Prepare for CMS audit of the EHR incentive program

By Amanda Scanlan | Published: January 25, 2012

CMS AuditTotal federal incentive payments for the use of electronic health-record systems have soared to just over $2.5 billion, according to CMS. Over 114,000 eligible professionals and hospitals have registered for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. These facts and figures are showing exceptional growth in adoption and implementation of certified EHR technology. Thus far, every step (registration, Meaningful Use measures, attestation, and EHR incentive payments) is going as smoothly as intended. What every provider needs to know is that any provider attesting to receive an EHR incentive payment for either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program potentially may be subject to an audit. The audit is to ensure that information exchanged is accurate; financial details are matching, and report of clinical quality measures (CQMs) is generated as output from an identified certified EHR technology.

CMS is scrutinizing inaccuracies in eligibility, reporting and payment through pre-payment edit checks and post-payment audits. Even if the provider received incentive payments and later on officials from CMS find out during audits that the provider is not qualified for the incentive, the payment will be recouped. To reclaim that, there will be an appeal process for the providers to prove eligibility in such a case.

Auditors would examine that eligible providers (EP) and eligible hospitals (EH) are properly using a certified EHR system and validate that the provider(s) accurately attested and submitted CQMs, as well as to verify that the incentive payment was accurate.

Make packets of documentation used in attestation for each year of participation.
CMS requires that all providers should retain documents (electronic or on paper) used in attestation for up to six years. It means that providers registering for attestation now are liable to audit anytime in the coming six years. To foolproof this looming audit, providers should compile packets of documentation used in attestation for each year of participation. If saving it electronically, they should be in damage resistant formats i.e. PDFs or image file formats. It is better to print them on paper as well and archive them annually. Furthermore, it is quite advantageous if your EHR system is capable of managing revenue cycle and payments. CMS auditors would be eyeing financial data as well so as to testify that incentive payments are made on justified financial calculations.

Maintain an audit checklist.
To streamline the process, maintaining an audit checklist is quite a pragmatic approach, counter checking clinical work practices on weekly bases or examining the tasks processed through an EHR system that passed the 90 day attestation period for the first year. The checklist should ensure that the EHR system is meeting Meaningful Use measures i.e. recording demographics, vital signs, smoking status, etc., and fully utilizing the eRx/CPOE/CDSS functionalities. Similarly, clinical quality measures are rightly achieved and patients’ health information is exchanged on HIPAA transaction standards.

CMS is going to implement the audits through third party contractors, will perform audits on Medicare and dually-eligible (Medicare and Medicaid) providers. As for audits on Medicaid providers, CMS, in addition to its contractors and States, and their contractors, will perform the audits. Regarding the appeals process, for Medicare, CMS and states will manage the processes, while States will implement appeals processes for the Medicaid EHR Incentive Program. For more information about the Medicaid appeals, please contact your State Medicaid Agency. Nothing should be left for the eleventh hour, eligible professionals and hospitals should bring about periodic internal audits which should point out malpractices in advance.

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Health Information Exchange (HIE): Connectivity, Integration and Interoperability

By Jimmy | Published: January 25, 2012

The formation of a universally connected healthcare network has stirred a technology driven revolution in the United States. The network has been structured so that patients may have greater access to their health information, as well as increased connectivity with physicians, pharmacies, and clinics. To realize it, an influx of EMR, EHR, e-Prescription and other practice management tools by healthcare IT companies are harnessing the complexity of supported infrastructure and its implementation. The revolution is further corroborated with legislations, rules, standards and incentives by the Health Information Exchange HIE Connectivity Integration Interoperabilitygovernment.

Connecting the interwoven web of lines that link hospitals, physicians, data warehouses, insurance carriers, billing companies etc. is not as simple as this graphical illustration. The actual process is extremely complex due to secure, powerful and efficient health information. There are many factors that come in to play, such as, real-time connectivity, seamless integration of IT systems and interoperability of health information.

Connectivity lays the foundation for health information exchanges (HIEs) which promote themselves primarily to the provider community. The point of an HIE is to offer shared data that would not be there if not for the consent and participation of patients. HIE’s enhance the level of care coordination, i.e., in a specialty practice, a doctor might not have privileges at a patient’s hospital. The HIE provides them the ability to tap into a health exchange portal and access the hospital record which improves consultations and reduces duplication. It is indicative of how information is following the patient and points in the direction of where the future of medicine is heading.

Integration of healthcare IT solutions needs to come equipped with advanced information exchange protocols and coding capabilities. EMR systems are instrumental in digitizing and hosting electronic versions of medical records. Working parallel, EHR systems are more sophisticated in disseminating healthcare information. To create a web of healthcare networks, these applications are to be combined with the power of web and online solutions, such as, e-Prescription and patient portals. The whole idea of integration matures when a variety of software and hardware solutions work in harmony, sharing information across networks. There is a fine line dividing integration of these heterogeneous systems and interoperability and health information.

Interoperability is a leap ahead from just making a network of connected devices. Different technologies communicate with each other, using shared information for a purpose i.e. improving health care in a more efficient way. Currently the obstacles hindering the interoperability of health information are due to evolving changes e.g. (CCR, CCD / XML, HL7 coding and transaction standards) uniformity of which is necessary to align syntactic and semantic interoperability.

Working in the direction, ONC has planned 3 stages to ensure an effective exchange of health information among healthcare service providers. Demonstrating stage 1, eligible professionals must “provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and medication allergies) within four business days of the information being available to the EP.” Stage 2 focuses on interoperability, and the focus would shift to real use of patients’ health records at the point of care and improving outcomes through collaborative decision making. Similarly, stage 3 would be focused on improving efficiency through examples of healthcare delivery and payment reforms.

Security and privacy of the data exchanged is of extreme concern for healthcare technologists nowadays. Cases of data breaches and theft of health information is raising questions over the success of this system. Without edifying the trust among all the stakeholders, health information exchange cannot bear its fruits for providers, patients, researchers and public healthcare entities.

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EHRs and Revenue Cycle Management (RCM)

By Jimmy | Published: January 13, 2012

Transition to HIPAA 5010 electronic transaction standards and implementation of ICD-10 codes are meant to refine newly deployed electronic health record systems for improving healthcare service quality and cost management. Thus far it seems to be a win-win for everyone following the government led healthcare reforms for mutual benefits, but is it that simple to save billions of dollars when upfront costs to set up this electronic transaction and coding system is touching new levels day-after-day? Let’s dig into the whirlpool of these transitions to find if there were really loopholes in the healthcare system that need to be patched up, draining out all the money in hidden, deep pockets, or everyone is beating the bush in exaggerated hopes.

It is a bit complicated to calculate, but by avoiding unnecessary tests and eliminating mistakes in practice have made these huge savings possible. Payment claims manually sent to different organizations used to slow down and marginalize revenues while inaccuracies found later and objections by third parties further delayed the revenue cycle to complete its circle. EHR applications are instrumental in streamlining accurate coding, billing, and processing of claims across networks in digital formats. The technology has facilitated revenue cycle management (RCM) through integrating clinical procedures and connecting healthcare facilities with clearinghouses, insurance companies and government agencies.

A successful revenue cycle management (RCM) achieved through an EHR system relies on flawless processing from patient registration to payment clearance. Broadly speaking, there are four major steps (shown in the figure), which complete this cycle.

Revenue Cycle Management achieved through EHR

Patient registration is the first critical step in revenue cycle management. This is where insurance information of the patient is checked. Integrated patient portals have made it possible to schedule appointments before actual visits, which help providers who use an EHR system to make certain decisions and verify information in advance. However, most of the required information is entered in the EHR database on the actual visit. It is critical to check a patient’s ledger and previous billing history for a proper follow up.

Eligibility and authorization of the patient can be checked in a few clicks using an EHR system. After entering the initial information, the provider can electronically check a patient’s insurance plan and information about family members covered under the plan. One can check the benefits and services that the patients are allowed to get under their plan.

Payments are denied when the provider bills for a treatment that is not authorized by the insurance company for the service. This denial adds up cost and time for the payment to reimburse. Using an EHR system, the provider can perform an authorization check.

Coding of CPT Service & Diagnostic procedures is something that has baffled healthcare providers until now to receive payments without any objection. When sending a claim for payment, they must use the standard codes for their service and treatment. EHR applications have automated this difficult step by intuitively entering the corresponding codes. Currently, EHR systems are upgrading to HIPAA 5010 system for electronic data interchange.

Billing & Payment Posting is the final stage that completes the revenue management cycle. Billing companies and solutions had been operating long before EHR systems came into existence. Now integrated in EHR applications, bills are electronically sent and updated. On successful remittances, providers are notified and EHR applications update full transaction history on appropriate panels.

EHR systems have automated revenue cycle management (RCM) and now accurate coding and billing requires no additional services of a costly consultant in the field, hence, providing an intelligent solution to healthcare management and physician practices to cash on the nail.

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ACO Formation – First Round Begins

By Jimmy | Published: January 12, 2012

With the advent of this year, the formation of Accountable Care Organizations (ACOs) has stirred up interests of many in healthcare administration. Accountable Care Organizations (ACOs)are defined as ‘a set of providers associated with a defined population of patients, accountable for the quality and cost of care delivered to that population’. The ACO has significant priority for clinicians since they must comply with this voluntary accountability to secure performance based incentives and be penalized in the case of malpractice.

To construct this accountability system, CMS’s Final Ruleoutlines several ACO programs, modifications and timelines. The ACO programs offered are:

CMS is anticipating that these ACOs will evolve into sustainable systems over the coming months, evaluating performance and playing important role in balancing healthcare costs. The program would serve as a platform to show off public-private partnerships that fine-tune the healthcare system and show improvement through internal checks and reward pay outs.

The registration period for ACO’s to apply to CMS commenced on January 1, 2012. ACOs who apply now would enter into an agreement from April 01, 2012 for a first performance year of 18 or 21 months. Beneficiaries from the registered ACO have to report on 33 quality measures in order to qualify for the first-performance year shared savings.

Although, ambiguity and speculations surround the overall design, organizational infrastructure and effectiveness of ACOs, the government seems steadfast in making healthcare practitioners and organizations, mutually responsible for the betterment of the healthcare system.

There are many models that can be followed to structure an ACO, existing health delivery consortiums can also be replicated e.g.

ACO Models

(Source article S.M. Shortell, L.P. Casalino, and E.S. Fisher, “How the Center for Medicare and Medicaid Innovation Should Test Accountable Care Organizations,”)

From any of aforementioned suggested models, healthcare providers may follow one and form an ACO.

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EHRs: Importance of Data for Meaningful Use

By Amanda Scanlan | Published: January 9, 2012

Physicians can maximize the efficiency in their patient care by utilizing an EHR in their practice. When it comes to collecting patient health data, especially with Meaningful Use playing a key role in healthcare, the focus on accuracy should absolutely be paramount. Ensuring that the correct information is captured, the first time for clinical decision making goes hand in hand with the physician’s efficiency, effectiveness, and user satisfaction.

By putting into action and meaningfully using an EHR system, providers will reap benefits beyond financial incentives–such as reduction in errors, availability of records and data, detailed notes – complete with diagrams, reminders and alerts, clinical decision support, and e-prescribing/refill automation. The data that an EHR possesses helps to speed up as well as streamline the documentation process for the physician.

Electronic clinical documentation is vital to achieving meaningful use of HIT and is directly related to advancing care processes and improvements in quality, safety and efficiency. Additionally, it is central to the delivery of high quality care as well as improved care coordination. By a physician capturing meaningful use criteria for their entire patient population, they are able to realize the true potential of their EHR. The fifteen core objectives for meaningful use that a physician or their medical staff gathers comprise the basic functions to support improved health care. By collecting essential data such as a patient’s vital signs, demographics, active medications and allergies, up-to-date problem lists of current and active diagnoses and their smoking status, puts a dent in meeting some of the meaningful use criteria.

An eligible professional is required to report on a total of five out of ten menu set objectives. Out of the five, the EP must select at least one public health menu set option such as immunization reporting. The five measures should be relevant to the EP’s scope of practice, even if they qualify for exclusions in their other objectives. The final bit of data that needs to be captured for Stage 1 meaningful use are the total of six Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from alternate set). These measures are defined as processes, experience, and/or outcomes of patient care, observations or treatment that relate to one or more of the Institute of Medicine (IOM) domains of health care quality (e.g., effective, safe, efficient, patient-centered, equitable and timely). Although CMS requires all EPs to report core measures, there is no requirement to satisfy a minimum value for any of the numerator, denominator or exclusion fields for clinical quality measures. The value for any or all of those fields, as reported to CMS or the States, may be zero.

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Patient Portals – Going beyond Meaningful Use

By Amanda Scanlan | Published: December 15, 2011

As the final rules to support Meaningful Use have been clearly defined, it is guiding everyone to patient centered healthcare. Patient Portals are making it possible through real time communication solutions and efficient health information exchange.

It would not be an exaggeration to say that Patient Portals could eventually evolve into personalized Facebook-like platforms for doctors and patients. Two-way messaging and content sharing is already on the go but there is fear of data breaches and privacy infringements which is holding its integration in a more collaborative style.

On the surface, it seems that Meaningful Use measures are designed specifically to set right Electronic Health Record systems (EHRs) implementation but many of its core and menu objectives cannot be met without using Patient Portals.

For instance, one of the Meaningful Use core objectives requires that providers supply their patients with an electronic copy of their health information upon request, within three days. On the other end, HIPAA privacy and security requirements want this electronic information exchange encrypted and following safety instructions. Patient Portals serve this purpose by empowering patients with real time access to their health records. Let us preview it in a loop by comparing features of a Patient Portal and Meaningful Use objectives.

Patient Portals and Meaningful Use in the loop

Providers can share with the patients electronic copies of health literature and send them online test result reports via Patient Portals. Likewise, one Meaningful Use core objective requires submitting a summary of more than half of the clinical visits in three business days. Patient Portals that are well integrated with EHR and EMR systems update it automatically; and a patient can view a summary of these visits.

Patient Portals have intensified the urgency level required in critical situations and fatal diseases; patients are notified immediately about follow-ups through alerts and reminders.

Patient Portals are outperforming Meaningful Use objectives.
Patient Portals endure the convenience of work at flexible hours. Patients can send appointment requests and a summary of their symptoms while providers can schedule the appointment and ensure that the clinical resources are in place ahead of time. Moreover, prescription renewals and refills used to involve telephone calls and faxing on both ends. The process has been made easier by Patient Portals where the providers review and authorize the refill request online. Another perk to the Patient Portal is that patients can pay using their credit or debit card allowing them to remain up-to-date on payments and current balances. There is a lot more to expect from this promising technology, this is just the beginning.

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EHRs and Patient Portals Technology to Lower Overhead Costs

By Amanda Scanlan | Published: December 13, 2011

Patient Portals combined with electronic health systems (EHRs) work to induce ease of access to health information at reduced cost. Patients can log-in to their portals, set up a meeting with the physician, update their health records, request a prescription renewal and pay bills. Similar are the benefits for providers who can virtually visit and communicate their patients online.

However, healthcare providers today are working with narrow profit margins. They are working intensely to deliver the best quality at a minimal fee to their patients. An increase in their earnings is only possible if they treat more patients in less time. It requires a reduction in the time of waiting, diagnosis and treatment. Besides, they require patient portal technology to fulfill Meaningful Use program criteria.

“Patient portals empower individuals to become more involved in their own care, which may lead to better outcomes and lower costs”, a statement by The Office of the National Coordinator for Health Information Technology (ONC) summarizes.

Time is money
Providers are required to spend a lot of time discussing symptoms with their patient’s and for those still using papers, filling in charts. Similarly, they have to spend time maintaining and retrieving patient’s records for every visit. This time and effort is not something that healthcare providers are paid for. Through online patient portals, patients can fill out the initial information from their homes and their physicians can peruse at their convenience. In addition, when the patient visits the provider, their electronic health records are available beforehand. At average, four to five minutes of a clinical visit are saved in this way.

When patients send a request for visit, management can adjust time slots and resources accordingly. Similarly, when a physical visit by the patient is not required, the physician can give virtual advice, saving costs on both sides.

Patient portals eliminate spending on data entry
Data entry clerks, working for a healthcare provider used to cost around $25,000.00 annually. This huge cost is saved when patients themselves update their health records via the online portal and enter their basic information on eForms.

Print & postal expenditures are saved
Sending patients the registration packets bears the cost of printing and dispatching. It generally takes up to 2 days for the packet to reach the patient; the issue arises in that the provider needs that material in order to execute tasks. Now patients fill in the required information online by signing in to their health record page and can view reports from anywhere without requiring a printed copy.

Similarly, electronic versions of health education literature are shared on patient portals so that patients can stay informed about specific diagnosis’s.

Savings on telephone and fax bills
It has significantly reduced telephone and faxing expenditures by harnessing the power of e-messaging. Even sharing health information with a referral doctor is achieved electronically through EHRs and the patient portal technology which otherwise required information to be printed on paper and hefty faxing.

Prescription refill & renewal authorization on personal computers
It is easier to keep track of updates in a secure patient portal environment. Patients are provided with passwords and logins, which they can use to access their portals, regardless of time and space limitations. Request and authorization for prescription refills can be handled from the luxury of one’s home on a personal computer – the only requirement is a computer connection to the internet, which if not available can be done on a kiosk terminal.

Billing and payments made easier, reducing processing cost
Billing and payment has never been that easy. Payment options available in patient portals are not only quicker, it also diminish third party processing charges.

More than that there is a long list of patient portal features.

Money saved is money earned. EHRs and patient portal technology are saving monies through less expensive modes of communication and scaling down overhead costs. It is a simple, one-place solution, which is infusing resilience and value to healthcare.

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EHRs and a more harmonious workplace

By Amanda Scanlan | Published: December 9, 2011

We want to live in a connected world: songs, videos, photos all at one’s fingertips. This user behavior is prevailing at doctor’s office as well. EHR systems have polarized health record repositories and communication nodes, interchanging health records.

When Google’s co-founder Sergey Brin posted on his blog that he carries an inherited gene that could predispose him for developing Parkinson’s disease, everyone was shocked by the revelation. His mother was diagnosed with the Parkinson disease and Brin discovered that he also possesses the same gene, which caused the disease. This high-profile disclosure made us believe in the marvels of health information exchange (HIE). How connected reservoirs of electronic health records center on one and work to improve healthcare.

Medical facilities equipped with an EHR system, betters workplace practices. It automates clinical procedures and increases venues of communication. Effective communication is the key to harmony at any workplace. Clinical staff interacts with each other even when placed in different departments; they tend to work as a cohesive group.

EHR systems are embedded with advanced tools of communication. One can check emails and messages sent by patients and co-workers, right into an EHR system. Instant messaging improves two-way communication between staff and providers. Clinical staff can access an integrated EHR application on multiple computers where content entered on one automatically updates on every screen. Via an integrated patient portal, patients can send personalized messages, schedule visits and request medical records. By logging on an EHR system, medical staff can view daily rosters and tasks assigned to them.

Setting priority to tasks and scheduling ensued by an alert system, organizes staff at every level. At an EHR installed workplace, tasks are assigned electronically according to the roles, job responsibilities and time-shifts. A vigilant flow of clinical procedures evades possibility of lagging assignments.

It is easier to keep track of mistakes and errors. Figuring out the origin of an error; who made the incorrect entry is easily traceable through EHR systems, leaving less space to blame subordinates or colleagues of a wrongdoing. Everyone is clear about responsibilities and chores to perform, working through an EHR system, with zero chance of clash with one another.

Proper training in a technology driven work environment brings everyone to an equal level of skills and practices. EHR systems are enriched with customizable panels and intuitive decision support functionalities that help maintain the standards and unanimity. The learning curve when using an EHR system as a beginner might feel cumbersome, but as with the experience, its well-organized templates help improve the efficiency of workflow.

The use of an EHR can decrease the workload within a practice in many ways. Office environments and workplace dynamics can affect the performance of employees. For instance, record keeping used to consume a major portion of a hospitals resource with it being quite an expensive liability in addition to the filing cabinets consuming huge spaces. EHR systems have redesigned the whole concept of the setup in a medical office.

Harmony comes to a workplace when everyone performs in perfect balance. Contributing to each other and leaving no room for workplace inefficiencies. EHR systems combine all the constituents of a healthcare facility and gear them together to an optimized workflow.

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Paper-based Records to EMR: A Transition in Context

By Amanda Scanlan | Published: November 29, 2011

From Paper to EMROnce you have decided to switch to an EMR system, conversion of paper-based records to digital formats would take a major part of your resources and efforts. First thing that troubles the management of a healthcare facility is finding the most efficient way of achieving this goal. Healthcare facilities that have been functioning on paper-based charts are going to have a plethora of papers that need to be scanned, converted to digital copies and successfully transfused to an EMR system.

Individual practitioners tend to have a more convenient time deciding which documents to scan and what to leave. However, hospitals and large healthcare facilities usually embroil up at this stage, therefore it is better for them to take poll the majority and decide appropriately. An all-inclusive approach in turn would scan every piece of paper which would be extensive and requires a lot of time and money. To some providers it would become a task worth $100 million. Partial scanning of health records is a more workable approach. A recommendation is to start with active patients and visitors and then move on to older, stagnant entries. Scanning the most urgently required records such as reports and charts of the scheduled patients in the coming weeks and their basic information should push start this process.

Outsourcing this hefty task can be helpful in many ways as it removes the potential burden of charging your employees with the task. Secondly, data entry companies that have established a presence in the industry are experts in tackling such tasks and would execute the tasks more professionally. The key is to ensure that the digital formats are as per the EMR system requirements so as to demonstrate a successful integration.

One must be careful that the electronic medical records meet universal standards set by the industry. EMR systems are not targeted to operate in isolation, interoperability and exchange of health records is among the core objectives. Standards and requirements set by organizations such as The American National Standards Institute (ANSI) and HL7 Clinical Document Architecture (CDA) are helpful to ensure accurate conversion and integration of health records into the system.

Note that when the scanning has been completed, it is not the end of process. The papers still hive the bulky shelves of the storeroom. What should a practice do with them? How long should they retain them? What are safe ways to dispose of them? Every State has different laws about keeping records; some prefer that a healthcare facility retains them for five to seven years. The Center for Medicare & Medicaid Services (CMS) does not require a practice to keep the physical paper chart as soon they are digitally archived. However, they should be retained as long as they are required for legal issues and until the practice is confidently working with their EMR system. Ultimately, paper shredders or waste incineration machines should end the fate of paper-based records.

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Advantages to an Electronic Health Record (EHR)

By Jimmy | Published: November 29, 2011

When it comes to “the highest attainable standard of health”, there is a consensus that adopting EHR technology is a step in the right direction. It is true that change can be difficult to adopt, but as soon healthcare practioners are exposed to phenomenal EHR advantages, it becomes difficult to continue with old practices.

There are countless reasons to adopt an EHR system, take for instance a hospital in Missouri that was hit by a tornado, damaging it to the extent that they had to evacuate every one hospitalized. The worst thing that happened was to the backup of records on paper that were found as far as 72 miles away from the hospital. However, just three weeks before this catastrophic storm, an electronic version of the health records had been maintained and transferred to an EHR system, helping hospital administration start again at a mobile facility in less than a week.

“Anyone who has doubts about the benefits of electronic health records, when they see how quickly we had access, and the greater security we have with EHRs, they’ll see you can’t beat it,” said Dr. Tracy, a family physician at Missouri. This is just one benefit realized in the aftermath of a crisis; EHR systems are improving the quality of practice at every level.

  • An EHR system offers greater access to records and increases communication possibilities between healthcare providers and patients.
  • It is easier to maintain, update and backup electronic health records through an EHR system than by previous practice of keeping records on papers and filing it in huge cabinets.
  • Drug-drug and drug-allergy interaction alerts functionality in an EHR system is pivotal in helping doctors reach the right medication through clinical decision support system.
  • E-prescription and medication management are the hallmarks of EHR technology, connecting pharmacies and healthcare units.
  • An EHR system streamlines administration and management of health care workers through customizable panels, reminders and scheduling.
  • Health information exchange (HIE) and interoperability of data has made possible much avowed patient centered care through ease of access to health records, regardless of time and space.
  • Computerized physician order entry (CPOE) capability of an EHR system has added functionalities, which range from electronic forms to end result reporting.
  • An EHR system reduces errors, ensures accurate coding and minimizes cost.
  • Adoption of an EHR system is helpful in meeting national standards and health laws.
  • And what is it meant for? An EHR system improves quality of healthcare, automates clinical procedures and decreases operational cost.

Advantages to an EHR system are diverse in proportion and effect. Fruits of this promising technology can only be relished in its complete form if utilized properly and after appropriate training. Without a doubt, the adoption of an EHR system is the doorway to achieve the next level of healthcare.

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