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One of the major changes facing physicians is the switch from paper to electronic clinical records. While adoption remains slow, the Centers for Medicare and Medicaid Services (CMS) is trying to advance the process through its EHR Incentive Program, which pays providers up to $63,750 to adopt electronic health records (EHRs).

As healthcare technology advances exponentially and deadlines approach, many providers find themselves scrambling to install equipment only to see it quickly become outdated. Systems that are not able to change with the times will become tools of a bygone era.

Many doctors looking to purchase a records system are unaware of the significant difference between electronic medical records (EMRs) and EHRs. An EMR will make it extremely difficult to not only attest for Meaningful Use and EHR incentives, but to improve the quality of care as well.

This whitepaper will discuss the differences between EMRs and EHRs, why EHRs make it easier to attest for Meaningful Use, and how they can improve patient management and outcomes.

ealth care is going through a period of change unlike any other in the modern era. Evolving code sets, Meaningful Use criteria and reporting requirements are making it increasingly difficult for doctors to stay up to date on everything necessary to run a successful practice.H

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Breaking RecordsIt all began with paper records, which can work for a single physician providing care, but make sharing health care information across providers more difficult. Notes scribbled in the margin, blurry faxes and inconsistent shorthand can lead to errors, delays and a degraded level of care.

EMRs were the next step, giving healthcare providers the ability to create a record that allowed for a third party to independently verify diagnoses and treatments. First introduced by Lawrence Weed, MD, in the 1960s, EMRs were a major step forward in medicine; however, any system developed over 50 years ago could not be prepared for the technology requirements of today.

EHRs take the progress made over decades of EMR use and incorporate it into a system that gives providers greater accessibility, flexibility and functionality. The evolution of how music is shared and enjoyed is a great example of how technology can provide an improved experience for the user.

Records, Discs and CloudsLike the paper chart, the album was an early delivery mechanism for information. It was great for listening to music in one place but it could easily be broken or scratched, making it difficult to transport and share. Finding the exact song you wanted was somewhat challenging. If you wanted to listen to your music somewhere else, you had to delicately load your albums into a crate or bag, lug them around and protect them.

Compact discs provided a compressed version of the record that was easier to transport, gave greater access to specific files and delivered a clearer sound. As with an EMR, transporting data was still challenging, but the carrying case wasn’t as large. Music could be better protected and transported, and you could make copies to share with friends, but those CDs still had to be delivered manually.

With the advent of digital music, the way we store, transport, share and enjoy our music changed forever. Services like iTunes warehouse your music in the cloud, much like an EHR does with health records, giving you nearly unlimited storage and access to any and all of your content anywhere you are. You can listen to your favorite artists on your computer, phone, tablet and/or TV. Cloud-based storage protects your music files from physical damage, makes them easily transportable and gives you greater access to enjoy and share them.

Utilizing EHRs to share information and collaborate in real time provides a complete picture of a patient’s health, instead of forcing you to manually pass pieces back and forth between the care team.

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EHR vs. EMR: Why One Letter MattersWhile only one letter differentiates EHR and EMR, that little variation makes a big difference. Oftentimes the two terms are used interchangeably, but they are not the same thing. The word sandwiched between electronic and record in each term changes the meaning of the phrase – with the main differences being comprehensiveness of the record and interoperability.

Definition of EMRThe Office of the National Coordinator for Health Information Technology (ONC) defines an EMR as “a digital version of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of the patients in one practice.”

EMRs provide some advantages over paper charts, such as:

• Data tracking over time• The ability to quickly identify patients due for preventive screenings or checkups• Tracking patient parameters like blood pressure results or vaccinations• Monitoring and improving the quality of patient care within the practice

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However, these advantages are confined to the single practice where the EMR is being used. Patient records aren’t easily shared outside of the practice and may even have to be printed and mailed to specialists or other care providers, creating opportunities for mistakes and delays in the care process.

Definition of EHRThe ONC states that EHRs provide all the benefits of EMRs plus the interoperability necessary for diverse systems to work together:

EHRs focus on the total health of the patient—going beyond standard clinical data collected in the provider’s office and inclusive of a broader view on a patient’s care. EHRs are designed to reach out beyond the health organization that originally collects and compiles the information. They are built to share information with other health care providers, such as laboratories and specialists, so they contain information from all the clinicians involved in the patient’s care.

The ability to easily create, manage and share patient data across separate organizations will streamline health care, reduce redundancies and improve patient outcomes. Providing the best care possible for patients requires teamwork – and EHRs provide a secure way for clinicians, pharmacies and patients to work together toward better outcomes.

Incorporating all of the participants in the healthcare team – including the patient – into the healthcare process is one of the key expectations of the Stage-1 Meaningful Use requirements. Qualifying for the EHR Incentive Program will be much easier with a Meaningful Use certified EHR than with an outdated EMR system.

Comparing TechnologyIn a survey conducted by the Medical Group Management Association (MGMA), 47.3 percent of respondents rated themselves ‘unsatisfied’ to ‘very unsatisfied’ with their current EMR system. Collaboration is a major differentiator when it comes to EHR and EMR systems, each with varying methods of deployment.

EMR systems are generally client-server based, meaning a closed system where the data is stored on a server inside the practice and difficult to share with other organizations. The practice owns the system and is responsible for the cost, upkeep and security of the hardware.

EHRs can be run on either client-server technology or cloud-based based systems. Client-server EHRs make sharing easier, but present IT cost and management headaches similar to the EMR system. Cloud-based EHRs are hosted on external servers and allow access to data from any computer with an Internet connection. The cost of this deployment method is generally a predictable monthly fee. Storing, sharing and collaborating on patient data is easier in these systems.

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Benefits of EHRThe CMS is incentivizing EHR systems for the improvement they can provide to patient care, but the benefits for healthcare providers are also very real. According to a survey by MGMA, over 60 percent of physicians who have optimized their EHR system increased productivity and revenue. Here are some other ways EHR systems benefit both physicians and patients:

• Improved Collaboration – Information gathered by primary care providers can be easily shared and reviewed by specialists and other members of the care team, resulting in less duplicate testing, lower costs of care and better outcomes.

• Continuity of Care – EHRs can travel, so if a patient moves, changes providers or is admitted to an emergency room, a complete, up-to-date health record will be instantly accessible to the physician through a health information exchange (HIE). This prevents unnecessary delays in treatment and reduces clerical work for staff on both ends.

• Practice Mobility – The ability for physicians to review labs, order tests and submit prescriptions outside the office will allow greater freedom for doctors and increased speed of care for patients. Instead of waiting on faxes or couriers or rushing to get back to the office, physicians will have the ability to view records on a phone, tablet or computer anywhere they have Internet access.

• Patient Engagement – Patients can log in to their own record and track trends, review lab results and get medication information – without having to contact their physician – through secure patient portals. A Harvard Medical School study surveyed over 37,000 patients and found that more than 90 percent were enthusiastic about online access to their medical information.

Getting patients more involved in their own health care has been shown to lead to better outcomes, which is why information sharing is one of the key components of Stage-1 of Meaningful Use. These incentive payments could significantly offset the cost of the necessary EHR upgrade, improve patient care and help practices avoid CMS penalties in the future.

Getting Paid for Meaningful UseThe goal of the EHR Incentive Program is to accelerate the process of EHR adoption, ease the fiscal burden of implementing the new technology for clinicians and, ultimately, improve overall health care for patients.

The program is working according to data from the National Ambulatory Medical Care Survey, which reported that 57 percent of office-based physicians used EMR/EHR systems in 2011, with 52 percent planning to apply for Meaningful Use incentives, up from 41 percent in 2010.

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To qualify for the maximum Medicare EHR incentive of $44,000, Medicare eligible providers must begin participating by 2012. Physicians who are eligible for the Medicaid EHR incentive of up to $63,750 over a six-year span could have started as early as 2011 and as late as 2016. Providers who are eligible for both must choose only one.

3 Main Components of Meaningful Use (As specified by the American Recovery and Reinvestment Act of 2009)

1. The use of a certified EHR in a meaningful manner, such as ePrescribing.2. The use of certified EHR technology for electronic exchange of health information to

improve quality of health care.3. The use of certified EHR technology to submit clinical quality and other measures.

To qualify for Meaningful Use incentives, providers must show they’re using certified EHR technology in ways that can be measured significantly in quality and quantity over the specified time frame.

Stage-1 Meaningful UseThe Meaningful Use criteria are broken into three steps over the next few years. Stage-1 occurs from 2011 through 2013 and “sets the baseline for electronic data capture and information sharing,” according to the CMS. Stage-2 will begin as early as 2014, and Stage-3 should begin in 2016 with both building on the foundation set by Stage-1.

CMS Meaningful Use Stage-1 Requirements:• There are 25 total meaningful use objectives. Eligible physicians must meet 20 of 25

objectives.• There are 15 required core objectives.• The remaining 5 objectives may be chosen from the list of 10 menu set objectives.

Clinical Quality MeasuresTo successfully demonstrate Meaningful Use, healthcare providers must report on clinical quality measures. Clinicians are required to report on six total quality measures – three required core measures and three additional measures selected from 38 clinical quality measures.

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Stage-2 Meaningful Use Beginning as early as 2014, Stage-2 will focus on expanding some of the requirements of Stage-1, increasing the health information exchange between providers and engaging patients by giving them secure online access to their health records.

Stage-2 will make mandatory some EHR measures that were optional in Stage-1 (incorporating clinical lab results), increase thresholds for measures that stay the same (increase ePrescribing rate from 40% to 50%), and expand the required core measures from 15 to 17.

“[Stage-2] will lead to more coordination of patient care, reduced medical errors, elimination of duplicate screenings and tests and greater patient engagement in their own care,” according to a statement from HHS Secretary Kathleen Sebelius.

The End of EMRWhile switching from paper to electronic records is an essential step to streamline and improve health care, the switch should be to an integrated EHR system instead of an archaic EMR system. It is a tool that was an improvement over its predecessor, but is now outdated compared to the functionalities of today’s EHR systems.

Physicians who don’t do their homework and are sold an EMR system lacking true interoperability will find it difficult to meet Meaningful Use requirements and most likely be forced to upgrade in the near future. It could be an extremely expensive mistake that will affect patient care as well as their practices’ bottom lines.

An EMR limits what providers can do with the data they collect. An EHR system provides all the tools that a practice will need to collect, manage and share data with the entire care team as well as the patient. Make the right choice and select a system that can grow with your practice, provide better care for your patients and get you paid for your efforts.

While changes in technology and health care spell the end of EMRs, it presents the perfect opportunity for EHRs to create a more connected healthcare experience.

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CareCloud is a leading provider of web-based practice management, revenue cycle management, electronic health record (EHR) and medical billing software and services for medical groups. The company’s products are connecting providers to one another – and to their patients – through a fully integrated digital healthcare ecosystem that can be accessed on any browser or device.

CareCloud is helping physicians in over 30 states increase collections, streamline operations and improve patient care. The company was named a winner of IBM’s SmartCamp Silicon Valley 2010 for its innovative technology and received over $20 million in Series A funding from Intel Capital and Norwest Venture Partners.

To learn more about CareCloud, please visit www.carecloud.com.1-877-342-7517 – hello@carecloud.com

Additional resources:Visit carecloud.com to learn more about electronic health records and Meaningful Use. Check out other resources to improve practice performance, like the whitepapers 7 Best Practices for Medical Accounts Receivable Management and Actionable Analytics: 10 Steps to Improve Profitability and Patient Experience Through Data-Driven Decision Making.

Contributors:Juan Reyes, MD, Ian Bjorsvik, Mike Cuesta, Shawn McKee, Michael Gold and Madelyn Young.