Congratulations. You're making the leap into an electronic health record (EHR); there's buy-in from top to bottom in the practice; and you've selected the system of your dreams. Goodbye filing cabinets, cluttered desks, and piles of forms; hello great open spaces, right? Wrong! Installing an EHR is only the midpoint of the sometimes long journey to digitizing a medical practice.
Kevin Mullen, project director for the non-profit Massachusetts eHealth Collaborative, says eliminating storage space for paper records is not the only or even the most significant result of implementing an EHR. The Collaborative has guided EHR installations at hundreds of practices — most recently for 300 physicians in the Beth Israel Deaconess Physicians Organization, LLC. Mullen says many people underestimate the impact an EHR can have on work flow in a medical practice.
"Many of the practices we work with have very little internal real estate and things are already quite congested so it's not as easy as just walking in, loading the application, and telling the staff to start scanning all the records into the EHR," Mullen says. "We make a considerable effort to identify what is the best footprint for the technology."
The footprint of new technology may be bigger than you think. Scanners and card readers use counter space. And it may take time — six months to a year — for the records room to empty, especially if you digitize paper records only as patients show up for appointments.
Scott Somers, AIA, principal architect and owner of Arch-101, a Spokane Valley, Wash., firm specializing in ambulatory medical office design and project management, cautions that information technology places unique demands on an office.
"The records room may be going away or shrinking but your IT space might grow from a closet to a room with extra HVAC needs for equipment and, perhaps with one or two people working in that room, too," Somers says.
Many medical practices are in spaces that were never carefully planned, he says. Those inefficiencies don't go away just because you bought new software.
"Ninety-five percent of the time the design of a medical office's space is an afterthought," Somers says. "If someone is in 3,000 square feet and needs another one or two thousand (square feet), they'll just call around, find a bigger space, and lease it."
The better way to go about things, whether you are moving or staying put, is to take a whole systems approach to measuring and designing work flow, starting as soon as you make the decision to buy an EHR. Once it's installed, you'll be too busy trying to pull productivity back up as physicians and providers acclimate to a new way of working.
Placing a PC with monitor in an exam room — and doing it properly — isn't as easy as it sounds. Most physicians are loath to turn their backs on patients while documenting a visit. But the placement also must allow the physician to reach the patient easily without stepping around a workstation. The physician, medical assistants, and the patient will all need clear pathways to reach the door, the exam table, or other equipment in the exam room; again, without having to sidestep obtrusive computer parts. And don't forget the cables needed to make the EHR run and interface with other systems. If exam rooms are not identical in size and shape, then each will need its own work flow design. And then there are the administrative and clinical staff's work areas and work stations to consider.
Taking a careful and strategic approach to planning for a new EHR and a new work flow isn't an easy sell to most practices because it takes precious time, says Cynthia Dunn, a consultant with the Medical Group Management Association (MGMA) Healthcare Consulting Group.
"People are not looking at their work flow and process steps in enough detail because they don't see any return for all that effort," Dunn says. "It doesn't have a CPT code attached to it but the time and effort to plan your new work flow will pay off in the long run."
Mullen says his Collaborative clients should expect a 20-week implementation period leading up to the go-live date.