Transitioning to Electronic Health Records
- To avoid having physicians search through thousands of illnesses in problem lists, create a list of common illnesses physicians come across on a daily basis.
- Do not let physicians forgo the training provided by the EHR provider: It will help with implementation.
- Reduce patient load by 25% for the first two weeks an organization goes live with EHRs. It may be a small financial burden, but it improves the chances of success.
No matter how hard they try, health care providers are finding it increasingly difficult to ignore electronic health records (EHRs). Perhaps the most challenging component of adopting EHRs is meeting the “meaningful use” requirements established by the Centers for Medicare and Medicaid.
To receive incentive funds, physicians must meet six clinical quality measures and 20 different objectives provided by their EHRs, including physician order entry, clinical decision alerts, and electronic prescribing. The goal of step one of meaningful use is to demonstrate physicians are mastering the fundamentals of EHRs, such as creating a medicine list and a checklist for patient vitals.
Transitioning from paper charts to computers is not easy, said Terry Ketchersid, MD, a former nephrologist and current vice president and chief medical officer for Acumen EHR. “With EHRs, data are there and it is presented in a more robust way, but change in habits is something you never want to underestimate and it is a painful process,” Dr. Ketchersid said.
Here are some tips to help work through that process.
Ease into it
“Don't start by making doctors drink from the fire hose,” Dr. Ketchersid said.
Instead of learning every detail of an application, start with a simple component that physicians use every day, like an application in the dialysis unit. As doctors become more adept with the system, they can begin using more complicated portions of the application.
Another option is to allow physicians to do just what is necessary to meet the meaningful use requirements in the early stages of adoption.
At Dallas Nephrology Associates, the point-and-click data required to meet meaningful use is one of the most cumbersome parts of utilizing the electronic health record, said Linda Rivera, the group's IT Director. This process has nearly tripled the time it takes physicians to create patient notes, and the physicians do not feel these notes clearly communicate the patient visit or health status, she said.
Identify an internal champion
Dr. Ketchersid said when he sees failures with implementation early in the process, it is often because an organization has not named a clinician who can rally the troops.
“If you are doing this in a group practice, there needs to be a physician champion in that group, someone who understands the value of bringing EHRs in and who commands the respect of the people in the practice,” he said. “Because when the going gets tough, you need someone inside the practice who is committed to the effort.”
Assign a staff guru
Doctors may be signing off on the data, but office staff members perform a substantial portion of the tasks involved in checking patients in and collecting vital signs and demographics. This is where the staff guru comes in. This person should look at the meaningful use objectives and identify where certain steps in the necessary processes are being missed, from measuring a patients' height to asking about their preferred language or if they smoke.
“Physicians aren't in the weeds enough to know the workflow,” Dr. Ketchersid said. “I encourage empowering a nurse or PA that understands the meaningful use framework to take charge.”