What does a successful EHR implementation look like?
• Is it the elimination of patient charts?
• No more transcription costs?
• A reduction in medical records staff and no more chart hunting?
• Fast access to patient information?
• Data mining for drug recalls?
• Easy and accurate identification of patients overdue for follow-up care or screenings?
• Physicians leaving the office on time most days?
• Reduced staffing and supply costs?
• Increased charge capture and/or improved coding support for billing?
• No more legibility issues?
• Remotely accessing patient information such as medications and test results?
• Tracking outstanding orders for test or imaging results?
• A reduction in phone calls from pharmacies?
• Addressing incoming patient phone calls without taking messages?
• Collecting and reporting on clinical information to participate in pay-for-performance programs?
By optimizing your EHR implementation process, your practice will have most of these characteristics. Even for small practices, technology has leveled the playing field and has changed what is possible for many physicians. Wondering where to start? Try a good old fashioned assessment.
First, look at your work flows — who does what and how often? Also look at your template development; comparing ease of use and available functionality within each template. Invite your vendor to assist with your assessment.
Now that your practice has successfully transitioned from paper charts to virtual, electronic health records, it is time to spruce up your virtual "chart room." Identify which processes work well for your day-to-day operations and what you'd like to see changed. Give your vendor the opportunity to identify functionality that you and/or your staff are underutilizing. Ask about features you haven't adopted that could drive further efficiencies into your operations?
Once you have a better understanding of weaknesses you've found in your own practice, visit other practices who use the same EHR and shadow them for a day. Observe how they've integrated the EHR into their work flow. By being present in another practice and freeing yourself from your own daily routine, you're more likely to think creatively and challenge the status quo of your own office. Read white papers and case studies of other practices' EHR implementations to learn how those medical groups have succeeded (or how they've failed, so that you can avoid that as well). And, you might want to bring in outside assistance to perform a gap analysis of your existing implementation.
After completing an assessment and observing your own practice, it is time to look at the specific functionality of your existing EHR/technology. Have you implemented a patient portal and promoted it to your patients? Increased use of the patient portal will drive practice efficiencies. Patients can complete many tasks on the portal that otherwise would mean a telephone call to the practice to ask for help, which frees up your staff and improves the service level provided to your patients.
Patient registration via the portal eliminates data-entry tasks by your staff. And you can create rules within the health maintenance and disease management aspect of your EHR to support your quality initiatives; such as quality measures reports delivered to the clinical team daily.
And don't forget to examine which documents get scanned routinely, while looking for ways to determine how to reduce the volume of scanning. Is it possible to have the information interfaced into your EHR? Look at a digital fax service, which minimizes the number of touches for each document, which will drive more staff efficiency.
Finally, focus work-flow assessment on nursing operations. How can your EHR system facilitate the nursing staff's ability to support the physicians? Nurses touch the chart much more often than physicians. Messaging is a good example — nurses typically touch every message twice for each touch by the physician. Have you created standard message formats for the high-volume requests, such as repeat lab work, medication requests, etc.?
These are just a few ideas to get started on optimizing your own EHR. Good EHR adoption is iterative. Manage change by managing the evolution of your EHR adoption and you will realize the benefits you dreamed about when you started down the path to EHR acquisition.
Rosemarie Nelson is a principal with the MGMA healthcare consulting group. She conducts educational seminars and provides keynote speeches on a variety of healthcare-technology and operational topics. Drawing upon her diverse experience, Nelson provides practical solutions to help medical groups succeed in their practices. She may be reached at www.mgma.com/consulting/nelson.