Making the most of what you’ve got: EMR optimization strategies for medical groups
Many physician practices expended considerable time, dollars and effort to implement electronic medical records in recent years. And, some leaders at these groups are now thinking: All that for this?
In fact, a variety of studies show that physicians and other medical staff leaders are not completely satisfied with their EMR journeys, to date. For example:
- Some practices are struggling to successfully incorporate the EHR into daily routines, as about 16 percent of the 1,181 physicians and medical professionals surveyed in a Physicians Practice study said that a drop in productivity was their most pressing information technology problem. In addition, more than one-third of respondents said they were seeing fewer patients post EHR adoption.1
- Satisfaction and usability ratings for certified EHRs decreased 12 percent from 2010 to 2012, according to the results of a survey of clinicians conducted by the American College of Physicians and AmericanEHR Partners.2
- Some physicians are experiencing a touch of buyer’s remorse, as 70 percent of 952 physicians surveyed by Medical Economics described their EMR investment as not worth the effort, resources or costs. Also, more than two-thirds cited system functionality as a source of their discontent.3
Indeed, dissatisfaction with EMRs is running high. Part of the problem, however, could be that provider organizations – especially those with limited resources such as small medical group practices – simply are not optimizing the systems that they have in place.
But instead of throwing in the towel or switching to a new EMR, practices should first try to make the most of what they’ve got. In fact, it’s possible for most medical practices to take their EMRs from ho-hum to amazing by carefully and methodically ensuring that they are getting the most out of the technologies that are loaded on to their computers.
Need to shift into high gear?
Before scrapping EMR efforts, physician practice leaders need to determine if they are not fully leveraging current EMRs. According to the ONC, healthcare provider organizations might not be getting the results they need and could need to go down the optimization road if any of the following is occurring:
- Leaders are receiving complaints about the use of the technology
- Walkthroughs reveal that workarounds are frequently being used
- User log-ins show that some users are not logging in
- The volume of dictation, printer usage and handwritten forms has not decreased
- Staff continue to work overtime to enter data
- There is a lack of goal achievement relative to patient safety and quality improvement4
After determining that there is, indeed, room for improvement, medical practice leaders can then conduct a formal post-implementation assessment (see below: All the right questions). Through such an assessment, they can identify exactly what is working well and what needs to be overhauled, changed or merely tweaked.5 This evaluation could help medical group practice leaders develop more specific optimization plans that include a wide array of remediations that address shortcomings in their use of the technology.
While interventions will vary from group to group, many physician practices will need to ensure that each and every function of the EMR – e-prescribing, electronic referrals, lab orders – is being regularly and optimally used. Obviously, medical practices will not be able to experience any care coordination or efficiency benefits if functionality simply sits dormant.
Time for a diagnostic engine check?
If certain functions are not being used, leaders need to find out why. Perhaps the end-user simply doesn’t see the value of the electronic capabilities or finds the interface difficult to use. So, instead of simply ensuring that certain functionality is operational, provide the training that ensures all users understand why and how to utilize each function. In addition, instead of simply ensuring that your practice is outfitted with hardware, ensure that each staff member has the hardware that they want or prefer to use the system.
Similarly, leaders also cannot simply plug an EMR in and expect processes to improve. No, you need to meticulously adjust workflow so that your practice is making the most of the EMR. To start, leaders should define exactly what data is required – and who is responsible for entering data into the system. If it’s possible to scan documents into the system, this is always preferred over manually entering data.
And, of course, all processes should be evaluated with an eye toward ensuring that licensed and credentialed staff are working at the “top of their license.” For example, it’s not a good practice to have a nurse scanning documents, if there is a medical assistant or receptionist available to handle such duties.
Documentation issues also frequently need to be addressed as part of the optimization initiative. Many times EMR programs falter or even fail because end-users find the documentation requirements too onerous. One way to improve documentation is to zero in on template use. Leaders need to ensure that the group is using the optimal number of templates. In essence, a group should leverage enough templates to satisfy the diverse needs of everyone in the organization. At the same time, the group should not deploy so many templates that end-users become paralyzed when trying to choose one. In addition, it’s important to explore how voice recognition might be able to streamline various documentation processes.
Show ‘em how it’s done
Training also needs to be continually addressed as your practice works to optimize its EMR. Of course, staff members need to be trained to ensure that they are aware of and are actually using all of the technology’s functionality.
This often requires shadowing staff members and providing “at the elbow” support – as sometimes clinicians and others simply don’t realize that they are not taking advantage of various functions or don’t know what questions to ask. In addition, you might want to have a “super-user” peer work with staff members to model the possibilities. For example, a nurse who has truly mastered the system would be able to work with other nurses to demonstrate how to best use various functions specific to the delivery of nursing care.
Training shouldn’t stop with staff, as patients need to be in the know as well. For instance, instead of simply firing up a patient portal, work with you patients to make sure they know why – and how to use it. Ask patients to use the portal for refill requests. If you have a dedicated refill line, repeat the request at the beginning of your recorded message. Insist that all email communications go through the patient portal for security purposes.
A staff member should then work with each patient to not only make sure they know the portal exists but to also ensure that the patient is comfortable making appointments and completing registration forms; reviewing and paying bills; requesting medication refills; and initiating secure communication with clinicians and other staff.
Unchain that technology
Adding mobile devices into the mix could also help medical groups take their EMRs to the next level. According to results from a survey at the 2015 HIMSS conference, 54 percent of respondents achieved significant cost savings after deploying mobile devices in their practice.6 In fact, groups can use mobile devices to:
- Access, review, and complete medical records in their EHR system from any location
- Share educational information (videos, diagrams, charts, etc.) during the patient encounter
- Initiate secure two-way communication with referring physicians, medical staff, and patients
Mobile technology also eliminates many of the workflow bottlenecks that result from inadequate hardware and workstations, another major consideration in optimizing your small practice EHR.
Finally, if you are using separate EHR and billing systems, an interface could help to integrate the two to eliminate duplicate processes and reduce billing errors resulting from manual entry. In addition, it’s important to meet your patients’ financial preferences. Make sure you’re set up to accept credit cards for co-pays at the time of registration, and also through the portal for settling bills from home or work. Look for systems that allow patients to establish installment plans to cover larger balances. As such, your group can improve collection percentages and build better long-term relationships by keeping accounts in-house whenever possible.
For the greater good
While it is important to use an EMR to improve what your practice is already doing, EMRs also can be used for the greater good. Indeed, electronic systems can collect data in a form that can be shared across multiple health care organizations and leveraged for quality improvement and prevention activities,
More specifically, according to an article published on the ONC website, EHRs can:
- Improve public health reporting and surveillance. By making it easier for your organization to collect standardized, systematic data, EHRs will improve your reporting capabilities. Through syndromic surveillance data submission, immunization registries, and electronic laboratory reporting, providers can transmit public and population health data to public health officials. And, with this data available, public health organizations can better monitor, prevent, and manage disease.
- Prevent disease. With electronic population health data, clinicians can better meet the needs of patients. EHRs, for instance, can remind clinicians when patients need immunizations, enable providers to send reminders to patients for preventive/follow-up care, and give providers access to clinical protocols.7
- Expand communication with public health officials. By using an EMR, medical practices can expand communication and collaboration with public health officials.7
All the right questions
According to an article published on the ONC website, healthcare leaders should ask the following questions to evaluate EMR performance:
- Were the goals and needs met?
- Do workflow processes need to be re-evaluated?
- Is additional training required?
- Are you capturing the required data elements needed for internal clinical priorities, as well as for reportable quality measures?
- Do staff roles and responsibilities need adjustments?
- Is the technology in the appropriate locations?
- Is the technology reliable?
- Is the technology “fast enough?”
- Is additional hardware needed?8
1. Physician’s Practice 2015 Technology Survey. Physicians Practice Magazine. Accessed at: http://www.physicianspractice.com/login?referrer=http://www.physicianspractice.com/healthcare-reform
2. American College of Physicians. Survey of Clinicians: User satisfaction with electronic health records has decreased since 2010. Accessed at: http://www.acponline.org/newsroom/ehrs_survey.htm
3. Verdon, D. Physician outcry on EHR functionality, cost will shake the health information technology sector. Medical Economics, February 10, 2014. Accessed at: http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/ehr/physician-outcry-ehr-functionality-cost-will-shake-health-informa
4. Strategies for Optimizing an EHR System. Accessed at: https://www.healthit.gov/providers-professionals/implementation-resources/strategies-optimizing-ehr-system
5. Bresnick, J. EHR optimization: What to watch for after implementation. HER Intelligence. Access at: https://ehrintelligence.com/news/ehr-optimization-what-to-watch-for-after-implementation
6. Leventhal, R. HIMSS15 Survey: Mobile Tech Helps With Cost Savings, Patient Care. Healthcare Informatics. Accessed at: http://www.healthcare-informatics.com/article/himss15-survey-mobile-tech-helps-cost-savings-patient-care
7. How can electronic health records improve public and population health outcomes? Accessed at: https://www.healthit.gov/providers-professionals/faqs/how-can-electronic-health-records-improve-public-and-population-health
8. ONC. How to Implement EHRs. Step 6: Continue Quality Improvement. Accessed at: https://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-6-continue-quality-improvement