I had a déjà vu experience recently when I visited a medical practice that was like so many others I’ve been to before.
This practice just wasn’t getting their investment back from their EHR.
The practice had been live on the EHR for about five months and was functioning effectively without pulling charts for patient visits. The clinical staff was comfortable with the system and seeing a full complement of patients.
The transition to the EHR had been accomplished by scanning the physician’s preferred information (last two visit notes, ultrasound, etc.) from the paper chart in advance of the patient’s first appointment post-changeover. The group established specific folders for the different scanned documents based on the physician’s preference for easy access.
The physicians and nurses each have a netbook device connected wirelessly.
The physicians bring the netbook into the exam room for reference but do not document in the room.
The nurses also bring the netbook into the exam room for documenting vitals but they use a desktop PC at the nurses’ workstation to enter data such as injections because it’s easier to read data on the larger desktop monitor than on the small netbook screen.
The practice currently has no lab interface so all lab results are scanned into the system.
And all orders are still paper requisitions even though the practice could create the order electronically and print it to accompany the specimen, which would establish a tracking for outstanding results.
Instead, the group continues to maintain a paper tickler file with duplicate requisition copies for tracking outstanding results.
But in a truly successful EHR implementation, the practice would be reducing the redundancy in an office by changing processes. Even before a full lab interface is developed, there are process improvement opportunities like the one presented with the lab requisition forms.
Only when such processes are changed do you gain the real operational efficiency that drives the return on the investment in an EHR.
Not all the practice’s staff members are completely comfortable with technology, either. So they fall back on comfortable ways of doing things as a backstop. For example, the front desk check-in person prints the day’s schedule and checks off patients as they arrive, even though she is also using the check-in function on the electronic schedule.
Although there’s no huge harm in doing this, it still presents a challenge to the work flow. Because the information must be captured electronically, the job is being done twice. To make sure you maximize staff productivity, you might just need to take away print privileges!
In this practice, as in many others, medical device output continues to be a challenge to integrate. For example, the EKG output strip is a long scroll of paper and the office maintains a paper chart file for those documents, although they do enter the interpretation into the EHR.
To fully realize the benefits of the EHR, it may be necessary to invest in new medical equipment, such as a PC-based EKG.
The office manager — who’s driven the entire implementation and has an excellent relationship with the physician-owners of the practice — has been able to move even the most technically-challenged physician onto the system. That being said, the technophobe is a reluctant user, only occasionally e-prescribing and continuing to dictate all patient visit notes.
Bottom line: The implementation “works” but the office has not adopted much of the functionality that would deliver increased operational efficiency.
Unfortunately this is fairly typical. To find out if it’s the case in your practice, walk around the office wearing your consultant hat.
It’s likely that you’ll find plenty of opportunity to increase utilization and earn a real return on your investment.
Rosemarie Nelson is a principal with the MGMA Health Care Consulting Group.