EMRs Aren’t Billing Software

The other day, I caught a piece in FierceEMR which brought up an important point.  In the article, the writer summarized comments by a medical practice manager and cardiologist who argues that the tight connection between billing and EMRs makes them less valuable for clinical use.

The article quotes Ira Nash, senior vice president and executive director at North Shore-LIJ Medical Group, who contends that “nearly all of the things that doctors dislike about [EMRs] are features designed to capture information needed for billing purposes.” In other words, he says, EMRs are focused on documenting with doctors did for or to the patient, not about how the patient was doing.

The bottom line, Nash suggests, is that fixing EMRs requires changing the way we pay for care:

Like so many other things that doctors hate about the current health care environment, the flaws of the current crop of commercially available EMRs are a consequence of how we pay for care. Since we are paid for “doing stuff,” we are constantly being challenged to prove that the stuff we are doing is justified, and that we actually did it. We are getting killed by the focus on process. We ought to be focusing on outcomes.

While it’s hard to argue that Dr. Nash is wrong — that a focus on billing for “doing stuff” turns EMRs into billing software — my question is, what is the alternative?  Or rather, what is the best alternative (as EMRs will inevitably have some connection to the billing process even if my colleague John Lynn asked us in 2010 to imagine an EMR world without billing)?

After all, billing does need to be done correctly; if that doesn’t happen, the healthcare organization loses money, or may even face a CMS or private health plan audit, and nobody wants that for their practice. So where do we go from here?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • Absolutely – single payer is a fine model but every US politician risks re-election failure if they suggest it. Funny how suggesting the French system meets with howls of “Socialism”. So what if it was? However it is a mix private insurance & government based, kind of how the US system is? But it actually works at nearly half the cost of the US and rates #1 in the world on the OECD/WHO scale.
    Jean de Kervasdoué, a health economist, believes that French medicine is of great quality and is “the only credible alternative to the Americanization of world medicine.” (Le Monde)
    Japan, Sweden, and the Netherlands have health care systems with comparable performance to that of France’s, yet spend no more than 8% of their GDP (against France’s spending of more than 10% of its GDP and the US 17.9%).

    Yes the way providers are reimbursed creates the criteria for the design of the systems they use!

  • There are many tentacles when it comes discussions like this one. One comment that caught my eye was “he also thought EMRs were bad because they promote fraud”.

    Yes, one can simply check a box to cover the ROS of an exam even if they may not have actually asked about one aspect of it. But I have seen countless times where providers simply draw a line through multiple boxes of paper ROS documents too.

    One example is when a dermatologist speaks to patients about the risks of sun exposure and the recommendation of sunscreen. They add a macro to every progress note that states they had this discussion. Is it wrong if they were distracted in the exam room and neglected to mention this? Maybe, but it is definitely wrong if they use functions like this to knowingly increase their E/M code. But they don’t need and EMR for that.

    I think it is very naive of anyone to presume that EMR’s are opening a new environment of fraud, when it is already happening. One is the stoke of a pen, the other is a click of the mouse. Only now, an audit with an EMR is much more streamlined and makes it easier to see when fraud has been committed. This in and of itself I would believe will reduce potential fraud.

    Many folks lose sight of the forest for the trees when it comes to EMR’s. Outcomes should be the focus. Imagine when a provider has used an EMR for a few years and will have the ability to clearly see what code pays the most for this time. What code gets rejected the most. I can go on and on. I am also an advocate of the information sharing that will happen with the HIE’s. One day a provider will be able to see what others have done for a quicker and more positive outcome than spending time and money on unnecessary tests. Message me and I can explain this in more detail.

    In the end, EMR’s and their proper use will save time, money and lives.

  • It will be interesting some years from now to see if ACO’s have some effect on the emphasis on billing in EHR’s. If outcome then controls reimbursement, the issue should ease.

  • Forgot to mention; a provider still needs to document every action taken even for ACO oriented reimbursement. Everything the provider does is important; the EHR ought to translate actions into CPT’s. Or at least this would seem to make sense.

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