Joni Wyatt, healthcare advisor at Kassouf, agrees. “But it’s never too late. At any point, you can do an assessment,” she says.
Because of time and resource constraints, and often naivety, most electronic health records (EHRs) get purchased without the detailed analysis needed from both staff and physicians to make them seamless tools. But options do exist.
At one Birmingham practice, the existing protocol called for placing red stickers on the charts of VIP patients, ensuring everyone noted their status. “But no one addressed that piece of the workflow when choosing the EHR system,” Wyatt says. “And the physician was immediately angry at the EHR.” But the EHR was blameless.
Finding a solution was tricky. Nothing in that EHR allowed for a continuous visual alert to make a patient stand out. Customized coding would cost thousands. “So you use the tools that are available in the system,” Wyatt says.
This EHR did allow color coding by service. “We created a service called VIP,” she says. Although that service has to be designated each time the patient visits, it did put their name in red on the schedule.
“80 percent of unhappiness with an EHR comes from those little things that add five minutes a day, 10 times a day,” Wyatt says.
Sometimes the EHR’s programmed workflow proves better than the physician’s or practice’s traditional protocol, if only given a chance. An area orthopedist normally performed a service on both sides of the body before moving on to the next service. But their new EHR presented all the services on the left side before switching to the right.
On the first day using the EHR, he found that he had to continuously jump between tabs and pages to find the appropriate section. Realizing that wasn’t going to work, he gave in and followed the EHR’s process. “The system guided him smoothly through the whole visit, and he said it actually worked better that way,” Wyatt says. “Sometimes it’s that simple.”
At other times creative solutions are required to make an EHR match the reality of the practice. “At any given time, it should be relativity clear on the EHR what’s next in the workflow,” Wyatt says.
One local practice hit a snag in their new EHR when realizing they designated the same room with two purposes. That made it impossible to track patients through their visit. “That screen should give you a picture of your entire clinic. So you may not be able to see from your desk who’s in each exam room, but you can see it here on your screen,” Wyatt says.
Unfortunately, the practice used Exam Room 8 as Triage Room 2, depending on who was working that day. “It wasn’t a simple fix,” Wyatt says. They ended up creating a virtual room labeled Triage 2 within the EHR. So although a single room exists in the practice, in the EHR, it now shows as two rooms side-by-side. Not ideal, Wyatt says, but workable, adding again how vital it is to note every detail of workflow before investing in an EHR.
Solutions, though, can be more readily found than most administrators may think. Wyatt suggests finding a network of people using the same EHR, either online or through the vendor. “Those people have encountered and solved most of the problems you’ll face,” she says. “Many times you also learn about a functionality you didn’t even know was available.”
Recently she had someone share a feature on an EHR when registering new patients. If a patient requests directions, the staffer only needs to click a button on the screen and the EHR automatically sends Google map directions to the patient’s phone. “It’s all based on the information just entered for that patient. That’s a huge timesaver at your front desk,” Wyatt says.
Those not-so-obvious functions plus added features make scanning the vendor’s EHR newsletters worthwhile. “Don’t dismiss them, even if you only take one minute to scan them. It could save you 30 minutes a day,” Wyatt says.
With EHR upgrading to cover reporting requirements, vendor newsletters and alerts could become more valuable. “Greenway just introduced a population health module now that pulls data out of the EHR and puts it into a Meaningful Use model,” Wyatt says. That means physicians can get credit in their EHRs for PQRS and MU qualifiers without having to check off additional boxes during exams, such as after giving a flu shot.
“Vendors are looking at making required things available in their EHRs, and these are the kind of things coming out,” Wyatt says. “But you have to engage enough to know it’s there.”