Hundreds of EMR vendors, from giants such as AllScripts, GE Healthcare and McKesson to low-priced online medical record services, are competing for the business of hospital and medical practice groups that are expected to adopt HITECH compliant electronic records systems in the next two years. With its roots in the medical transcription market, MxSecure management believes that combining transcription and EMR adoption can improve physician efficiency and the quality of patient care. MedHealthWorld spoke to Colin Christie, MxSecure president and CEO, about his take on the stubbornly slow EMR adoption rate among small medical practices, as well as his company’s integrated EMR solution.
MedHealthWorld (MHW): MxSecure has been providing services to physician practices and community health centers since 2003. What do you see as barriers to EMR adoption among your customers and other medical practices that have not yet adopted electronic health record systems?
Colin Christie (CC): There are multiple reasons behind lack of adoption, especially among smaller physician groups where doctors have to focus on office and practice management efficiency, along with improving patient care. In the early 2000s, most EMR systems were extremely expensive. It was hard for small practices to cost justify the transition from paper records. We saw EMR vendors who wanted to identify cost savings to convince practices to forgo transcription services and substitute an EMR system where the record entries substituted for dictation. I personally think that contributed to the slow adoption of the early EMRs, because many doctors didn’t actually want to give up transcription services and take on the work of entering their own data into a records system.
MHW: Doesn’t the HITECH incentive program to reimburse the cost of EMR implementation eliminate that barrier?
CC: Only in part. Remember, HITECH compliance comes with a larger cost to medical practice groups, especially if it means changing long-standing processes for office management, billing and reimbursement, prescribing and so on. So doctors are not by any means rushing into converting their systems. Our transcription client base includes over 500 small practices and the physician’s priority is to ensure that implementing a new EMR system doesn’t overwhelm the operation of the practice. Our customers want to discuss how to make incremental progress with EMR adoption in ways that will improve patient care and increase office efficiency. That is more important to them than the reimbursement and meaningful use mandates.
MHW: What is MxSecure doing to address these concerns?
CC: In designing MxChart, our EMR system, we focused first on usability and ease of implementation and integration for the medical office. From our experience with transcription services, we know that every small practice is different. So MxChart supports selectable work flow and customization options to allow each practice to match the use of the EMR to how they operate best. MxChart can be implemented as the closest thing to the paper record from the physician interface perspective, which is important for doctors who are not really excited about technology for its own sake – they want to treat patients and run their practice efficiently rather than learn new systems. Offering a familiar user experience is highly valued – many systems are over populated with buttons and input screens. Of course, MxChart has all the core features of certified EMR systems, but this emphasis on user control of the interface sets us apart from many other solutions. Every customer can decide where they want to start and how many features to use; some start with just e-prescribing, while others start with accounting and patient management
MHW: How long does it take small medical practices to implement?
CC: Because MxChart is a cloud-based, browser accessible system, implementation is very fast. In offices with one to five doctors, we have seen clients go live in just a few days after a half day of training. That time line is very different from large vendor EMR solutions that require a big investment in the installation, training, and maintenance of the system.
MHW: How do your current transcription services integrate with MxChart?
CC: For our existing clients, MxChart and Transcribe are seamlessly integrated from day one – all records and notes that have been previously transcribed are ready to go into the EMR.
For new clients, we think there is a real value in implementing both EMR and transcription services. Electronic record adoption shouldn’t turn the doctor or any care provider into a data entry clerk. But many of the EMR systems are so keyboard entry oriented that when the care provider has to use the system during a patient visit it really detracts from face to face patient interaction. I believe dictation is still a very powerful and natural tool for doctors that should be complementary to the EMR. Even beyond time efficiency, dictation touches on a quality of care issue. Dictated medical records and patient notes are not limited by an electronic record with pre-designed templates and field entries. The doctor can document each patient encounter and diagnosis in individual words, and the record adapts to those notes rather than the other way around.
MxSecure makes it cost effective to have both transcription services and EMR systems work well together.
MedHealthWorld covers developments related to the HITECH meaningful use requirements and analyzes issues that impact EMR adoption
Dr. Cronin is a Professor of Management in the Information Systems Department at Boston College. To read more of her articles, please visit her columnist page.
Edited by Jaclyn Allard