Don’t minimize EHR disruption, manage it

Medical groups intent on minimizing disruption often configure their electronic health records (EHRs) around physician preferences. This is a mistake: Your organization can underuse the technology and encounter new inefficiencies as you try to fit paper-era processes into an electronic system.

Rather than trying to minimize disruption, manage it.

Unintended consequences: waste and inefficiency

Some physicians are ready to take advantage of automation. As a group, however, doctors are slow to embrace technology and wary of anything that could interrupt their work flow. Groups that try to insulate physicians from technological change may:

  • Unplug potential benefits — For example, some systems can warn physicians when a service requires an Advance Beneficiary Notice for a Medicare claim. Turning off this function means you’ll miss chances to improve patient service and net collections.
  • Create back-end billing issues — Disabling EHR functions such as upfront code scrubbers can create huge bottlenecks in billing and collections.
  • Lose checks and balances — Under most EHR configurations, incomplete charges simply sit in a pending file. Without a new way to keep tabs on the process, these charges will never be billed.

Don’t let physicians’ comfort level determine EHR design.

Transforming the paper environment

What’s the right amount of disruption? Too little results in system underuse and creates back-end problems. Too much generates resistance from physicians. Three techniques can help you identify the clinical and operational changes essential for a successful EHR implementation.

Work forward from current processes

Identify operational processes that need to change with an EHR, including:

  • New-patient entry into your system;
  • Patient pathways in the organization;
  • Referrals;
  • Scheduling; and
  • Patient information from charge ticket to payment posting.

Highlight procedures that will require customization of your system.

Work backward from system functions

Next, trace processes in the opposite direction. For every EHR function, ensure that you have clinical and operational work flows to provide required inputs.

This step is important for making the most of your EHR’s capabilities. For example, many systems can automatically feed drug charge information into practice management software. To take advantage of this function, however, a patient’s electronic record must capture National Drug Code (NDC) numbers for all drug therapies administered in the office. Develop processes that ensure clinicians accurately enter NDCs into the electronic chart during all encounters.

Create new checks and balances

As a practice matures, employees develop “checkpoints” to catch oversights in the reimbursement process. An EHR can automate these checkpoints — if you create them in the system.

In a paper-based practice, you typically monitor charges by running reports from the practice information system. If, for instance, a report shows that a physician has prescribed an injection but the nurse has not submitted a charge for its administration, you’d follow up to ensure the encounter has been fully coded. An EHR system can monitor these processes automatically. Recreate all manual checks and balances as edits that feed into an electronic task-monitoring system.

Help physicians make the transition

Identifying process changes will help you develop a strong EHR design, but it won’t soothe physicians who have to deal with the aggravations of a new system. To get doctors committed to the transition, make sure the expected benefits of an EHR get as much attention as the current hassles. Involve physicians in planning and implementation. Create a physician advisory board comprising the medical director and other key practice leaders. Involve this group in system selection; ask members to educate other physicians on the technology’s economic benefits. The advisory board’s most important job is to connect the dots among electronic health records, better patient care and greater patient satisfaction.

To gain physician buy-in, consider sending the physician advisory board and other doctors to observe a practice with a fully functioning EHR. You may also want to bring in an outside physician comfortable in an electronic environment to address issues that keep your physicians from committing to the new system.

Relaunching and fine-tuning

If your physicians have rejected an installed EHR, it’s especially important to analyze your work flow and organizational development. You can often relaunch a system successfully when doctors perceive that the implementation and their input have been carefully considered.

Even if physicians and staff are generally satisfied with an EHR, analyzing operational processes and system capabilities can help your practice realize further clinical and financial improvements.

join the discussion: How disruptivewas your EHR implementation? Tell us atmgma.com/connexioncommunity or connexion@mgma.com

Reprinted with permission for six months from Medical Group Management Association. MGMA Connexion, Vol. 9, No. 5. 06/29/09