If you engage in the exercise Moore recommends, you’ll quickly find that most of the paper your practice deals with isn’t even located in the chart.
Consider all of the different ways information arrives at your practice. Most outsourced ancillary services come into your practice via fax. That includes lab results, and consulting reports, not to mention EOBs and the vast amount of communication from insurers. All those things may end up in the chart eventually, but someone still has to carry those pieces of paper to the chart and file them. If the chart is electronic, you will have to figure out how to get those pieces of paper into digital form — and who will do it.
It’s not as difficult as it sounds, but it does take some planning. Simply having an EMR doesn’t guarantee that your practice is ready. You need to make sure that your EMR has a compatible scanning module that allows you to scan documents directly into patient charts in a way that they can be easily indexed. If physicians have to search through 60 pages of scanned documents to find the item they need, then time is wasted. The point of digitizing patient records is to make your practice more efficient, not less.
Most practices will also want a scanning module that allows them to route newly scanned documents, such as test results, to the appropriate nurse or physician for approval or follow-up. After all, what good is digitizing a piece of paper if no one ever sees it? In fact, this is one area where your EMR definitely has it over paper: patient safety.
“When we get results that need to be followed up on, we can track that electronically far easier than we could on paper,” says Rosemarie Nelson, an MGMA healthcare consulting principal based in Syracuse, N.Y. Nelson notes that an electronic tickler function in EMRs can be especially useful for internal medicine, primary care, and OB/GYN practices, where lab results frequently require review.
But there is still the question of how paper makes the transition into your EMR. First, consider adding a fax server that is compatible with your EMR. A versatile fax server will digitize incoming faxes so that your staff can avoid having to print and rescan paper faxes, which can be an incredible waste of time. Someone will still have to file those faxes in the appropriate electronic chart (or route them to the appropriate nurse or physician), but that’s much easier and less time-consuming than filing paper in a physical chart.
Some lab and consultant reports most likely will still arrive via mail, so someone will need to scan those items. Azim Shaikh, practice manager for Springfield Cardiology, a three-physician practice in Springfield, Ohio, recommends making only one or two people responsible for scanning documents into the EMR. Springfield Cardiology uses the checkout person to scan in all incoming mail, and Shaikh estimates that person spends about two-and-a-half hours each day on scanning and electronic filing.
But be sure to ask your EMR vendor how the scanning module works. EMR systems index scanned documents differently. “All vendors do not create scanning the same way,” warns Nelson.
Prescription for success
One area where paperless can help to improve your practice’s efficiency is in e-prescribing. “Twenty-five percent of calls from patients asking for a refill on a prescription happen within a week of their last visit,” notes Moore.
Why? Usually because there was no electronic system that reminded the physician to renew the prescription during the patient visit. An e-prescribing tool can eliminate those follow-up calls, as well as the inevitable telephone requests for cheaper prescriptions. A good e-prescribing tool will have some of the formularies from the major payers in your area and can prompt physicians for less expensive options.
With e-prescribing, a physician should be able to send the prescription to the patient’s pharmacy with just a couple of clicks. Although some pharmacies still don’t accept e-prescriptions, most will be able to accept that electronic signal and print the prescription as a fax. Whatever the case, an e-prescription also eliminates another reason for frequent calls to practices: illegible physician handwriting.
Often the primary resistance in the practice to e-prescribing comes from physicians themselves. “Every physician is always going to find that it is faster to write a prescription on a piece of paper than it is to enter it electronically,” admits Nelson. But that’s generally true only for first-time prescriptions. Nelson suggests trying to help physicians focus on the downstream benefits of automatic prompting and reduced call-back volume.
If that doesn’t work, remind physicians of how frequently that prescription goes missing. “All too often, physicians have to leave the exam room and walk out into the hallway to get their prescription pads,” says Moore. “They leave them in the other exam room; they leave them at a table somewhere. They just don’t have them on hand, and there is the inefficiency of walking in and out. Then when you hand that patient that piece of paper, they end up losing it and have to call back in to get another version written.”
No such troubles with e-prescribing.
