Return on Investment (ROI) Analysis EMR Benefit Overview
How does a computerized medical record affect an eye clinic? An EMR dramatically reduces the handling of paper (pulling and re-filing charts, handling the tapes from autorefractors and lensmeters etc.). Some systems conduct an automatic graphic trend analysis of visual acuities and intraocular pressures that speed up and enhance the physician’s decision-making. Patient throughput is increased due to automated instrument interfaces and rapid data entry methods such as predefined workflow templates. It is the data that moves through the eye clinic instead of the people working there. An EMR reduces errors in transcription which in turn eliminates incorrect medication prescriptions or even wrong therapy decisions. Even the traditional doctor/scribe relationship is enhanced through more efficient computerized transcription of dictated findings. Traditional ophthalmic photography is replaced by instantly available digitized images from retinal cameras or video capable slit lamps, thus saving time and money. When used among co-managing eye clinics, the sophisticated EMR allows for “real time” video teleconferencing including displays of anterior and posterior segment images, OCT files, visual fields etc. as well as “electronic mailbox” communications. Professional EMR systems (like the ifa software) are so “user friendly” that the physicians who swore they would never record their own exam data are doing so, freeing up technicians for other duties. The time and expense of manual creation of letters to colleagues and other required correspondence is eliminated due to simple data merging functions with pre-stored “boiler plate” letters. The computerized medical record, due to its ease of use and comprehensive data collection, creates a much more defensible record in cases of litigation.
How do eye clinics make the transition to a computerized medical record? Anyone contemplating a computerized medical record should understand that the process is easy with the right product and the professional support of an experienced team, but it should not be viewed as a “walk in the park” either. There will be changes in clinical procedures, resistant staff members, some fairly extensive training and a certain period of time where the paper and “paperless” systems will be used concurrently.
ifa united i-tech Inc. 1850 SE 17th St. Ste.C – Ste.309 Ft. Lauderdale, FL 33316 fon: +1 (954) 713-1476 www.ifa-united-i-tech.com
DMS ifa 9201 Sunset Blvd., Ste.709 Los Angeles, CA 90069 fon: +1 (310) 598-5979 www.dmsifa.com
ifa systems AG Augustinusstr. 11b 50226 Frechen, Germany fon: +49 2234- 933-670 www.ifasystems.de
ifa systems AG Calle Manuel Herrera 139 Santiago de Surco Lima - Peru www.ifasystems.com
As long as tape backup routines for the creation of software duplicates of patient visits are followed, there is no need to create more paper than already existing in the eye clinic. However, until having created a sufficient level of “visit history” for the active patients, there is the need to refer to the paper records from time to time. Most eye clinics already use “HIS” software (Hospital Information System) and need to add the medical records capability offered by the EMR system. It is standard for these two software systems to co-exist in an eye clinic through an “interface”. Typically an individual interface shall be developed based on standards like HL7, DICOM or according to IHE eye care concepts (see glossary). Depending on the needs of the eye clinic, additional information can be “shared” between the systems based on individual SW engineering.
What happens to eye clinic productivity? It is normal that for 2-3 months after the installation of a computerized medical records system, productivity on the examination side of the eye clinic actually takes a slight drop – somewhere between 5-10%. This is because of the learning curve for professional staff and physicians of the new method for recording data. Somewhere between the third and fourth month of use, the productivity levels of physicians and staff surpass the levels of the paper-based system. Time saved with the automation of work flows, instrument integration, history taking, letter writing and recording of exam data usually represent productivity increases of 15-20% overall. In six to nine months, the lessened dependence upon archived paper records combined with the benefits of digitized imaging, reduced claims rejection, faster treatment decisions, automatic forms generation and the problems associated with transcription errors can increase productivity by as much as 35-40% overall from the paper based recording and retrieval method.
ifa united i-tech Inc. 1850 SE 17th St. Ste.C – Ste.309 Ft. Lauderdale, FL 33316 fon: +1 (954) 713-1476 www.ifa-united-i-tech.com
DMS ifa 9201 Sunset Blvd., Ste.709 Los Angeles, CA 90069 fon: +1 (310) 598-5979 www.dmsifa.com
ifa systems AG Augustinusstr. 11b 50226 Frechen, Germany fon: +49 2234- 933-670 www.ifasystems.de
ifa systems AG Calle Manuel Herrera 139 Santiago de Surco Lima - Peru www.ifasystems.com
Productivity Increase Chart Introduction Period thru Proficient Period
10-12 months Treatment Decisions Automated Chart Filing & Retreival Co-Management Pt. Communication
Practice ProductivitylRealities
7-9 months
Maximum Productivity with Present Staff
Image Processing Dictation/Transcription Correspondence Claims Turnaround Medications/Prescrpt.
Proficiency & the Paperless Practice are Reality
4-6 months Equip. Interfaces Paperless Perimetry Histories Automated Rapid Data Entry
0-3 months Install & Training Grasp Concept Learning Curve Change to Routines
Productivity level before computerized records
3
6
9
12
15
18
Timeline in Months
**Actual results may vary and are dependent upon the eye clinic’s ability to learn and adapt the system
ifa united i-tech Inc. 1850 SE 17th St. Ste.C – Ste.309 Ft. Lauderdale, FL 33316 fon: +1 (954) 713-1476 www.ifa-united-i-tech.com
DMS ifa 9201 Sunset Blvd., Ste.709 Los Angeles, CA 90069 fon: +1 (310) 598-5979 www.dmsifa.com
ifa systems AG Augustinusstr. 11b 50226 Frechen, Germany fon: +49 2234- 933-670 www.ifasystems.de
ifa systems AG Calle Manuel Herrera 139 Santiago de Surco Lima - Peru www.ifasystems.com
How does the computerized medical record affect productivity? Function
Patient Registration Pulling and filing charts (includ.misplaced charts) Pre-screening (lensmeter, autorefractor, tonometry, perimetry, OCT, HRT etc.) Input of exam data to the patient record Patient education
Medical decision making
Dictation & letter
Statistical searches and queries, outcomes, cost per patient
Doctor / Staff messaging
Coding (diagnosis, billing)
ifa united i-tech Inc. 1850 SE 17th St. Ste.C – Ste.309 Ft. Lauderdale, FL 33316 fon: +1 (954) 713-1476 www.ifa-united-i-tech.com
Estimated increased productivity (increased speed of data input and/or retrieval or decision making). 0% 100% (2.5-5 minutes vs. instantaneous) 10%-15% - Depending upon the use of diagnostic equipment and the use of automated phoropters that are pre-set with autorefractor values etc. 25-50% - This depends upon the present method and the intended computerized method (workflow templates.) 0-50% - Depending upon present method. The use of computer graphics and digitized images greatly helps here. 0-50% - Depending upon eye clinic methods. Computer generated trend graphs for acuities, IOPs, visual fields etc. speed up analysis. Digitized images are delivered immediately which also facilitates decision making. At least 50% - Pre-written standard letters which are writing customized by the automatic insertion of specific patient, colleague and exam data are generated on demand. This functionality is only available using a computerized medical record. It would not be realistic to attempt to capture this data manually. 50% - LAN/WAN messaging, workstation to workstation, and communications eliminates notes, physical movement through the eye clinic. Efficiency improvement here depends upon the experience and skills of the existing staff. ifa medical record software offers a linkage, for the potentially chargeable codes.
DMS ifa 9201 Sunset Blvd., Ste.709 Los Angeles, CA 90069 fon: +1 (310) 598-5979 www.dmsifa.com
ifa systems AG Augustinusstr. 11b 50226 Frechen, Germany fon: +49 2234- 933-670 www.ifasystems.de
ifa systems AG Calle Manuel Herrera 139 Santiago de Surco Lima - Peru www.ifasystems.com
What kind of equipment is needed and where does it go? Because the data required for a complete medical record is collected at many places in the eye clinic, and because that data also needs to be accessible in many places, a computer “network” of some type is required. This means that where data is collected or reviewed; there should be a “computer workstation”. In a fully functional network utilizing computerized medical records, there are workstations at the front desk, pre-screening room(s), OCT and HRT etc. rooms, visual field room(s), photography rooms(s), ASC and/or laser room, examination room(s), the doctors’ desks and the administration areas. The type of network is dependent upon the data input and the output required (see hardware requirements).
Who enters the medical record information and how is it done? Because of the sophistication of some of today’s medical records software systems, anyone in the eye clinic, technicians, administrative staff, scribes or physicians can input data into the system with a minimum of training. This means that in a well planned software acquisition, which includes a variety of data entry methods, there need not be a radical departure from the doctor/scribe or doctor/technician interaction regarding the record, unless one is desired. Within the implementation process, workflow templates (“Smart Screens”) are developed for the most important processes. Template proposals/examples are provided for all specialties like retina, glaucoma, cataract and refractive surgery, orthoptics etc. The data entry productivity depends on the individual adaptation of the existing clinical pathways (intensive analysis of user requirements).
ifa united i-tech Inc. 1850 SE 17th St. Ste.C – Ste.309 Ft. Lauderdale, FL 33316 fon: +1 (954) 713-1476 www.ifa-united-i-tech.com
DMS ifa 9201 Sunset Blvd., Ste.709 Los Angeles, CA 90069 fon: +1 (310) 598-5979 www.dmsifa.com
ifa systems AG Augustinusstr. 11b 50226 Frechen, Germany fon: +49 2234- 933-670 www.ifasystems.de
ifa systems AG Calle Manuel Herrera 139 Santiago de Surco Lima - Peru www.ifasystems.com
ROI Calculation
Productivity Analysis & Worksheet Chart Handling 1. How many patient visits or charts per day? (5 minutes to locate, deliver, retreive & refile a chart) (Total people minutes that can be saved with EMR) (Convert mins. to hrs. X # of days practices is open per month) (Total people hours that can be saved with EMR) (Use an average hourly wage of clinic and multiple the total number of hours to get your potential savings)
avg. x 5 mins. = mins. =
hrs.
€
month
=
avg. x 3 mins. mins.
=
hrs.
€
month
€
avg. x €X month
=
avg. x 6 mins. mins.
€
#VFs month
Dictation & Correcting 2. How many letters per day does the doctor dictate? (Average per Patient Record is 3 mins.) (Total “doctor” minutes that can be saved with EMR) (Convert minutes to hours.) (Multiple # Hrs. X # days doctor sees patients per week) (Multiple # of hours X Euro to get your potential savings) Euro x per HR. = Euro salary / x available hours) Transcription 3. How many letters per week are transcribed? (Average Euro x per letter for transcription) (Multiple the # of letters by Euro x to get savings with EMR) Paperless Perimetry 4. How many visual fields are performed and printed per month? (Total time to process & print each exam result) (Total time saved in performing perimetry with EMR) (Divide the # above by 40 mins. average VF time per patient) (Total number of additional visual fields per week) (Additional fields performed per week X Euro per field) Productivity Worksheet & Analysis ifa united i-tech Inc. 1850 SE 17th St. Ste.C – Ste.309 Ft. Lauderdale, FL 33316 fon: +1 (954) 713-1476 www.ifa-united-i-tech.com
DMS ifa 9201 Sunset Blvd., Ste.709 Los Angeles, CA 90069 fon: +1 (310) 598-5979 www.dmsifa.com
ifa systems AG Augustinusstr. 11b 50226 Frechen, Germany fon: +49 2234- 933-670 www.ifasystems.de
ifa systems AG Calle Manuel Herrera 139 Santiago de Surco Lima - Peru www.ifasystems.com
Digital Photography 5. How many photographs are taken and developed each week? (include fundus camera, B-Scan, Slit-lamp Camera) (Average material and expense per image is Euro1.50) (Total savings per month with digitally images in the EMR)
avg.
€
x € 1.50 month
Additional Patients Reduced Chair time & Rapid Data Entry 6. Does your practice use automated LM - AR - NCT - Kera? (Patient chair time can be reduced 15% with these automated instruments interfaced directly with the EMR) (Average time per patient to perform pre-screening tasks) (Average time per patient that can be saved with the EMR) (Multiple the # of patients per day X average time saved) (Total time saved in the pre-screening area with the EMR)
7. Rapid data entry to a medical record can reduce documentation time by up to 40%. This saves either the doctor or scribe time. (Average time to complete the documentation of a record) (Multiple the average time X 40% savings with the EMR) (Multiple # of patients seen X the average time saved) (Total time saved in the exam lane documenting with the EMR) 8. Increased patient throughput, effects of #6 combined with #7. (Total time saved in the pre-screening area from above #6) (Total time saved in documenting from above #7) (Total time saved) (Divide “total time saved” by 15 mins. average per exam) (Total # of new patients that can be seen per day with EMR) (Multiple # of new patients X Euro average charge per exam) (Total Additional Income with more productivity per day) (Multiple additional Euro for new patients X # days per month)
ifa united i-tech Inc. 1850 SE 17th St. Ste.C – Ste.309 Ft. Lauderdale, FL 33316 fon: +1 (954) 713-1476 www.ifa-united-i-tech.com
DMS ifa 9201 Sunset Blvd., Ste.709 Los Angeles, CA 90069 fon: +1 (310) 598-5979 www.dmsifa.com
ifa systems AG Augustinusstr. 11b 50226 Frechen, Germany fon: +49 2234- 933-670 www.ifasystems.de
Yes
7-9 mins. 1-1.4 mins. =
mins.
2 - 3 mins. .8 - 1.2 mins. =
mins.
= + =
mins. mins. mins.
=
#pts.
= €
€ month
ifa systems AG Calle Manuel Herrera 139 Santiago de Surco Lima - Peru www.ifasystems.com
Investment Worksheet 1. Estimated cost of investment 2. Average monthly runtime license and support ** (Use 1,5% of software cost per month for support) Anticipated savings from productivity analysis Chart Handling Dictation & Correcting Transcription Additional VF Digital Photography Increased Patients Other Areas
€ € € € € € €
Total savings per month Total months Euro X # 12 months practicing per year Total annual savings Months to pay off investment
ifa united i-tech Inc. 1850 SE 17th St. Ste.C – Ste.309 Ft. Lauderdale, FL 33316 fon: +1 (954) 713-1476 www.ifa-united-i-tech.com
DMS ifa 9201 Sunset Blvd., Ste.709 Los Angeles, CA 90069 fon: +1 (310) 598-5979 www.dmsifa.com
€ €
ifa systems AG Augustinusstr. 11b 50226 Frechen, Germany fon: +49 2234- 933-670 www.ifasystems.de
€ € €
ifa systems AG Calle Manuel Herrera 139 Santiago de Surco Lima - Peru www.ifasystems.com