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Technology can benefit medical practices, but it can also slow them down. Here's how to avoid some common pitfalls.
You invested no small sum in information technology solutions that enable your practice to deliver care more effectively, more efficiently, and in compliance with regulatory mandates. But that doesn't mean you're more productive. Indeed, medical offices with all the IT bells and whistles can still encounter roadblocks that inhibit both their work flow and the patient experience.
Some, including subpar Internet speed, poor Web design, and inadequate staff policies pertaining to online access, can be easily rectified in-house. But external impediments to operational success are harder to address, such as reimbursement schedules, state licensing restrictions on telemedicine, and the lack of momentum surrounding data sharing among providers.
Here's a closer look at some of the common technology slowdowns practices face, and what your practice can do about them.
"The biggest complaint you'll find is speed," says Derek Kosiorek, an IT specialist with the Medical Group Management Association Health Care Consulting Group. "If you click on something and it takes a few seconds for the screen to refresh or move to the next screen, that's frustrating for the provider because it slows productivity, and worse it can be dangerous." How so? A nurse who puts an electronic checkmark in a box on a patient's health record may click twice if it doesn't respond promptly. In doing so, the computer might process that as a double click and reverse the intended entry, says Kosiorek.
To minimize lag time, practices must ensure that their Internet connection speed and bandwidth are sufficient to support their software, laptops, tablets, and any telehealth technology they deploy. Telehealth devices, including two-way video, e-mail, smartphones, and laptops, allow doctors to monitor, diagnose, and treat patients from a remote location. "We work with a lot of groups that deal with 35 [-second] to 60-second delays because they have not updated the backbone of their Internet connection," says Michael Gleeson, senior vice president of product strategy for Arcadia Healthcare Solutions in Burlington, Ma. "They're still using their cable connection and they may not have enough bandwidth to support their EHR."
A high quality, dependable Internet service provider is all the more critical as the industry moves to cloud computing, or the Software as a Service (SaaS) model, he says, in which EHRs are hosted and managed by software vendors at a secure central data center - rather than a physical server. Providers who deploy SaaS software need not purchase server hardware. Instead, they pay a monthly subscription fee, which covers the cost of IT support for upgrades, modifications, installations, and routine back-ups. Because providers access their EHR through a Web browser in the SaaS model, however, access to their system is unavailable if their Internet goes down. "We're at the dawn of SaaS, or cloud-based services, in the medical world," says Kosiorek. "All software is moving in that direction and it's just a matter of time before EHRs are doing that, too."
Practices with a sluggish system, despite adequate connection speed, should examine their Internet traffic and tighten up staff policies regarding online access, says Gleeson. "Sometimes we'll find that a particular person in the office is watching YouTube videos or downloading something on their lunch breaks," he says. "When you have a hosted EHR, you need to be a lot more judicious about that. Your Internet speed is mission critical to productivity."
If you don't already have one in place, Gleeson suggests creating an online usage policy that clearly defines expectations. It should indicate that staff must use the Internet responsibly and only for job-related activities - not online shopping or planning their next vacation. They should also never download software without approval, which can corrupt and slow your system. To enforce internal compliance, you can install a Web-hosted system that combines software with a remote monitoring service, but merely communicating your in-house policy is often enough to keep employees on task.
All too many practices also take a productivity hit due to ineffective template design within their EHR, says Gleeson. Templates, which provide for data-entry uniformity, can actually limit a provider's ability to create comprehensive notes. They may also distract staff with an overabundance of alerts. Or, they may be well-designed, but poorly suited to your specialty - a common problem among practices that rushed to adopt an EHR for the sake of meaningful use incentive payments.
At the same time, Gleeson says many practices struggle with work flow well after EHR implementation because the documentation requirement is more onerous. "A lot of these EHRs are deployed with more documentation requirements for providers, particularly around value-based reimbursement or meaningful use, where you have to perform at a certain level and document the quality of care you deliver to patients to receive incentive payments," he says. "EHRs have a real work flow impact, which can be even worse if they have been badly or inappropriately configured."
DATA SHARING LIMITS
The exchange of health information among providers, or data sharing, lies at the heart of patient-centered medicine. By sharing data digitally, public and private payers believe physicians, hospitals, and other providers will be better equipped to coordinate care, manage disease, reduce costly hospital admissions, and eliminate redundant testing. Those that do get rewarded under value-based reimbursement models, which are fast replacing fee for service. Thus, to maximize profitability, practices today must be able to access and share health information electronically.
But most still aren't. While the adoption of EHR technology has accelerated significantly in recent years, fueled largely by federal mandates, data sharing among providers has not made meaningful gains, according to a 2014 survey led by Michael Furukawa, a senior staff fellow with the Agency for Healthcare Research and Quality. While 78 percent of office-based physicians had implemented an EHR as of 2013, just 14 percent were sharing data electronically with providers outside their organizations, it found. Increasingly, that will affect their bottom line.
Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via firstname.lastname@example.org.
This article originally appeared in the March 2015 issue of Physicians Practice.