It’s Never Too Late: Process Improvements After An EHR Implementation

June 9, 2012
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It has become widely accepted that electronic health record systems have the capacity to improve quality in the healthcare industry by reducing or eliminating errors. For this to be successful requires clinicians and staff become proficient and effective users of the EHR. Converting from paper charts to an EHR necessitates a paradigm shift in learning, work effort, and workflow changes associated with any transition to a electronic database system – more so with a mission critical system that has the potential to impact the health of a patient.

It has become widely accepted that electronic health record systems have the capacity to improve quality in the healthcare industry by reducing or eliminating errors. For this to be successful requires clinicians and staff become proficient and effective users of the EHR. Converting from paper charts to an EHR necessitates a paradigm shift in learning, work effort, and workflow changes associated with any transition to a electronic database system – more so with a mission critical system that has the potential to impact the health of a patient.

In the rush to meet government mandates or receive CMS incentives, many hospitals and providers have adopted EHRs utilizing the same clinical workflows established in their pre-EHR setting. In other words, they have simply automated an inefficient process overlooking strategies to improve decision support, workflow efficiency, effectual user training, communication, and financial performance. That said, there is still ample opportunity to for process improvements in a post EHR implementation environment.

Following completion of the EHR implementation, the office can still develop a strategy to move beyond simply using the features and functions of the EHR and begin focusing on the data in the system to maximize the benefits that a functional EHR system can provide. An ideal start is to take advantage of the reporting features of the EHR to assess and measure the effects of the EHR to date. Analysis of reports will assist in determining what areas of the EHR are most effective and what can be improved upon in order to advance actual practice transformation.

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Primarily, evaluate interfaces to other providers and healthcare systems with which the practice communicates (i.e., clinics, labs, hospitals, etc.). A EHR implementation can be compromised and data rendered ineffective if the interfaces are not operating effectively. Presuming all interfaces are working as designed, the office manager can begin the course of action of measuring operational specifics such as percentage of clinic visits, the amount of lab values entered, the number of e-prescriptions sent over a set timeframe, etc. Additionally, some practices measure the effect the EHR has on reimbursements and if the practice is realizing higher revenue related to the introduction of an EHR.

Once the effectiveness of the EHR has been properly evaluated, the office manager can begin to identify areas of opportunity to further optimize the operations of the practice. While there are a myriad of ways to increase EHR utilization, the following points represent examples as to how to achieve this:

Refresher training post EHR implementation

Electronic Health Records are similar to any other technology we use in that we are unsure if we are taking full advantage of all available features. There are many reasons why this may occur. First, during the first few weeks of use and training, users are typically focused on grasping the functionality of the system as opposed applying it in a meaningful manner. Secondly, once the user becomes accustomed to using the system in a way that appears adequate, it becomes difficult to change embedded routines. In order to mitigate these issues, it is beneficial to have the users go through refresher training courses in order to fully comprehend what EHR functions may have been overlooked or are not being utilized to their maximum degree. Refresher training is also beneficial for users who only use the system periodically or who are less knowledgeable of the system.

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Establishing a “super user” who is proficient in using the EHR is a recommended industry practice. The super user is someone who has become proficient in the system and takes on the role of resident EHR expert assisting others in the practice come up to speed in a rapid manner. The super user is also the go-to person for system related questions as well as issues related to functionality and works as a mentor to new users entering the practice.

Enhanced Workflows post

It is essential to evaluate both clinical and operational workflows after EHR implementation. Used properly and aligning staff roles with the new technology, the practice has the opportunity to maximize value and eliminate waste and redundancy.

All too often, staff will remain in their pre-EHR roles after EHR implementation. Redeploying staff to perform tasks to augment the use of an EHR should be explored. Even in a post-go live environment, the staff can enhance their ability to evaluate internal operations such as care management and streamlined processes .

An EHR driven staff realignment methodology can have a positive effect on productivity as well as cost and patient care. To leave the workflow in a paper-based state is to not take full advantage of all the performance improvement opportunities the EHR can offer.

Determining whether the practice has realized the benefits of an EHR optimized environment are visible by way of the following examples; some are more tangible than others:

  • Increase in staff productivity (i.e., less time spent looking for patients and other staff).
  • A noticeable improvement in the perception of the value of an EHR.
  • Reduced time spent reviewing patient charts after hours
  • Ability to see more patients without extending hours.

Although the impact of these examples may vary from specialty to specialty, the practice will invariably experience a notable and positive change to both its clinical and non-clinical workflows.