The Medical Group Management Association (MGMA) has an interesting study on the benefits of electronic registration.  In January, 2009 the MGMA launched an initiative call SwipeIT.

Project SwipeIT is an industry wide initiative launched by the Medical Group Management Association (MGMA) in January 2009 to advance the adoption of standardized patient health-insurance identification (ID) cards containing machine-readable information.

The concept is that the insurance providers will issue patient health-insurance ID cards that contain patient information including demographics, health plan information, co-pays, etc.  The cards will act and function like a credit card.  Each medical practice, hospital, clinic will need to have a card reader that can process the information on the card.  The card reader can then be linked to a practice’s EMR or practice management system which will populate the patient demographic and insurance fields automatically.  The whole process is referred to as electronic registration.

The MGMA study takes a look at the costs of non-electronic registration and calculates the savings that can be realized by implementing electronic registration.  There are enough numbers and calculations in the study to make your head spin but I will highlight a few statistics that are eye opening.

Model Assumptions and Raw Inputs	Values
Number of claims per year for physician professional services	1,160,542,000
Hours saved per year during registration process by implementing electronic registration	95,280,498
Dollars saved per year during registration process by implementing electronic registration	$1,931,753,287
Number of claims per year that must be resubmitted due to payer denial due to incorrect patient demographics from non-electronic registration	57,168,299
Hours per year to resubmit claims denied due to payer denial due to incorrect patient demographics from non‐electronic registration	14,292,075
Dollars saved per year by not having to resubmit claims denied due to payer denial due to incorrect patient demographics from non-electronic registration	$289,762,993
Total savings due to implementing electronic registration (dollars per year)	$2,221,516,280

The MGMA estimates that $2.2 billion per year can be saved by implementing electronic registration.  It should be noted that the study does not estimate the cost to implement the electronic registration including the cost to insurance providers to issue the card, practices and hospitals to purchase and install card readers, EMR and practice management vendors to modify their software to interface with the card readers, etc.  I suspect that a good part of the initial $2.2 billion in savings would go to the implementation costs.  The savings on-going would still be significant.

The MGMA also studied the impact on a typical 6 FTE physician practiced and published their results.  They took conservative and non-conservative estimates on the impact of electronic registration.  The difference in the estimates are described as:

A conservative estimate where only 10% of patients have their insurance cards copied, presumably because of changes in their information.

The non-conservative estimate is where:

(a practice) copies the patient’s insurance card on each visit. This practice may also have a much larger proportion of patients whose information needs updating.

The highlights of the study are listed below:

Conservative estimate	Time
Time saved by Swipe card	7 h/ day	1820 h/ year
Non-conservative estimate
Time saved by Swipe card	23h45m/day	6175h/year

If these numbers are accurate, the need for front desk personnel could be reduced and savings could be realized at a practice.

Electronic registration is an industry wide initiative.  All stakeholders including insurance providers, EMR vendors, medical practices and hospitals would all need to be involved and implement the appropriate technologies.  Until then, the savings highlighted in these studies are only theoretical.

There are literally hundreds of Electronic Medical Records (EMR) systems for sale.  Some have similar feature sets while other differ in their offerings.  There are many articles, blogs, and whitepapers on picking and implementing the best EMR for a practice.  Most of these seem to focus on the software selection, the workflow process, the implementation process and ongoing support of the EMR.  What seems to be missing is the focus on the actual network and computer system that the EMR will be running on.

As a practice goes from paper charts to a full blown EMR implementation, there will be a need to grow the practice’s computer network dramatically.   With the old paper chart model, there may be a couple of computers at the front desk for patient sign in and insurance information collection.  There may also be a few computers for billing and administration.  On the whole, a practice may have a very small or limited computer network. 

On the other hand, once a practice moves toward an EMR implementation the amount of technology required increases dramatically.  The front desk will may need scanners to scan insurance cards, driver’s licenses, etc.    Additionally the front desk may check on insurance coverage which may require Internet connectivity.    Physicians will need tablet computers to enter patient information during a visit.  If a practice decides not to purchase tablet computers then perhaps each exam room will need a computer, laptop or terminal to access the EMR system.  The billing department will need access to the EMR system as well as Internet connectivity to submit insurance claims.  Workgroup or network scanners may be needed to scan old patient records into the EMR or to scan patient’s new paper information i.e. letters, referrals, etc.  Electronic fax servers may be required to send information out of an EMR to another physician’s office or the fax server may be used to receive electronic faxes and attach them to patient records within the EMR. 

In addition to the equipment mentioned above, there is the EMR itself.  The EMR may require a database server and database software such as Microsoft SQL Server.  There may be a need for a network domain controller which stores the user names and network credentials for a practice’s employees.  The EMR database may be backed up to a tape backup unit or by a remote backup service that backs up the data securely over the Internet.  The reliance on the Internet become essential and requires a dependable and fast Internet connection.  These connections can be a T1 from a phone carrier (i.e. Verizon, AT&T, Qwest, etc.), DSL or a Cable Modem.  The Internet connection should be secured via a Firewall which protects a practice’s network.

Once all of the above technology is purchased and deployed a practice may want to roll out Email for both internal and external communication.  Email with patients may require additional email encryption technology.  With all the new computers and employees that now have access to the Internet, the potential for abuse may arise.  Technology to limit employee’s access to the Internet may need to be implemented.  Additional technology to provide Disaster Recovery of the EMR or network may also need to be purchased and implemented.  Remote Access to the EMR may be required which may require additional network technology.

As you can see, a practice may go from a handful of computers to a full blow computer network with a lot of advanced technology.  The network will need to be maintained which may include verifying data backups, security patch deployment, software upgrades, preventative maintenance, etc.  In addition, the HIPAA Security Rule and HITECH Act requires that a network be secure, audited and access to patient information must be available.  These requirements bring along the need for additional technology and network maintenance processes.

We will go into detail about a lot of these technologies in future updates.  A final thought to think about when a practice is evaluating EMRs – Don’t forget about the computer network!