Refining EHR Usage

August 25, 2010

EHR adoption doesn’t end when your system is installed; you have to continue to improve your use of the product.

EHR adoption doesn’t end when your system is installed; you have to continue to improve your use of the product. Many offices see EHR as a burden instead of a tool that can improve the lives of both patients and medical staff. One of the keys to changing this mindset is to improve your work flow and refine user skills to take full advantage of your EHR. Our practice has been using its system for over 14 years, and we are still making improvements. So what does the “culture of improvement” look like? That depends on the problems your practice is facing.

There are two essential areas that, if neglected, could hamper the effectiveness of your EHR:

• Not using your EHR to its full potential
• Not proactively managing change

Achieving full potential

Making changes that improve the lives of your staff by allowing them to do more work with less effort will quickly improve attitudes toward EHR adoption. Find out where your staff are stumbling and work to relieve these problem areas. Here are five areas that often need attention:

Wasted time. Are your doctors and nurses wasting valuable time by manually performing tasks that can be done more efficiently using an EHR? Phone protocols and access to labs via interfaces are two good examples of functions that can be done more effectively through your EHR.

Quality of care. Search for children who have missed well-care visits, call diabetes patients who haven’t been seen in over six months, or develop a system that flags patients who shouldn’t get controlled drugs due to a history of abuse. (We have done all three of these.)

Lost revenue. Improving your E&M coding, automating the capture of vaccine administration fees, and calling patients who are due for follow-up care are three easy ways to increase revenue. But the very top financial priority should always be to make your clinicians more efficient in the exam room.

Patient satisfaction. Don’t forget, in the end, your job is to care for your patients. Improving the referral process or giving patients an encounter summary at the end of their visit will make their care better and increase their happiness with your practice. Our patients were thrilled when we started e-mailing lab results - and it saved clinicians time as well.

Follow up. Our office recently “closed the loop” on test results and referrals to specialists. We are now using our EHR to track tests and referrals that have not been completed or those that do not have results recorded. This is a huge gain in terms of quality of care for our patients. Initially, we were unable to implement this feature because our EHR system did not have the capability to make this process practical.

Managing change

Changes can’t all happen at once. Making too many changes causes confusion, decreases efficiency, and increases grumbling. Our experience is that taking a deliberate approach is always best. Here are some of the main lessons we have learned:

Involve everyone. Don’t just put doctors or administrators in charge of EHR adoption; your nurses and clerical staff are affected as well. By putting a team together that represents a cross-section of your practice, you will be able to better anticipate the effects any changes will make in each area.

Prioritize. It’s important not to have too many projects going on at once. Start out by picking out three areas to work on. Focusing on the most important areas will speed up and improve the quality of implementation.

Finish things. Don’t move on until a task is done - completely done.

Assess changes. After changing things, look back to see which changes were good and which were bad.

Don’t neglect the future. Don’t get too focused on putting out fires. Some projects take months, even years to complete. Have a mix of short- and long-term improvements on your priority list.

Products change over time, as does technology. Keep an eye out for emerging technologies such as wireless networks, tablet computing, and higher-speed Internet connections. But don’t forget to invest the necessary time and money to train your staff so they can effectively use your current EHR system. It will pay off in the end, giving your practice a better working product that results in better patient care.

Robert Lamberts, MD, who is board-certified in internal medicine and pediatrics, practices in Augusta, Ga. His practice won the 2003 Davies Award for outstanding application of IT in a primary-care setting. He authors the popular medical blog “Musings of a Distractible Mind” ( Dr. Lamberts can be reached at

This article originally appeared in the September 2010 issue of Physicians Practice.