Among other benefits, they allow sharing of patient histories and reduce medical errors
[This information was provided by the Renal Physicians Association of Rockville, Md. (ww.renalmd.org), which has partnered with Renal & Urology News to create this new department. This article, which is the first of two parts, is based on material that appeared first in RPA's newsletter, RPA News.]
AN ELECTRONIC health record (EHR) is an electronically stored documentation of a patient's total medical history, including records from all sources—the clinician's office, hospitals, other physicians, and pharmacies. The adoption of EHRs can transform your practice.
“I don't see how practices are going to survive without EHRs,” commented Larry Lehrner, MD, of Kidney Specialists of Southern Nevada and Board member of the Renal Physicians Association, who has been using an EHR system since August 2005.
Among other benefits, EHRs can:
• Offer access to far-flung clinical information to improve provider decision-making capability
• Facilitate billing, coding, and documentation
• Allow providers to share information regarding a patient's history
• Reduce medical errors resulting from readily correctable mistakes, such as prescribing errors
• Enhance office work flow
• Improve efficiency through automation of coding, filing, and other administrative tasks associated with paper/document management
• Ease methods of sharing clinical information among providers.
The ability to view an electronic record at any location at any time is crucial in a practice such as Kidney Specialists of Southern Nevada, which has four offices, Dr. Lehrner said. Always knowing the location of the record— instead of wasting time looking for charts and trying to transport paper records among multiple office locations—has been especially helpful, he added.
Franklin W. Maddux, MD, former president and chairman of the Danville Urologic Clinic in Virginia, said the portability of the record system allows for informed decisions while physicians are at the hospital, the dialysis unit, or on call. For example, if a patient calls Dr. Maddux to ask about needed medication when he is at home, he can access the patients' labs and medication list, enabling him to make decisions and give advice based on accurate, up-to-date information. [Dr. Maddux assisted with the development of RPA's EHR CD-ROM, which helps a nephrology practices evaluate and choose an appropriate electronic health record (EHR) system. The CD includes answers to frequently asked questions, a sample RFP for selecting a vendor, and an assessment grid to determine which characteristics various EHRs contain. To obtain a copy, contact rpa@renalmd.org or call 301- 468-3515.]
To achieve the benefits of an EHR system, a practice must be prepared for the intense process involved in its adoption. The AmericanCollege of Physicians (ACP) divides the process into the following stages:
1) EHR investigation: Do I need it? For what?
2) Selection and purchase.
3) Installation: Getting your EHR up and running.
4) Basic implementation: Achieving base functionality.
5) Enhanced implementation: Taking EHR into the future.
EHR investigation
When determining whether to adopt an EHR system, decide what processes the system should improve. The goal is to streamline such functions as gathering data for analysis, calculating bills, and writing prescriptions. Can the system do these tasks more efficiently than they are being performed presently? Once goals are determined, identify the steps and personnel involved.
The transition to electronic records “requires substantial effort, but you really can change the way you work,” said Dr. Maddux, whose practice went paperless near the end of 2003, when the combined urology and nephrology practice had about 56,000 active patient records. It is helpful to confer with other practices about their systems.
Selection and purchase
Before moving forward with the selection of an EHR system, your partners should agree on objectives and priorities. Assemble a team representing all areas of the practice and establish goals targeting clinical, financial, and operational improvements. The team can help develop a timeline to determine how long the practice will run its old and new systems and how training will be scheduled.
ACP recommends grouping procedures into lists—perhaps dividing them into clinical and business tasks—and comparing them to vendors' services. You can use this to create a checklist of your purchase criteria, which includes the features that will match the information management needs of your practice.
Your list of personalized criteria can be used to decide which vendors to contact for information, demonstrations, and site visits. Developing a “request for proposal” (RFP) will prioritize issues a practice seeks to resolve and delineate the characteristics of the practice before making a decision.
During the RFP process, it is important to specify what kinds of computers and servers are required. A common configuration is to have PCs in the exam rooms, doctors' offices, nurses' stations and at the check-in desk, all linked to a common server. Some practices use wireless laptops in conjunction with networked PCs, allowing the practice to purchase fewer PCs and invest in a wireless network. The practice should take an inventory of its current equipment, understanding that the new software might require updating hard drives and memory.
The second part of this article will appear in the September issue.