Current economic conditions has set forth unprecedented stimulus packages aimed at solving the current credit crisis.  Among the areas garnering strong support by the Obama administration is healthcare cost containment.  To achieve that, many stimulus packages have been either implemented or are in process:

• tax incentives in 2009 to implement paperless electronic medical office.
• medicare incentives to provide electronic prescriptions beginning 2011.

But where does a busy physician who is consistently asked to do more with less turn to for legitimate unbiased information?  There are no less than 20 major companies that deal in the EHR/EMR arena.  How do you sift through voluminous advertisements and targeted claims of improving revenue, streamlining work flow, and decreasing practice overhead?

A good starting place would be to look at CCHIT (Certification Commission for Healthcare Information Technology).  What is CCHIT?  It is a non-profit certification body for EHR and related fields.  Its purpose is to accelerate adoption of EHR by medical community.  It offers valuable listing of EHR/EMR  companies that have met or exceeded CCHIT standards.  CCHIT sets the gold standards by which EHR/EMR products must achieve.  In short it is the “certifying” board for EHR/EMR products.  A list of CCHIT approved companies are listed at the website.

Many professional organizations for physicians including American Academy of Family Physicians (AAFP), American Medical Association (AMA), American Osteopathic Association (AOA), and many other organizations have extensive reviews and support forums for EHR and EMR systems.  Additionally, many local and state physicians associations also have resources available for physicians starting their research.

Tap into the community resources available to you.  Practices are beginning to adopt paperless concept by employing IT infrastructure, software deployment, and workflow implementation.  Most physicians are eager to offer their insights and advice on how their system works.  If possible, visit the office and observe the work flow produced by the particular EHR system.  Some of the questions to ask are:

• How extensive was the IT implementation (including hardware requirements and cost)?
• Has it streamlined work flow and has the practice gained efficiency?
• What software is used?  How was the implementation process?
• What type of maintenance is required?
• How is the technical support for the software?
• Is the physician happy with the results?  Would he recommend this system?
• What was the cost involved in operation and implementation?

A good EHR vendor should have excellent support staff and they should be eager to help you.  Additionally, a good EHR system will have a built in community of physician who have successfully implemented the system.  Does the software company in question have a burgeoning community of users who offer valuable advice, forums, and insights?  Additionally, can the software vendor in question have a network of reliable consultants who can implement IT infrastructure, offer technical support, and provide practice management solutions at reasonable cost?

Take an active role in educating yourself in the often confusing world of EHR/EMR systems.  What may be right for one practice may not be right for another.  However, it is generally accepted that a good EHR/EMR systems tends to increase its user base.  Quite often the most expensive systems are not necessarily the best.  Call representatives from companies that interest you and schedule a demonstration, visit their websites, and talk to vendors at trade shows.

Currently, the top systems, according to CCHIT are:

• e-MDs
• eClincalworks
• Allscripts Professional EHR
• NextGen EMR

The above list are highly recommended systems within the professional community.

Whatever the case may be, the right time to start the educational process regarding EHR/EMR is now.  Additionally, there are myriad of consultants available to help choose the right EHR/EMR system.  If choosing this route, one must carefully evaluate the consultant group’s field of expertiese, their product offering, and effectiveness.  But, this is another topic in itself but it is another avenue to help in finding the right system for the practice.

The current economic situation presents severe challenges for small business owners. For all intents and purposes, banks are insolvent. Despite multi-billion dollar government bailouts, banks are no longer capable of providing liquidity to fuel business growth both small and large. The central thesis of why the credit market has “seized” up is a topic for another time as it is too complex for the scope of this article.

Small business is the life-blood of “American Dream.” It is the engine that drives American economy. However, without availability of credit, many small businesses are forced to drastically curtail business operations, limit expansion plans, reduce payroll, and ultimately forced out of business. Current Administration has neglected to see the central importance of small businesses for the American economy and has proposed to further burden already strapped small business owners with rising payroll taxes, stifling health insurance requirement, and inability to revive bank lending.

Despite such dire predicaments for small business owners, opportunities exist for the prepared and enterprising. Leverage is what got this economy into the current crisis. Likewise, those businesses that will survive and even thrive in this environment are those that have “de-leveraged” or have taken care of debt load.

The balance sheet must be pristine. If it is not, active effort must be undertaken to achieve clean balance sheet. This can include debt restructuring with creditors, curtailing expensive projects that will not add to revenue, analysis of profit margin, and review of local demographic trends for the business in question. If the business cannot pin point these items, it will have challenges ahead as this economy will not improve overnight.

Cash is king. Business owners must ensure prompt payment for their services. If a business is dependent on extending credit, a serious evaluation must take place on the accounts receivables. Any account that is aged beyond net 30 days must be aggressively attended to. The business practice of allowing the AR to age past net 90 days in this economic environment is near suicide.

Marketing is important. More than ever, small businesses must make their existence relevant and recognizable to potential customers. Sadly, one of the first business expense cut during tough economy is marketing. However, there are cost effective and creative ways of marketing without sending the business to financial dire straits. One of the most neglected avenues for business generation is B to B (Business to Business) marketing or networking. It is cost effective and creates tremendous cross marketing power. The power of B to B marketing is in its simplicity. A united alliance by two dissimilar business types creates tremendous reach into diverse dissimilar potential customers or clients.

Web presence must be relevant and focused. A simple well designed website that is configured to be searchable and customer friendly is important. Many businesses still do not have web presence. This, I believe is a mistake. The customers’ shift away from traditional telephone books is a reality. Expensive advertising need not be undertaken. For less than $3.00 per customer acquisition, CPC (Cost Per Click) offered by many search engines is a cost effective and efficient way to promote your business on-line. Additionally, supporting local print media targets your potential customers, and while a bit more costly, you get the desired effect of targeting your demographics.

The final small business tactic to consider in severe recessionary economy is to expand. It is a bit radical but if the business was prudent and managed the business conservatively, the free capital can be used for expansion or investment. Businesses could be acquired or initiated at pennies on the dollar. Labor cost is falling and talent pool for potential employees is high. It will be tough to do, no doubt. However, while competitors are being forced out of business, the current economic climate presents unique opportunity to gain market share like no other. If the business is generating free excess cash flow it may be the right time to provide capital for exciting start-ups and act as a Private Equity Firm.

Whatever the case may be, formulating small business tactic is important. Creativity and sound management is crucial for survival.