A well-designed and well-implemented EMR can save your medical practice time and improve patient care. Yet many physicians see EMR as a major time suck because their new software often requires them to work longer hours and see fewer patients. So what is a medical practice to do?
Common EMR time wasters
Many practices only partially implement an EMR. Meaning, they end up heavily reliant on pen and paper due to the challenges of moving fully electronic or concerns with the move.
In these situations, Dr. Tom Giannulli, chief medical information officer of Kareo, Inc., based in Irvine, California, says these providers can have the worst of both worlds in that workflows end up being even more complex than prior to EMR deployment and many of the economic and patient care advantages are not realized.
“This doesn’t mean a practice shouldn’t implement in phases, just the opposite,” he says. “But practices deploy parts of the EMR and parts of their legacy process without really having a plan on how to migrate systematically to electronic workflows over time.”
Another time suck is the note generation process, where a practice relies on typing and extensive editing versus using text accelerators that are less time consuming or smart templates that have prioritized menu selections based on the topic that successively build the correct narrative and prevents users from dropping in a large text block and having to revise to fit the case.
“A related problem is that many EMR deployments are actually on dated applications and technology where user-centered design principles were not followed in building the physician interface in the EHR,” says Dr. Giannulli.
These systems typically are difficult and frustrating to use. Many EMR products launched in the last few years, on the other hand, were built with the user experience in mind and have been able to take advantage of advances in usability, mobility, and tight integration with other applications in the practice (like practice management applications).
Finally, many providers do not fully consider the value of the EMR deployment on their front and back office operations. Ideally, an EMR should be integrated with the practices practice management systems and processes to take full advantage of the efficiency and quality advantages of integrating the documentation aspects of the EMR with the billing process. This can reduce staff time while improving the speed and quantity of payments to the practice.
Solving the EHR time suck
One way to avoid the EMR time suck, according to Carol Slone, RN and principal advisor at Impact Advisors, a healthcare information technology consulting firm, is to acknowledge the need to learn the new system and where key functions are located on the displays.
“Time devoted to learning the new system and developing good workflows that are interactive with other team members, such as medical assistants, nurses, and lab techs, will save time in the long run,” says Slone.
She adds habits developed with paper records are not necessarily good habits to continue with EHR. Re-documentation of medications, lab results, and consult findings into the office note are not necessary given that this data is part of the record already.
“Most EMRs have functionality in which the provider can indicate that the information was reviewed on today’s date rather than re-inserting or copying the data into today’s note,” she says.
In addition, if the data is available to be viewed in the EMR, view the information online. If the practice is still printing and posting information, ask the team why and look for alternative measures that utilize the system.
“Perhaps, it’s as easy as adding one laptop in the central workstation to continuously display the schedule,” says Slone.
Practices will need to really think through its requirements, why it intends to deploy and EMR and to what extent, and how these requirements may evolve over time.
“These requirements should be referenced in evaluating both EMR solutions but also deployment and utilization plans,” Dr. Giannulli says.
Many of the issues faced with EMRs today are caused by a combination of selecting the wrong solution for the practice, not having clear expectations when deploying an EMR, and not really having a plan for utilization over time that builds on early successes and allows a practice to systematically move from a paper to electronic approach in logical steps.
Finally, Slone says a practice and its usual de-centralized location is inherently vulnerable to interruptions in EMR service. The EMR could be down due to an internal system and practice issue if the EMR is hosted locally, or other factors could also contribute to the EMR not being available. If the EMR is cloud based, then interruption in the Internet service could yield a downtime of the EMR. Likewise, electrical power is required to run the servers, computers, printers and long-term recharge the batteries of mobile devices.
“Most practices do not have dual feeds for electricity or Internet, so any cut in service will interrupt the use of the EMR,” she notes.
As a result, a practice should investigate the need for dual feeds for electricity and Internet depending upon their volume and location. At a minimum, use EMR functionality to extract a summary patient report for scheduled patients and print this information locally with a computer and universal power supply (battery) and have paper forms available for patient care.
“Create policies and procedures, maintain supplies and practice the downtime drill,” she says. “Be ready and be proactive.”.