Computers in Medicine Online (sm)


Computers in Medicine (sm) –   Online Newsletter is a quarterly online newsletter on computer applications for the medical profession (Published on the Web since 1996)

4th Quarter ‘2009 Edition



Practice Management Systems and Electronic Medical Records

Practice Management Systems

Most medical practices throughout the country are currently using and have been using Practice Management Systems (PMS).  These are software packages that perform billing, scheduling, and provide tools to analyze your financial data and other business metrics.  Most modern PMS solutions provide for professional and institutional billing, statements and claims, ANSI 837 electronic claims, ANSI 835 electronic remittance, collection processing, resource scheduling, referral/authorization tracking, recalls, patient reminders, practice analysis tools and reporting.  PMS offerings vary in price range based on several factors such as: functionality, reliability, capacity, and others.  In a nutshell, PMS solutions are mission-critical software applications designed to handle the business or financial concerns of the practice.

Electronic Medical Records

Due to advances in technology, government mandates, and other factors, Electronic Medical Record (EMR) Systems are being deployed these days more frequently than ever before.  Physicians across the country are faced with the difficult decision of which EMR package to purchase.   The physician must base this decision on cost, functionality, user-interface, and of course, which one fits their specialty or meets their needs the best.

While the PMS solution focuses on the business or financial side of the practice, the EMR system focuses exclusively on clinical issues.  After all, in a typical practice it will be the providers that use the EMR system while the office staff uses the PMS.


  • EMR = Clinical
  • PMS = Business/Financial

It’s hard to find a valid reason to replace an existing PMS or EMR system in favor of a Single Source solution; they are clearly 2 separate systems with separate purposes that when properly integrated offer you seamless functionality and data sharing.  Acquiring your PMS and EMR systems from individual sources is know as Best-of-Breed, and it allows you to pick the best solution for each function.  In a Best-of-Breed solution, when you purchase your PMS and EMR solutions from separate vendors your risk is reduced by half.  If your PMS works out for you, but your EMR does not, you can replace the EMR and keep the PMS you like (or vise versa).  The financial impact to you is much less than having to abandon both systems.  Basically, Best-of-Breed gives you the best of both worlds.

The government plans to make EMR systems mandatory.  The current Healthcare Stimulus Package contains a component known as the HITECH Act Physician Reimbursement Plan which rewards individual physicians (that accept Medicare) with up to $44,000 (over a 5 year period) starting in 2011, as long as they demonstrate “meaningful use” of their “certified” EMR system.  A similar plan for physicians that accept Medicaid provides up to $64,000.  In both cases the total reimbursements decrease every year after 2011, until they totally disappear in 2015.

Physicians that do not adopt certified EMR systems or have not demonstrated “meaningful use” of the certified EMR systems they have adopted will be penalized.  These physicians will see a decrease of 1% in their 2015 Medicare Fee Schedules.  These fees will decrease every year by an additional 1% until a maximum of 5% is reached (if they determine by 2018 that the adoption of certified EMR systems is below 75% of eligible providers).

The replacement of ICD9 diagnosis codes by ICD10 diagnosis codes will force providers to change the way they have been coding for years.  The new ICD10 codes have much higher levels of specificity and as such are much more difficult to code.  It is expected that the use of EMR systems will alleviate much of the effort of selecting the correct ICD10 codes.  As of this writing the implementation date for ICD10 codes is scheduled for 10/1/2013.

For reasons such as the ones discussed above, there is considerable pressure for physicians to adopt certified EMR systems.  We’ll leave it here with a few things to keep in mind and some advice:

  • The HITECH Act Physician Reimbursement Plan does not start till 2011
  • Certification for some specialties have yet to be defined
  • The selection of an EMR system should not be taken lightly – research the products based on the needs of your specialty
  • Take your time!  There are many changes going on at the moment – you might want to wait for things to stabilize – a poor decision now, can be very costly later!
  • Consult with your PMS vendor – some PMS software packages (such as Brickell Medical Office) can link to products from many EMR vendors
  • Be cautious when considering EMR vendors that insist on their own PMS solutions (Best-of-Breed has many advantages over Single Source solutions)

As time goes by, the current situation will become clearer.  The keyword here is patience.  If you must get an EMR system now, please do your homework!


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Last Update: 10/1/2009

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