Many EHR implementations have failed to meet practice expectations and, in the worst cases, have damaged the practice. EHR implementations by necessity will impact every process and activity in the practice. For example, immediate access to the patient record could be used to speed answers to patient questions at less cost, or have no impact in a paper-based workflow that remains in use. In order to set the stage for EHR success, practices need to:
1. Redesign Workflow
Workflow redesign is a challenging process since EHR workflow will dramatically differ from the paper-based environment. For example, every process involving a patient question is delayed by the location and disposition of the paper chart today. The patient chart must be located before we have the information we need to address the patient issue.
In many cases, multiple people in the practice need the chart at the same time. With an EHR, practice staff and doctors do not have to deal with patient issues sequentially, and could be working on the same patient at the same time. For example, surgery scheduling may be delayed until transcription is completed. With an EHR, the patient note may be completed at the completion of the visit and surgery scheduling efforts started immediately. In order to redesign your workflow, you should start with your operational and clinical needs and figure out how the EHR tools can be effectively used. Be wary of cookie cutter strategies that may inhibit success. For example, standard workflow may be inappropriate for a practice that has an affiliated ASC.
2. Rethink Patient Service
Patient service today is mostly driven by patients. The patient is notified by the doctor of necessary tests and services, but the patient is responsible for negotiating the maze of issues associated with the treatment plan. In many cases, patients lose track of the requirement when the practice cannot schedule or facilitate the clinical service. Such delays may be caused by limited scheduling calendars of 3 months, or a busy front desk.
The practice should take a new look at their patient service goals and standards. EHRs enable the practice to more proactively manage patients and, as important, manage patient services across the practice. For example, EHRs allow you to track specific outstanding clinical treatment plan items such as MRI, lab test, procedure and return office visit. These outstanding items are presented on the patient summary screen, and you can produce a list of outstanding treatment items for all patients. Triage calls, surgical scheduling and other items can be dramatically improved, if you get the right EHR and design your EHR effort to use these tools.
3. Rearrange Responsibilities
Changes to responsibilities can face a number of organizational challenges. For example, many practices have designated specific staff to work with each doctor. Changes to responsibilities are enabled through the change to the workload as well as the flexibility enabled by immediate access to the patient record. For example, nurses will be able to more effectively communicate with patients when they have immediate access to the key information on a patient.
Nurses will be able to review patient prescriptions and the last visit information when the patient calls rather than deferring communication with the patient until the paper chart is available. Similarly, clinical staff could easily help any patient when they are accessing a patient record that is structured like any other patient record. However, changes to responsibilities and more flexible patient services requires a practice decision to use staff more effectively across the practice and not focused on the specific workload of a single doctor or office.
4. Refine Collaboration
Physician practices are very collaborative environments. Physicians rely on clinical and administrative staff to keep the patients moving through the office visit. Physicians also rely on their partners and colleagues to collaborate on complex and diverse patient problems. Unfortunately, much of this effort is subject to thrashing paper chart contents and allowing all involved to see the patient chart information. For example, some practices are constantly faxing patient chart information to other locations where the doctor is located.
Instant chart access through an EHR simplifies the collaboration process and can lead to more effective use of resources. For example, EHRs simplify calling on staff to assist doctors with patients in the office as well as communicating with patients outside the office. Similarly, passing a patient issue to a colleague in another office is cheaper and faster with an EHR.
You need to select a good EHR product to have the right tools to service patients and improve operations. However, even the best EHRs are subject to the limitations on changes that you are willing to make to take advantage of your investment. Rethinking how your practice works and the use of staff and doctors will help you get the most from your EHR effort and investment.
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