems that are necessary, where most of us
tend to down code is on our medical decision making and most of us need to
remember that these specific pieces of information are the tools we can use to
prove that the service we are providing fits into a certain category and there
are systems today that enable us to do this quite nicely.
DR. MARK DELEGGE:
Now one of the issues that I always see to in my office is
communication with my own staff meaning I am trying to get a point across to
the nurses or they are trying to tell me something about the patient and we are
writing things down on a little scrap of paper or may be jotting it into the
chart or perhaps the chart is not seen. Can you communicate with your staff in
your office using this EMR tool?
DR. LARRY KOSINSKI:
EMR is one of the biggest strengths as in communications.
The person you need to communicate the most with is yourself though. When I
perform a procedure or when I see a patient in the office, I need to prompt
myself to remember to do certain things. For instance, if I perform a
colonoscopy lets say and I remove a polyp, a pathology report is going to be
generated on that, I need to communicate with myself that a path report is
hanging out there on this patient. So what our system does, our system automatically
generates a message in our inbox that that pathology report is sitting out
there. When the report arrives, the receptionist would then change that
message that’s in my box from results sent to results available. So now I know
that the report is there, I can then using a series of dropdowns decide what I
want to do with that patient, whether I want to bring the patient back in 3
years or 5 years. I can even send the letter to the primary care doctor from
the EMR and without me having to make the phone call at all, I can direct the
type of conversation that my nursing staff has with my patient. Of course,
there are many cases where we have to speak with the patient directly, but the
EMR allows you to improve the communications and to make sure you do not forget
that you ordered a CAT scan on the patient. You ordered some other type of
imaging study, the EMR generates that prompt in your inbox as soon as you
generate the order. It’s very useful.
DR. MARK DELEGGE:
If you are just tuning in, you are listening to GI
Insights on ReachMD XM157, the channel for medical professionals. I am your
host, Dr. Mark Delegge, and joining me today to discuss turning data into
intelligence with electronic information systems or the EMR is Dr. Larry
Kosinski, Managing Partner of Alegent Gastroenterology in Alegent, Illinois.
Larry, another thing and you alluded to this as the fact
that communication with other physicians is very important. I cannot tell you
how many times things get missed or mis‑communicated. If I am hearing
you right, EMR allows you to communicate more effectively with other
physicians.
DR. LARRY KOSINSKI:
It definitely does. If I see a patient in the office as I
am putting in my bill, my electronic bill at the end of the service, when I save
that bill, it automatically notes the fact that I have performed a consultation
lets say, well you cannot bill for a consultation today unless you send an
accompanying letter to the primary care doctor, you cannot just fax your office
note to the PCP, you have to have a letter attached to it in order to bill for
a consultation, so the software realizes that you just performed a
consultation. It knows who the primary care doctor is because that’s already
on the bill and so a window pops up and says do you want to send a letter to
the primary care doctor and when you say yes, it will automatically place your
impression and plan in the letter so that the PCP gets direct communications.
By the time the patient is getting into the car to leave the office, the
primary care doctor already has a copy of your office note and an accompanying
letter. This is essential today. The primary care doctors demand this,
specifically many of them are practice carriers also require this degree of
communications. So that every time you see another physician's patient, that
physician should be receiving some type of referral letter.
DR. MARK DELEGGE:
Larry, I have also heard that we are being asked by our
mother organizations like the AGA and some insurance cares and frankly Medicare
to do a lot of practice performance improvement and I know for GI
re-certification on the boards, that’s an important topic. So, if I have this
EMR system and I wanted to do practice performance improvement, could I do it?
DR. LARRY KOSINSKI:
Yes, and in fact, we do this all the time. In order to
maintain our accreditation, we have the performance improvement studies; we
usually perform 3 or 4 of them per year.
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