Phase One – Move To Electronic Charts
At a recent clinic visit I thought about the hectic pace surrounding our EHR projects and reflected on the basic outcomes we expected: increase the well-being of patients, no lost charts, increase office space and improve operational efficiencies.
When I started working with EHRs in 2000, my provider was surprised at the path I took with my nursing career after many years of direct patient care. Although the group had no interest or plan to move towards an EHR, she did listen attentively about excitement in my new field. Year after year I returned and saw them lagging behind the clients I worked with throughout the nation. I watched as staff worked the enormous moving walls of charts. Having one of the “lost charts” a time or two and giving my history from birth was annoying. I had been with them twenty years.
I considered changing providers as they said they were never going electronic, and yes I inquired at each visit. As their practice grew and the rules changed so did they seeing the benefits of transitioning from paper to EHR. Reluctantly they moved forward and with their progression came a transformation. Charts disappeared (in a good way), a chaotic environment was calming down, providers used tablets and histories were up to date.
Now, on that recent visit, the charts were completely gone and the huge empty space was filled with a Med Spa which is one of the greatest draws for this clinic being right inside the office. Of course, I stopped by to make an appointment! Their revenue is beyond what they expected. Observing the initial frustration and seeing them leap towards optimization was an amazing experience as a patient.
Phase Two – Benefits Of Optimization
Leveraging the benefits of an EHR and meeting your initial goals with optimization is one of the most critical steps in your journey. This assessment is an example of how lack of utilization and a delayed rollout is just a few steps away from full utilization. Taking the leap to the next level is now at the point of necessity. The needs for the initial rollout are different from the needs for optimization and it takes a little while before you are ready to fine tune and optimize. The optimization assessment was performed over a few days by an expert consultant. This view from outside was able to transform the clinic after project delays caused frustration and increased costs.
EHR use was observed at several specialties and with a wide variety of users. Ways to streamline, automate and improve efficiency were identified including areas requiring build adjustments and additional training. Current state analysis of each specialty presented different levels of utilization. Dual documentation, in electronic and paper charts appeared to be common.
Strategically identifying streamlined workflows based on practice guidelines within each specialty was vital. Additional workflow and application training was required to accomplish the organization's goals. Several challenges and recommendations were outlined in an overall report. Here is a sample:
Challenges and Recommendations
Challenge: Pulling paper charts, information not scanned before the visit used time and resources and kept reliance on paper charts and duplicate processes.
Recommendation: Scanning and abstraction should be completed before the visit. Dates should be set to no longer pull paper charts or create shadow charts.
Challenge: Users had varying views and lists which made supporting issues more cumbersome and time consuming without consistency throughout the user base.
Recommendation: Limiting the number of optimized views per role would decrease duplications as well as minimize support questions.
Challenge: Standardized documentation for routine visits was not being utilized.
Recommendation: Work with providers should be done to build structured notes around common visits. Identifying mandatory verses optional components and using clinical content optimization would address insufficient documentation.
Challenge: Doing simple things quickly as related to charting and repeat tasks.
Recommendation: Documentation forms should be set up based on specialty and related to well check or acute visit. Retraining on scenario based specialty workflows and top ten diagnoses with a continued effort to refine workflows and provide coaching at point of care would increase adoption and improve usability. Distraction free training is key to making incredible strides. Focus on clinical staff process improvements and small adjustments in workflow. Circling back on training would deliver a dramatic impact with rechecks at 30, 60 and 90 days.
Challenge: Super Users need clearly defined roles. For essential onsite support they require additional training to offer follow up and new employee training.
Recommendation: Retraining the designated Super Users with very consistent training and cross train roles for stable onsite support. Consider addressing the process of Super Users being pulled to assist and their current roles being proficiently managed while they are away.
Challenge: Communication and next steps was underutilized leaving users a feeling of uncertainty.
Recommendation: A clear communication path should be identified; develop communication boards to announce new functionality, celebrate success and show timeline of events to foster enthusiasm and morale. Changes will be anticipated and welcomed; efficiencies will be achieved with recommendations.
Optimization of your EHR with a decisive partner will provide the attention and assertiveness to assist in leaping ahead. Most users are willing to move forward and thrive on feedback. They have a readiness to learn and they do anticipate positive changes ahead moving through the two phases: initial rollout and optimization. A smooth running EHR is extremely beneficial and the realization that the system is as good as the information entered into it is valued.
Benefits will be achieved by including representatives from all groups and providing regular feedback on the optimization process. Efficiencies will come and recommendations will enhance and increase knowledge of your staff and in return highly advanced care of your patients will be fundamental to your success. Three quarters of those groups who implemented an EHR have seen no ROI, optimization is critical to improve the operational efficiencies required to achieve ROI. Let us help you and contact us for an optimization assessment!