Eyeworld

OPHTHALMOLOGY BUSINESS 78 November 2017 by Liz Hillman EyeWorld Staff Writer could be falling short of efficient utilization is with the EHR's other capabilities, such as integrating test- ing and diagnostic devices. "We've shown if you don't have patient demographics pushed down to each device and you have your technicians typing in names and medical record numbers, that creates errors and missing data. You can spend staff time chasing that information down, so that's one way it could be inefficient," Dr. Boland said. "One of the measures of a suc- cessful implementation of a new sys- tem or of an upgrade is how many of the capabilities of that system the doctors will take advantage of on a continuous basis," Mr. Gans said. "Another element is being able to tap the information for other purposes," he added later. "There are substantial administrative benefits of using the data, [such as] using the electronic health record for patients who need to return for care, manag- ing your patient population better to understand what the trends are in patients you're caring for, and [see- ing whether there] are new services you could be providing that are currently being referred out." Maximizing your IT cost-benefit There are several ways to make sure you are maximizing the benefit of your IT operations given its cost, ac- cording to Dr. Boland and Mr. Gans. On the EHR front, spending time up front to build your system in a way that functions well for your practice will save you time and mon- ey in the long run, Dr. Boland said. "If you were going to build a new building for your practice, you wouldn't buy a building off the shelf. You would sit down with the architect and say, 'Here's the kind of practice this is, we see this many With IT operation expenses expected to rise, effective utilization is key to get the most bang for your buck I nformation technology (IT) expenses for physician-owned practices went up by $2,000 to $4,000 per physician within the last year, according to a survey from the Medical Group Manage- ment Association (MGMA). That brought IT operating expenses to between $14,000 and $19,000 per physician, according to the 2017 MGMA DataDrive Cost and Revenue Survey. This number is not surprising to Michael Boland, MD, director of in- formation technology, and associate professor, health sciences informat- ics, Wilmer Eye Institute, Baltimore. "The number of systems and devices that are now IT-related is large, especially in an ophthalmol- ogy practice," Dr. Boland said. "… Every new device that shows up is an IT problem because it has to plug into the network. We have clinical systems like the electronic health record and image management, and we have other business-related systems like accounting, billing, and HR." With all of these services being run through IT, the question becomes: Are these services and their associated IT costs lower than what you were paying before for the equivalent manual process? "That $19,000 may be cheaper than the $50,000 you were spending on billing office staff and medical record filing and whatever else was involved in the manual system," Dr. Boland pointed out. David Gans, senior fellow, industry affairs, MGMA, Englewood, Colorado, said that IT expenses, like other administrative expenses, add to the practice's bottom line, but they don't necessarily increase the benefit to the patient. "In IT, there are some patient benefits, but much of these expenses add to the cost of the practice with very little direct patient benefit, so one thing we want to look at is how practices can be more efficient in their operations," Mr. Gans said. Another element, he added, is that many IT costs are relative- ly artificial, meaning a portion of these expenses are occurring to meet federal regulations or requirements of "meaningful use." "There is some benefit to 'meaningful use,' but the question we want to raise is are the benefits worth the cost and are there other ways of providing similar ben- efits for lower cost?" Mr. Gans said. These questions and more are things many ophthalmic practices are still trying to figure out. EHR: The largest IT cost A survey conducted in 2007—a few years after the U.S. Department of Health and Human Services estab- lished a 10-year strategy to promote electronic health records (EHR)—of nearly 600 members of the American Academy of Ophthalmology (AAO) revealed that at that time, only 12% of practices had implemented an EHR, 7% were in the process of EHR implementation, and 10% planned on starting an EHR within the year. 1 Of the 12% who had an EHR in place, 69% were at least satisfied with it, and 76% would recommend implementing such a system to their ophthalmic colleagues. A similar survey was conduct- ed in 2011 with nearly 500 AAO members responding. 2 According to the survey, adoption of EHRs was up to 32%, 15% were in the process, and 31% were planning on EHR implementation. Satisfaction among practices with EHRs, however, was down to 49%, and 55% said they would recommend EHR to other ophthalmologists. The latest survey, which Dr. Boland said will be published soon, revealed between 70% and 80% of ophthalmic practices have an EHR. Satisfaction with the EHR is still down, Dr. Boland added. "It's a bit unclear why that is, but one hypothesis is the people who were going live with EHRs in the early 2000s were the gung-ho crowd, and the people who have gotten one more recently perhaps feel like they were made to do it and are not as motivated to make it work, so they're an unhappier group," Dr. Boland said. These systems not only cost money up front to bring into the practice, but there are annual main- tenance and licensing fees as well. "It's an ongoing cost, and there are people you have to have around you to help configure and use the system, so there are ongoing expens- es," Dr. Boland said. While Dr. Boland thinks most practices with EHRs are likely using the scheduling and practice manage- ment functions well, where practices IT expenses topping out at $19,000 per physician annually continued on page 80 " The shiniest tool in the marketplace is not always the best one for the practice. " —David Gans

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