EHRs in the Urology Office

Howard W. Follis, MD

Strategic Advisor for HealthTronics Information Technology Solutions Founder of UroChart EHR

The implementation of electronic health records (EHRs) to replace paper charts in urology practices is a recent phenomenon that is picking up some serious momentum. Although the transition from paper to electronic patient medical records is a difficult one for urologists to make, many practices recognize that EHRs, which were only used by so called “early adopters” just a few short years ago, are now important to the health and safety of their patients and to their practice’s bottom line. EHRs in urology practices are generally viewed extremely favorably by patients, who have typically seen their primary care physician using an EHR for several years, as utilization of EHRs among PCPs has lead the way for specialties such as urology.

EHRs increase patient safety by minimizing the chance of medical errors. Legible, accurate medical records and the electronic prescribing of medications are replacing handwritten medical records and prescriptions. Communications between healthcare providers is more accurate when both providers are using EHRs, as the records are clear and do not have to be interpreted by each party.

The collection of relevant medical information via an EHR allows a patient’s primary medical information to be supplemented with lab results, radiology results, and communications from other providers, hospitals, ambulatory surgery centers, nursing homes, rehabilitation facilities, and other care sites. This concentration of medical information in one place allows better and more coordinated decision making to occur. In addition, duplication of medical tests, which was all too common in the “paper” world, is greatly diminished by being able to review a complete medical record in one place.

The federal government has made the adoption of EHRs by healthcare providers a priority for the last few years in order to develop the infrastructure to support a nationwide EHR effort on behalf of patients. This has resulted in a standardization of medical data formats, the transmission of medical data from one EHR to another, or from a practice management/billing system to an EHR, as well as future plans for medical records to be available in a national “grid,” which is expected to improve patient safety and medical care in significant ways. The Meaningful Use program, a monetary incentive program for healthcare providers developed by the federal government after the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009, provides $44,000 for most urologists to adopt and implement an EHR. The Meaningful Use program is widely viewed by private sector healthcare thought leaders, government information technology leaders, and healthcare providers as an important step in the widespread adoption of EHRs.

Certainly the implementation of an EHR can be one of the more difficult processes that a practice can go through. However, while EHRs were truly optional a few years ago, their use is rapidly becoming mandatory in the business environment that urologists now have to negotiate. Furthermore, many EHR vendors have gained significant experience implementing EHRs, and the process does not have to be as cumbersome as once feared. Careful due diligence and purchase of an EHR system, and careful implementation planning can make the experience less disruptive. Critical parts of the implementation include training of urologists and their staffs on the most efficient use of the system, which allows a urology practice to realize all of the benefits of a well-designed system while minimizing the problems encountered.

Interface with the practice’s existing practice management (PM) system is critical so that relevant patient information passes back and forth between the EHR and PM system seamlessly. Interfaces that automatically import lab results into the EHR for easy review are also important. Medical device interfaces that automatically import medical data into the EHR from urinalysis machines, bladder scanners, prostate ultrasound machines, video and regular urodynamics machines, vital signs machines, and uroflow machines are critical to the accurate and complete capture of a patient’s urologic data in an EHR.

One of the most interesting aspects of the use of EHRs is the ability to collect data on practice patterns, utilization of resources, and outcomes to use for a variety of purposes. As reimbursement methodology continues to shift from fee-forservice to outcomes-based or evidence-based methodology, the Centers for Medicare & Medicaid Services, insurance companies, and third party payers are increasingly requiring providers to collect and present data for analysis. As a result, accurate EHR data will become a critical part of the reimbursement of urologists in the near future. Thus, the implementation of a well-designed EHR is no longer optional, and should be considered and undertaken by all urologists in the near future.