Pediatric Informatics: Computer Applications in Child Health (Health ...

208 D.E. Lighter
Most practices have a number of ways to reduce costs, however, including
Staffing reductions
Purchase lower cost supplies and perishables (e.g., vaccines)
Automation of business processes
Automation of clinical processes
Improved efficiency (eliminating steps in processes that do not add value)
Reduced costs for malpractice insurance due to improved documentation
The EHR provides a way of ensuring that several of these approaches are implemented
effectively. For example, many EHRs now provide support for proper coding, with
prompts that help practitioners understand the reasons for specific coding levels. After
an encounter has been entered into the system, the program makes a recommendation
for an Evaluation and Management (E&M) code that best fits the documentation that
has been entered. If the clinician thinks that the visit should be coded differently, e.g.,
with a higher paying code, the system can provide the reasons for selection of the suggested
code and recommendations for improving the documentation to justify a different
code. Optimization of the E&M code in this way can ensure appropriate payment
for services, as well as avoid legal problems and fines related to incorrect billing. 10
The EHR can reduce risk and improve financial performance in other ways, as
well. Although most EHR installations do not reduce staffing needs, in many cases
staff can be reassigned to patient care duties that reduce costs and risks or generate
revenue. Costs incurred for staff members finding charts, chasing down lab and x-ray
results, or writing in paper charts can often be reallocated to pay staff members to
provide billable services like telephone calls, blood drawing, office lab tests, and
similar services. Thus, staff costs that originally were expended for non-revenue producing
activities can be transferred to the revenue producing column of the ledger.
Implementation of an EHR should always include analysis of the processes of
care to identify non-value added steps and improve efficiency. Automation of any
process naturally changes the workflow and new work patterns must be developed
as part of the transformation of a medical practice. This work redesign effort sometimes
requires help from outside the practice. Almost invariably, effective automation
can improve efficiency and reduce costs, but installing a computerized solution
in a flawed process will always lead to frustration and increased costs, as well as
risks to patient safety and effective care. 11
Thus, the business case can be made for automating medical records through the
following cost reduction and revenue producing enhancements:
Reallocation of staff efforts to revenue producing activities
Improved process of care to eliminate costly, non-value added processes
Improved documentation for justifying appropriate coding
One final point about improving costs may be germane to some EHR users. Since
documentation of the visit is generally improved for most practitioners, malpractice
risk may actually be reduced at the same time that billing efficiency is enhanced.
Some insurers provide discounts for physicians who use these electronic systems,