clinicals whitepaper 1009 - amazon s3 · 2014-03-04 · economic barriers to ehr adoption by...

The Economics of the PatientWorkflow: Cracking the Code ofSuccessful EHR Design

WHITEPAPERathenahealth, Inc.Published: October 2009

The Economics of the Patient Workflow: Cracking the Code of Successful EHR Design

www.athenahealth.com3

I. The EHR Industry Is BrokenHealth reform advocates have long heralded the promise of electronic health records (EHRs) to improveoutcomes and lower costs. But after more than 30 years of being available to the nation's 800,000physicians, only 4% of physicians have an "extensive, fully functional electronic records system."1 Recentresearch suggests that this low adoption results from the simple calculus that existing EHRs provide toolittle value to physicians at too high a cost. The truth: traditional EHRs fail to consistently help physiciansdo less work, see more patients, make more money, or deliver better care.

President Obama's Health Information Technology for Economic and Clinical Health (HITECH) Act (part ofthe stimulus package known as the American Recovery and Reinvestment Act) is designed to overcomeeconomic barriers to EHR adoption by providing up to $44,000 in incentive payments from Medicare for"meaningful use." But concerns remain that such an incentive will do little to address the underlyingproblems of EHRs. While well-meaning, such an incentive could merely defray initial costs (which somestudies estimate range considerably higher than the federal bonus payment2) while burdening physicianswith expensive EHR systems and revenue-draining maintenance and upgrade costs. At its worst, theintensified push to drive up EHR adoption could have the unintended consequence of driving somephysicians out of business.

Where Do We Go From Here?There is a better way. We can transcend the failures of the past with a bold, yet simple EHR solutionrooted in a careful analysis of how EHRs can add economic value to physicians' patient workflow. Thispaper presents one solution.

EHRs have failed because they are designed without an understanding of the fundamental economics of apatient encounter. By breaking down each stage of the patient workflow and placing it in the context ofactual practice expenses, it becomes clear that the place of primary focus for most EHRs – the physician'sexam – offers little or no financial opportunity for a practice, while most EHRs ignore areas that offersignificant gains.

A careful economic assessment of the five stages of the patient encounter, from check-in to checkout,reveals the enormous potential EHRs have to increase revenue through increased patient throughput,improved staff efficiency, and easy-to-manage reporting, while capturing all pay-for-performancemeasures. In addition, a well-designed EHR can reduce the highest costs, which include client documentmanagement, patient orders, and results follow-up.

EHRs Can Be a Meaningful SolutionBy using an EHR that adds economic value to all aspects of the encounter, physicians are no longer forcedto adopt a narrowly-focused electronic exam and an entirely new, sometimes cumbersome workflow. Thesolution presented in this white paper allows doctors to achieve 100% of the benefits of a paperless EHRsystem, while documenting the encounter as he or she desires, and gradually optimizing the workflow.

Ultimately, such an optimized workflow can translate into higher EHR adoption, more revenue, bettercare, and more satisfied physicians, staff, and patients. And while the EHR solution presented will readilyqualify for HITECH Act reimbursement, it offers physicians a robust alternative that will benefit theirpractices and patients far beyond the scope and reimbursement cycle envisioned in the HITECH Act.That's meaningful change that can truly benefit physicians and their patients.

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II. The Basic ProblemThe basic problem of most EHRs on the market today is that they do not achieve a measurable positivefinancial impact. This is because traditional EHRs fail to account for a fundamental fact: the provider examis the only area where a practice earns revenue. Of course, a practice can also earn money throughancillary services, but the vast majority of practice income is generated by clinical encounters.

And here's the rub: most EHRs are focused primarily on changing physicians' workflow. Whenimplementing an EHR, providers (a practice's main revenue generators) must learn a new way to documenttheir encounters. Many EHRs have limited options for doing so. Thus, the physician is forced to shoulderthe full brunt of learning, adapting to, and recording information in the new electronic system. But in orderfor the practice to be profitable, the physician needs to be spending his or her time seeing patients andmaintaining patient throughput. Burdening or slowing down the physician with time-consuming andsometimes unnecessary data collection is costly to the practice and ultimately leads to sub-optimal care.

A Deeper ProblemThe reality is that the clinical exam is only one stage of apatient visit that can be made more efficient (and profitable)with an EHR. For example, practice staff spends many hours(and dollars) dealing with documents. From labs and testresults to prescription requests, the typical practice hashundreds or thousands of phone calls, faxes, and mail toprocess, deliver, and record. But traditional EHRs are notdesigned to automate the work associated with collecting and processing paper outside of the exam room.

The Basic Economics of a Typical EncounterThese two problems with EHRs – too much emphasis on theexam and too little attention on the rest of the workflow – arethe principle causes of failure and lack of adoption. Tounderstand why, it's helpful to look at the basic costs of thepatient encounter and how traditional EHRs fail to address thebiggest costs of all.

According to the Medical Group Management Association(MGMA) 2008 Cost Survey, in 2007 multi-specialty medicalpractices reported costs in two general areas. Less than one-quarter of a practice's costs was for rent, supplies, insurance,and other operating expenses. The remainder, about 78%according to the survey, was for staff costs (see Figure 1).



About athenahealth Data

athenahealth dynamically managesand processes large amounts ofinformation on behalf of its clients.Unlike other electronic health record,billing, and practice managementsolutions, athenahealth offers acombination of centrally-hosted Web-based software tools and behind-the-scenes support for clients. Thismeans that every detail occurringduring a billing transaction – everyclaim submission, denial, number ofdays in accounts receivable (DAR),and more – is captured electronically.athenahealth's data reflects theclinical and financial experiences ofthousands of providers and hundredsof payers across the country.

Figure 1. Cost Categories for Multi-SSpecialty Medical PracticesSource: MGMA Cost Survey, 2008 (Based on 2007 data)

Despite the fact that staff costs account for more than three-quarters of a practice's expenses, very littleanalysis tracks the allocation of staff costs along each stage of a patient encounter. Why is thisimportant? If EHRs promise to improve care and increase efficiency, it is essential to understand staffcosts along the entire patient encounter so the EHR doesn't add unnecessary bottlenecks and costs.

athenahealth data from a multi-year research project on the patient workflow shed light on the costsassociated with each stage of the patient encounter (see Figure 2).

Figure 2. Staff Costs for Each Stage of the Patient EncounterSource: Based on athenahealth, Inc. client data and lean mapping research, 2008.

Stage of Patient Encounter % of Staff Costs % of Practice Revenue

1) Scheduling, Check-in & Intake 10 – 20% 0%

2) Exam 20 – 25% 100%*

3) Orders & Results Management 30 – 40% 0%

4) Checkout 10 – 15% 0%

5) Patient Follow-Up 20 – 30% 0%

*Not counting revenue from ancillaries



Staff Time is78% of TotalPractice Cost

Cost Categories % of Total Practice Cost

Physician and provider consultant cost 43.67%

Total support staff cost 31.22%

Total nonphysician provider cost 3.21%

Medical and surgical supply cost 1.92%

Ancillary services cost 3.47%

Building and occupancy cost 5.97%

Other general operating cost 9.17%

Total Expense 100%



Exhibit 1. The Different Stages of a Patient Encounter and Staff Costs Associated with Each

The section below walks through the five stages of a patient encounter and identifies areas to improveefficiency, lower cost and boost revenue.

1) Scheduling, Check-IIn, and Intake – 10-220% of staff cost. Staff manages the first stages of the exam, including intake, where they collect data critical for thephysician's revenue and to populate the patients' medical records. This stage of the encounter istypically efficiently managed without too much waste.

2) Exam – 20-225% of staff costs, but 100% of revenue.* Billable providers (physicians and mid-levels) generally create the only revenue for the practice. It is,therefore, critical that these employees be as productive with their time (with high utilization and a highpercentage of time doing billable procedures) as possible. The more encounters the physician does, andthe higher the value of the encounters, the more he or she is paid. Time management is criticallyimportant.

3) Orders and Results Management – 30-440% of staff costs. A huge portion of a practice's expenses are the "hidden" costs associated with managing orders and third-partypaper (i.e., paper about the patient coming from referring providers, labs, pharmacies, etc.) in support of thepatient encounter. According to athenahealth data, each full-time employee handles about 1,155 pieces ofdocumentation per month and that's on top of patient charting. athenahealth estimates that this cost perprovider represents $1,000-$3,000 per month. This is one area of the practice workflow where there is greatpotential to improve efficiency and lower costs.

*Not counting revenue from ancillaries

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check-inscheduling intake follow-upexam checkoutorders

Staff Time - Chart Pulls andPatient Management

10-20% of Costs

1

Staff Time -

20-25% of Costs

2

2BillableProviderEncounters

20-25% of Costs100% Revenue

Staff Time - DocumentManagement Costs

30-40% of Costs$1,000 - $3,000 per Month, per MD to process documents

3

4Staff Time -

10-15% of Costs

5Staff Time -Follow-Up Costs

20-30% of Costs$2,500 per Month

Economic Drivers of a Typical Clinical Encounter

4) Check0ut – 10-115% of staff costs.Much like check-in, most practices are efficient in this area. The essential requirement of this stage issimply to insure that all encounters are closed, orders approved, and co-pays paid before the patientdeparts the physician office.

5) Patient Follow-UUp – 20-330% of staff costs.Following up with patients is another area where staff costs add up quickly if not managed efficiently.Calling, faxing, and e-mailing test results, returning phone calls, and tracking other patientcommunication typically generate hours of work for both staff and providers. This is another area wheremost practices lack efficiency, relying on staff to initiate and track follow-up in coordination with theprovider.

III. Uncovering Design Flaws in Today's EHR Industry

Exhibit 2. The Five Critical Failures of Traditional EHRs

In the section below, we'll explain where the traditional EHR breaks down – from overburdening thephysician during the exam to increasing practice costs without any efficiency gains and how each addscosts to the patient encounter.



The Five Critical Failures of Traditional EHRs

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High Up-Front Cost

Costly software purchase plus monthly maintenance and upgrades

1

4Clinical Document Process Management Weakness

Increases cost of processing, scanning documents.

3P4PDoes not optimizepotential for getting P4P during intake, exam andorders

2eExam - Time Tax on MD

Slows downdoctors up to1.5 hours per day

2eExam Time tax on MD compromises revenue generation


5Staff Time -Follow Up Costs

20-30% of CostsNo efficiencies gainedin patient follow up


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1) Typical EHR Software Is Too Expensive.EHR software is very expensive. It is generally priced on a per physician basis, so the larger the practice,the more quickly the costs spiral upwards. It is estimated that the cost of purchasing a traditional EHRsystem is $33,000 for each physician, with an additional cost of $1,500 per doctor per month formaintenance.3 Per physician, this translates to $51,000 in costs during the first year of using an EHR and$18,000 in annual maintenance costs. Despite such high costs, traditional vendors have few incentivesfor delivering a promised return on investment (ROI). Because the practice invests heavily up front, thevendor has little motivation to provide excellent service after implementation. And once the EHR isinstalled, it is usually up to the practice to provide, or pay for, IT support for software and hardware,interface management, data set management, and scanning support.

Most EHR software also requires regular upgrades due, in part, to the rapidly changing standards forsoftware and government definitions of health care measures. For example, in 2007 PQRI had 74measures, and by 2009 the measures had increased to 153. With each change and addition, it is theresponsibility of the practice to deploy software upgrades to remain compliant.

2) EHRs Don't Save Money Because They Slow Doctors Down.Most EHR software focuses primarily on the physician exam,creating an electronic interface for the physician to documenteverything in the patient encounter.

These EHRs encourage doctors to adopt the full electronicencounter immediately, which fundamentally changes theirencounter workflow (and not always for the better).

Physicians who are already accustomed to electronicallyrecording the patient exam are able to adapt to capturing theincreased level of clinical detail an EHR makes possible,especially if they believe exam data will be used in future P4Pprograms. But the traditional EHR model essentially forcesphysicians to become data entry clerks and to document patientencounters with time-consuming, structured data entry. Thismeans lots of typing in order to record a high level of clinicaldetail, often with little tangible benefit to the physician.

Currently, most EHR vendors are narrowly focused on updatingthe data entry component of the physician exam with over-structured elements that don't meet the broader needs of thepractice. In the process they have failed to improve the userexperience by failing to optimize all documentation methods,including dictation, free hand, jotter, or even paper. The net results are EHRs that slow physicians down,reduce patient volume, and force doctors to pay their employees overtime to remain with the physicianafter hours to complete patient visits.

Physicians who implement health IT systems typically experience an initial loss in productivity as theylearn how to use the system and adjust the ways in which they practice. In a survey of health IT adoptionconducted by Gans and colleagues, many physicians' practices reported that after they implemented asystem, productivity in their offices dropped by between 10 percent and 15 percent for at least several

Myth: Once software is paid for, thepractice is in the clear for any futurepayments and the ROI begins toaccrue.

Reality: There are lots of very real,hidden costs in the software model.

Myth: EHRs make physicians moreefficient.

Reality: EHRs force physicians tochange their workflow, adding aclerical burden for the provider whois the only revenue generatingresource in the office. This can put aphysician's business at risk.

www.athenahealth.com



months.4 Another study of EHR adoption by solo and small grouppractices found that among a sample of 14 small physicians'offices implementing a health IT system, the average drop inrevenue from that loss of productivity was about $7,500 perphysician.5 That amount may even understate the actual loss inproductivity, however, because in some practices, physiciansworked longer hours to keep the practice's income the same as itwas before the adoption.6

As a result of the time burden imposed by existing EHRs, manyproviders cannot generate the additional income necessary tojustify the significant investment in time and money that theadoption of such a system would require.

3) Software-bbased EHRs aren't currently designed to seamlesslymanage the complex P4P cycle or comply with payment reform ina convenient way – they only provide the tools. Most EHRs assume all doctors should gather complete structureddata in every encounter and that every piece of data is important.Unfortunately, this approach fails to carefully consider what datais currently and will eventually be needed for P4P programreporting, and even what reports will need to be pulled. In lieu ofa practical data-gathering strategy, traditional EHRs have passedon the burden of full data collection to the provider.

The reality is that only a small, specific set of data needs to bestructured to facilitate P4P reporting, and it doesn't need to beentered into an EHR by a physician. In fact, based onathenahealth's review of 35 national programs, 80% of all dataneeded for P4P or HITECH Act programs can be captured by staffat intake or when entering orders on behalf of the physician (seeFigure 3). Most EHRs aren't designed this way – they put theburden squarely on the provider during the exam.

What's more, software alone can't help practices keep pace withconstantly evolving programs like P4P, HITECH Act guidelines, andconsumer-directed health care. That's because once installed,software cannot change unless a new version comes out whichthen must be re-installed at every workstation. Reporting toMedicare or other payers is onerous and lacks integration with therevenue cycle unless staff performs significant manual work.

4) Traditional EHRs do not offer an efficient, closed-lloop solutionto the time-cconsuming process of collecting and monitoring paperand electronic orders and results. Despite the perception that adopting an EHR will effortlessly bringtogether all clinical documents into a chart, the reality is that EHRsoftware alone does little to manage the complex and time-consuming supply chain of clinical data. Because of this complexsupply chain, there are numerous pieces of data associated with asingle patient encounter that don't seamlessly come together intothe chart. To track labs, orders, and results, practices with

Figure 3. Where Does P4P Data ComeFrom? Source: athenahealth, Inc. Pay-for-Performance and Quality ReportingStudy, May 2009

Structural 2%

Exam18%

Intake10%

Plan69%

Management1%

EHR Exam-Room Headaches: ADoctor's Perspective

"Doctors in every specialty struggledaily to figure out a way to keep thecomputer from interfering with whatshould be going on in the exam room– making that crucial connectionbetween doctor and patient. I findmyself apologizing often, as I stare ata series of questions and boxes to beclicked on the screen and try to adaptthem to the patient sitting before me.I am forced to bring up questions inthe order they appear, to ask theparents of a laughing 2-year-old ifshe is ‘in pain,’ and to restrain mypotty mouth when the computermalfunctions or the screen locks up."

Excerpted from: "The Computer Will See You Now"

By ANNE ARMSTRONG-COBENThe New York Times

March 5, 2009



traditional EHRs need to invest in the development of specialized,bi-directional interfaces.Managing the documents associated with patient visits isexpensive, but it also comes with a high risk of error. What if anorder gets lost or results aren't communicated back to the practiceand patient? Health outcomes could be compromised. Even withEHR software, staying on top of labs, orders and results requires asignificant amount of staff time. Without a closed-loop order andresults management system, the cost of managing and trackingdocuments can be prohibitive.

5) Patient follow-uup work from orders and results involvessignificant cost and generally lacks process integrity.Most EHRs don't have built-in management and tracking of patientcommunication. This means that providers still need to initiate andmanually document follow-up with patients. This creates unknownfinancial leakage and significant care risks for patients.

IV. There Is a Better Way

While a careful economic analysis points to the failures oftraditional EHR software, it also provides a roadmap for a betterapproach. In fact, there are several opportunities to improve theeconomic impact of an EHR. By enhancing revenue drivers andreducing the most significant cost burdens, a well-designed EHReliminates the huge costs of EHR implementation andmaintenance, helps the practice automatically incorporateevolving health care initiatives like P4P programs, and takes awayall clinical paperwork from day one. This model truly helps thepractice relieve paper congestion, improve efficiency, and boostrevenue. In Exhibit 3 and in the text that follows, see how this newapproach works at each stage of the patient encounter.

Myth: Installation of an EHReliminates the need to managepaper.

Reality: The health industry isinundated with paper throughout thepatient workflow (which EHRsoftware doesn't eliminate). It'salmost impossible to manage thepatient workflow without having tokeep track of paper.

Myth: Patient care follow-up will bedriven by the available data andreporting capabilities of today'sEHRs.

Reality: There is no closed-loop post-encounter care process becauseresults follow-up still has to bemanually initiated and tracked.

Myth: Doctors need to collectcomplete, structured data in everyencounter for P4P reporting.

Reality: Most P4P data collectiontakes place outside the exam room.



Exhibit 3. Improving the Economics of a Clinical Encounter: A Better Way1) Web-bbased Software at No Up-FFront Cost.In this model, initial EHR investment is very low, which means that practices don't have to faceburdensome financial risk. This is because Web-based EHRs do not require expensive software, hardware,or special licensing. They arrive as a specialty-specific, pre-configured system with low or noimplementation fee. They provide Web-based software and upgrades at no charge. A good vendor canalso build and maintain clinical result interfaces at no charge. And some vendors link EHR pricing topractice revenue, offering more than just cost reduction. That means that the vendor shares a portion ofrevenue earned, so they have a vested interest in the long term success of the EHR.

2) Zero Compromising of Physician Time.Some vendors delivering this type of system also provide a behind-the-scenes team of experts thatregularly analyzes data coming from all the practices participating in the system. For leading vendors,this amounts to performance data from thousands of practices all over the country. As a result, they canclosely monitor physician and staff time to optimize the application and provide coaching for patientthroughput.

What's more, this approach doesn't force physicians to become data entry clerks. First, it only capturesstructured data that is necessary for reporting and qualifying for incentive payments. Second, it assigns

Improving the Economics of a Clinical EncounterW

ork/

Cost

Rev

enue

Gen

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No Up- Front Cost

1

2Allows PreferredCharting Mode

No loss of speed

4Efficiencies in DocumentManagementServices &Supply Chain

Savings up to$1,000 - $3,000/monthper provider

Automated Follow-Up Saves Money

Savings up to$2,500 per month

5

6All Stages of Patient Workflow Process Monitored & In Control


3Optimizes P4PBonus Payment

Up to 85% of data can be captured by staffduring intake and orders



data capture to practice staff where applicable.

Finally, with the flexibility built into this approach, the implementation process allows physicians tocontinue using paper documentation while beginning to take advantage of other EHR benefits. The vendorcan work with the practice to equip physicians with the knowledge to migrate to the next phase ofimplementation and continue toward full utilization of the electronic chart. This means that transitiononto this kind of EHR platform does not risk productivity by slowing providers down with too manychanges at once.

3) Optimizes Potential of Practices to Collect P4P Bonus Revenue.A flexible, comprehensive EHR model also identifies all the programs that clients are eligible for andassists with enrollment. The system can then adjust the medical record workflow of all clients to insurethe correct data is captured. For example, athenahealth data indicates that the vast majority (up to 85%)of data needed for P4P programs can be collected by the staff at intake or order entry. This suggests thatfor the first time staff can become a revenue generating resource, not just a cost center. And physiciansno longer have to bear the burden of capturing all the P4P data.

In this type of EHR, the vendor can do the necessary reporting for clients and collect payment for them. Agood EHR should have 100% electronic ordering capabilities, so it not only captures about half of therequired P4P data (such as labs and e-prescribing), but also sets up a closed-loop, high-integrity processfor results management.

Because this EHR model is Web-based, and not software-based, it turns the EHR into a revenue cycleservice driven by a continuously updated rules database. Collective clinical rules offer providers constantlyupdated, proactive clinical intelligence that supports increased revenues. An EHR vendor using thisapproach should maintain a clinical rules database that can incorporate P4P rules so the rulesautomatically appear for the practice as they are needed. Also, PQRI measures can be quickly added as theCenters for Medicare and Medicaid Services (CMS) expands this initiative and increases the number ofmeasures. The result is a constant stream of collective financial and clinical intelligence that is built intothe office workflow. Denials go down, cash flow goes up, and providers have more time for patient care.

4) Full Digitization and Management of All Clinical Paperwork. Here's one of the most important differences with this kind of EHR model: from the first day the practicebegins using it, the vendor should take responsibility for scanning and categorizing every incoming fax.They should match clinical documents to existing patients and patient orders, enter select data, routeinformation to appropriate staff members, and store documents where they can be readily accessed.

This helps practices automatically see the documents that need attention, from lab results to prescriptionrenewal requests, all in one place. Critical test results are sent directly to the appropriate doctor,eliminating delays and enabling providers to get the information they need as fast as possible. Thiscreates an automatic, closed loop system to keep all clinical information appropriately flowing.

As we have seen, results management (fax and mail) represents the single largest source of revenueleakage in a practice, averaging $1,000 – $3,500 per physician per month according to athenahealthdata. So vendors providing this type of EHR also send out (either electronically or via fax) reviewed andapproved documents, renewals, and authorizations, freeing up staff to do more high-value work. Theybuild and maintain electronic connections to labs, pharmacies, hospitals, and medical imaging archivesystems at no additional charge. This truly eliminates paper congestion, unlike other EHRs, and improvesprocess control.

5) Automatic Follow-UUp with Patients.



Vendors offering comprehensive EHR systems (those that will fully qualify for HITECH incentive payments)also provide patient communication solutions. These can generate live and automated phone calls and e-mails to patients for appointment reminders, past due balance alerts, prescription refill alerts, diseasemanagement initiatives, and more – all without the expense of valuable staff or physician time.In addition, some of these systems include a feature that automatically reaches out to select patientgroups. This can be a powerful and low-cost tool for disease management with the practice's patientpopulation. For example, when routine exams or follow-up visits are due, the practice can generatereminder calls to select patient groups. This can help with P4P compliance without added burden on thestaff. It also helps improve patient care as patients receive the preventive and routine care they need.

What's more, automating patient follow-up makes it easy for providers to follow best practices. Bestpractices are programmed into the system, and when results are in, they are communicated to the patientthrough a Web portal, automated phone call, live phone call, or another type of communicationdepending on the nature of the results. Having a system in place that can manage this efficiently andeffectively helps reduce cost, remove error, and improve care.

6) Practice Workflow is Measured, Monitored, and in Control.The best EHR vendors help increase and maintain efficiency in the practice workflow. How? By helpingproviders apply best practices in patient throughput. This feature is largely absent from most EHRsolutions. But the best EHRs are based on extensive study of the most cost-effective workflows and drawfrom best practices to boost efficiency and support the transition between each stage of the patient visit,from the front desk staff to clinical staff and providers. A five-stage workflow supports data capture whererequired for P4P reporting or "meaningful use" guidelines, while allowing flexible documentation of theexam where speed is a priority.

What's more, because of the large amount of dynamic data some vendors regularly analyze, practiceshave a real-time view into the financial and clinical performance of other practices of similar size andspecialty. Peer benchmarking offers opportunities for targeted improvement in workflow and practiceperformance.

The best vendors also employ their Account Management team to monitor each practice's performanceand share best practice insights. Added value through these consultative reviews means practices getregular, fresh insight about how to improve practice performance.

V. The Bottom Line

Traditional EHR systems focus narrowly on the physician exam, missing key opportunities to improveefficiency throughout the patient workflow. As we have seen, this approach can slow providers down andfails to automate results and order management, one of the practice's biggest staff costs. On top of that,traditional EHRs cannot keep pace with the rapidly changing health care environment, including P4P rulesand new "meaningful use" guidelines for EHR use, without burdening the practice with significant addedcosts.

As a business services provider, athenahealth recognizes that what's broken are the workflows aroundthe physician. EHRs have a unique potential to improve that efficiency, leveraging staff to maximizephysician time with patients, while leaving the physician to document the exam according to his or herpreferences. By expanding the power and potential of the EHR beyond the physician exam to the entirepatient workflow, the burden of a successful implementation can rest more with the staff than withoverburdened physicians. Thus, an EHR implementation can be a staff implementation, at least at the



start, with a far more likelihood of success.

athenahealth's EHR solution encompasses the entire clinical workflow from check-in to checkout. It takesaway the burden of excessive data entry during the clinical exam, sets up automatic closed loop orderand document management, and supports providers with a range of preferences for clinicaldocumentation. And every step of the workflow is based on best practices for smoother practiceoperations.

It's Time for a Better WayThe HITECH Act is going to drive thousands of practices into adoption of EHRs. And with the problemsoutlined here, we could potentially see many practices go out of business once they start grappling withunwieldy, costly EHR systems. This kind of large-scale mandate to improve health care efficiency iscommendable, but does not solve the economic problems of most EHRs on the market today.

The alternative model described in this paper does address those issues. With an emphasis on the fullpatient encounter (not just the exam) and a focus on generating revenue for the practice, athenahealth'sEHR helps providers do less work, be more profitable, and deliver better care.

athenahealth: Get Paid More. Get Paid Faster.athenaClinicalsSM is our unique EHR and practice management solution combining Web-based software,knowledge, and workflow management. It's a wholly integrated system that allows you to improve patientcare and practice performance. With proven ROI, an emphasis on results, and unparalleled service andsupport, athenaClinicals keeps your practice operating at peak performance. To learn more, visitwww.athenahealth.com/patientworkflow. or call 866.817.5738.

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2 Rock and a Hard Place: An Analysis of the $36 Billion Impact From Health IT Stimulus Funding. PricewaterhouseCoopers Health

Research Institute. April 2009.

3 Hoffman, S. and Podgurski, A. Finding a Cure: The Case for Regulation and Oversight of Electronic Health Record Systems. Harvard

Journal of Law and Technology. Volume 22, No. 1, p. 123. Fall 2008.

4 Gans, D., Kralewski, J., Hammons, T. and Dowd, B. Medical Groups' Adoption of Electronic Health Records and Information

Systems. Health Affairs, 24:5, pp. 1323-1333. 2005.

5 Miller, R. H. et al. The Value of Electronic Health Records in Solo or Small Group Practices. Health Affairs, 24:5, pp. 1127-1137.

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6 Congressional Budget Office of the Congress of the United States. Evidence on the Costs and Benefits of Health Information

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