EMRs: How to Address Challenges of Implementation
Many providers still find EMRs vexing, even after all these years.
After much arm-twisting by the federal government, a majority of doctors now have, or plan to get, electronic medical records (EMRs). Though they are supposed to increase productivity and reduce redundancy, many doctors who have implemented the systems find them clunky and not worth the financial investment.
Some major issues still hounding physicians with EMRs are interoperability and lack of productivity and specificity. Here is what experts say about these issues and how to manage them.
When it comes to interoperability, you are basically at the mercy of your vendor. Unfortunately, there is not a lot providers can do at this point to remedy the situation.
Nate McCarthy, senior manager at ECG Management Consultants, recommends using a patient portal to communicate with patients or interfacing with a health information exchange to swap data with other providers. Communicating with providers outside of your group is easier if they have the same vendor, if they don't, the EMR “isn't terribly helpful at this point,” McCarthy said.
Lack of productivity, however, is something over which you do have some control. Part of the equation is handling workflow. If you are not a great typist, using a scribe might be an option to keep you from spending your evenings performing documentation.
Ensuring everyone is working at the top of his or her licensure is also important, McCarthy said. Perform a workflow analysis to find out who is inputting what information. The physician should only be responsible for things that require a doctor's signature.
One Size Does Not Fit All
Robert Steele, clinical executive vice president with The HCI Group, said that even good systems should be considered mere templates with helpful workflows and best practices built in. Particularly for specialists, they “never work out of the box,” he said. A urologist, for instance, will need decision and support tools different from those used by an orthopedist.
Your EMR may be fulfilling basic needs, but it should be making your life easier and faster. If it is not, the next step you should be thinking about as you move forward with your application is “optimization,” Steele said.
Start this process by using the system for about 6 to 9 months. Sometimes early disruptions are simply the product of working with a new program. After that, you can take stock of challenges by:
- Making a list of what is decreasing efficiency and satisfaction, and slowing progress during visits.
- Shadowing an appointment to watch how the system works from a patient call through the patient intake and office visit and referral for tests or other services.
- Looking for areas of duplication.
Steele urges physicians not to think of the go-live date as the end, but the beginning of an evolving system. You should be continually working with vendors to optimize the system's potential. The implementation team should have an ongoing role assessing the system, its performance, and utilization.
When you do this, you can challenge your vendor to design a system that will meet your needs instead of adapting your practice to the system, Steele said.
There are many ways EMRs can reduce your office's workload by allowing patients to perform online scheduling or history input and email communication, Steele said. Providers have worked with the Department of Health and Human Services to adopt EMRs, and now they are looking for ways to make the systems improve their practices.