Interoperability - Part 1

Over the past year, I have written articles regarding important changes that will affect you and your pain management clinic: from the government mandates to get all of health care (doctors, insurance companies, labs, public health, patients, etc.) computerized by 2013; steps toward becoming paperless and being better organized using computerized systems; to how the Nasper Bill will affect you. This article will start a series discussing one of the most difficult and currently most costly hurdles you can face in order to become computerized, namely, interoperability.

Interoperability necessitates the ability to interface and effectively communicate all your informational processes with all of the outside parties you currently—and in the future—will need to communicate with, using some sort of electronic information technology. This includes referring doctors to patients, the 3rd party payer system, and the increasing role of the regulatory government agencies. In the very near future, without interoperability between the information technology you use and the systems you communicate with, you will not only be ineffective but also paid less for your services.

This means most of you will need to totally revamp your computer systems and learn and implement new technology. This is both time consuming, costly, and stressful. Processing information is time consuming. Think about your most time consuming task each week: the initial patient encounter. There is so much information to collect and report on. Most of you still have paper records and thus have a room or rooms of patient health records generated by you and your staff and collected from other sources (i.e., referrals, labs, insurance companies, etc.) As of now, very few private practice doctors have computerized those records.

Interoperability is the key to exchange information between independent laboratories, radiology centers, pharmacies, payers, public health systems, as well as the emerging patient internet portals for communicating with your patients. Your most important benefit for interoperability will be saving time and duplication of records across multiple systems.

So Many Languages!

I read somewhere that better health care communication among providers, patients, and 3rd party systems will be the most efficacious cure for the World’s diseases. More so than any new invention, drug, or treatment! I believe that to be true. Effective communication necessitates interoperability of all health care informational processes. Therein lies the problem. There are so many different ways of collecting, storing, retrieving, and reporting such information. It would be nice to have one standard form of communication. That would make interoperability a non-issue. However, that is not the case. Think how much easier it would be to communicate if there was one language in the world. I think health care interoperability communication is even more complicated! There are currently between 5,000 to 6,000 languages in the world. While there are a lot of languages, health care systems are more complicated and fragmented.

Given the analogy to languages above, let’s look at just one form of communication albeit a major one you do daily, namely, billing. There are more than 6,000 software-billing products in the U.S. alone. They are written in various software languages, database structures with unique storage and retrieval of financial, insurance and patient information methodologies. Even if they were all using the same software language and database types, you would still have variability in how they (i.e. calculate, store, retrieve and report patient fee schedules, co-pays, balances, etc.) That is why it is so difficult to interface billing to other systems and — for what I primarily write about — Electronic Medical Record (EMR) systems. That is also why companies are trying to launch and sell all-inclusive systems that do scheduling, billing, EMR, etc. Unfortunately, much of the all-inclusive concept is pure marketing. The closer you look at such systems, the more you will find major deficiencies. That is because no one company or one product has the capability of doing everything well. Health care is just too varied and complicated. That is why you will find the billing companies that offer some sort of EMR have a poor one. I liken that to the reason why you are a pain management specialist. You would not expect another medical specialty to know the same things you do as a pain specialist. Thus the need for specialized software.

Does My Billing Interface With the EMR?

One of the most important questions that just about every doctor asks when evaluating an EMR system is, “does it interface with my billing?” You, like most doctors, probably have a computerized billing system which is a key consideration in conforming to an interoperability requirement. But think about what is the most expensive part of your practice. You are! Your efficiency is crucial to your profitability. Thus, you will want to get an EMR system that understands and allows you to process the information you need to review, generate, and report as effectively and efficiently as possible.

At first glance, the importance of interoperability relates to savings in input time, duplication, and input errors. Thus, you will want to be able to have your billing “talk” with your EMR system. Given that your billing company will probably not have a good EMR system, you will have to find one that you like and interfaces with your billing. Yes, you could move to a new billing system but that is another long drawn-out process. And if you are happy with your billing and it works, don’t change it. That could cause time delays in reimbursement, relearning, and implementation of the new system and employee turnover. The old adage, “if it works don’t try to fix it.”