One ongoing obstacle that administrators face is with the staff’s reluctance to change. “No upgrades can fix that,” says Richard Stroud, practice administrator at UAB Eye Care. The solution lies in involving everyone at every transition.
Stroud broke his staff into committees. He had them examine their workflow with the EHR one section at a time, such as history, basic exam and medications. “We got everybody involved and went through the whole process about when, how and the timing,” he says. “It took several months.”
“I think the most important thing to get buy-in from the physicians and staff is to have adequate training,” says Jason Biddy, practice administrator at Alabama Allergy and Asthma Center. He adds that documentation isn’t enough. The best results come from hands-on training that walks staff through new processes.
Andrews Dean warns that upgrades to the software, which can be significant, also need time set aside for training. “Training is not only for the initial roll-out,” he says. Otherwise, efficient use wanes and frustration rises from growing confusion.
Alabama Allergy went beyond the usual in-house training. Biddy flew six of the staff to visit an allergy practice using the same EHR. “It was one of the most beneficial things we were able to do,” he says. “It allowed us to see things a little differently. Otherwise, you can get consumed with ‘this is the way we do it’ or ‘we don’t do it that way’.”
Besides bringing front office, billing and clinical staff, Biddy brought a physician who did clinic with one of the doctors. That helped ease one of the greatest hurdles to efficient EHR usage — physician reluctance to training.
At Southlake Orthopaedics, Barry Gallo, business administrator, found an easier solution. “We eased some of the physicians into the process by giving them a sheet of paper with some pertinent data on it for a sense of security,” he says. The dummy chart meant the doctors had in-hand the patient’s last visit notes, test results, and charge ticket without having to initially fumble with the computer before learning the EHR.
One Birmingham practice arms its physicians with the patients’ information through a common computer outside the exam rooms. “It means he’s not in the room bringing up and reading through everything while the patient sits there,” says Susan Pretnar, president at KeySys Health. “It means he has an efficient meeting with his patient.”
One physician at an area practice bypasses his EHR completely by dictating each visit into his phone while talking with the patient. A transcriptionist then keys everything into the EHR.
At UAB Eye Care, Stroud utilizes the EHR to relieve the physicians of tasks. “Our big thing was to push as much as we could to the staff instead of the doctor,” Stroud says. For instance, in the past, the physicians asked and noted what insurance and pharmacy the patient utilized. Now the EHR prompts for that information at check-in.
That reevaluation of workflow to suit the EHR has led many practices to save time and raise revenue. Pretnar says one practice even changed their physical plant to move the bloodwork area. “That change in the shuffling of patients reduced their time by five minutes per patient, and that added two patients a day,” she says.
At The Birmingham Pain Center, a simpler workflow change spurred by their EHR smoothed out the bottleneck of patients exiting after visits. “We’re collecting money up-front at check-in now, so we’re actually doing check-out in clinic,” says Lucy Gibson, practice manager.
EHRs most obvious efficiency has been optimizing the use of patients to input their own data in a secure, controlled fashion. At Southlake Orthopedics, patients enter their information through a kiosk in the lobby which transfers it into the EHR. At Alabama Allergy and Asthma Center, 50 percent of new patients fill out paperwork online using the patient portal connected to the EHR. At Birmingham Gastroenterology, patients using the online portal to request prescription refills notably resolved a common point of office congestion.
But with each demand on practices for changes in reporting, billing and security, they face mounting frustrations with their current EHRs. Untapped sources for advice on coordinating workflow with EHRs can often be found by consulting with Quality Improvement Organizations (QIO) or Regional Exchange Centers (REC).
A prime source for solutions is user group meetings. Hosted by the EHR vendor, usually annually, these gatherings showcase common problems brought up by users and often solved by them. “We sent a team to the user group meeting just to get a good overview of the product and how it’s used and what the capabilities are,” Biddy says. “There are usually labs with computers set up and you can go work on a dummy database.”
The hands-on interactions with those using the same product, everyone agrees, cannot be topped for buy-in by staff and utilizing the full potential of one of the biggest investments practices make these days.
Websites:
http://www.nextech.com/blog/ophthalmology-survey-names-top-4-reasons-for-emr-dissatisfaction
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_049747.hcsp?dDocName=bok1_049747
http://www.hrsa.gov/healthit/toolbox/webinars/pdfs/workflow.pdf
http://technologyadvice.com/medical/blog/ehr-for-orthopedics-specialists