Some early signs that your EHR is working as hoped

A practical look at information technology issues and usage

By — Posted Oct. 29, 2012.

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Within three months of going live with his electronic health record system in 2008, Mark Wyse, MD, knew that it was going to be a success. Dr. Wyse, a family physician with Family Practice Specialists in Phoenix, had increased his appointment schedule back up to pre-implementation levels and had become so efficient that he could open up the schedule even more.

That experience was a stark contrast to the one the practice had several years earlier when it adopted a different EHR. Practice administrator Carolyn Russell said that in the time it took Dr. Wyse to realize the second implementation had been a success, she realized the last one had been a disaster. She said features that were selling points turned out not to work, and it didn’t integrate with the practice’s billing system as promised.

Like most practices adopting new technology, there was trepidation — and even some grumbling — both times Family Practice Specialists adopted a new system. But through the complaints, a practice usually can tell pretty quickly whether the griping is the routine kind caused from change or indicative of an implementation gone wrong.

Each practice adopts an EHR for its own reasons. Along with those reasons should come goals that the practice plans to meet with the help of the EHR, said Carol Slone, RN, principal adviser with the Naperville, Ill.-based consulting firm Impact Advisors.

“Success means different things to different people, and if you don’t define it, someone else will define it for you,” she said.

Slone said setting goals, such as reaching pre-adoption baselines by a particular date, can keep employees and physicians focused and give early evidence of whether a new system is working. Here are typical goals practices can set and evaluate:

Better documentation. General surgeon Reavis Eubanks, MD, a solo physician in Asheville, N.C., said he wanted to reduce the number of rejected claims that cost his practice time and money to resolve. He thought an EHR would improve his documentation and result in cleaner claims.

Learning the new system was an adjustment, Dr. Eubanks said, simply because it was a new way of doing things. But despite the learning curve, it was “readily apparent” within two to three months that the implementation had been a success when he realized there were fewer insurance hassles and rejected claims.

Job reassignment. Slone said many practices go into an implementation thinking they will cut their staff by one full-time employee. That is generally an unrealistic goal, but many practices find that the EHR results in shifts of job duties. For example, Dr. Eubanks said his front-office staffer spent a lot of time on the phone with insurers before implementation dealing with denied claims. More of her time is now spent directly with patients.

The more that practices can plan ahead for how those jobs will shift, the better, Slone said. Specific goals should be set and verbalized for all staff so everyone is on the same page.

Ease of use. Slone likens learning a new system to going into your favorite grocery store and discovering it has changed the aisle configuration. You’re completely lost the first day, she said. The second day you may remember where one or two items are located. But by the third or fourth time, you don’t remember what the old configuration looked like.

Many times, when problems persist, they are caused by the system. But those problems can be resolved with customization or tweaking. Dr. Wyse said his system remembers physicians’ most common orders, problems and medications and creates “pick lists” for each user to find things quickly. But it took some time for the system to create the pick lists and for physicians to design the most effective templates. This frustrated some doctors, since they felt it slowed them down. But once those things were in place, physicians were able to gain the efficiencies they were looking for.

Productivity. Most consultants recommend that practices reduce their schedules by 50% in the first week or so post-implementation and slowly increase it back to pre-implementation levels as the physicians feel more comfortable. The reduced schedule can cause a lot of anxiety, so the goal should be to get it back up as soon as possible. Slone said the time it takes to return to pre-EHR levels varies by practice, but she might start to get a little concerned if it’s not looking good after three to six months.

Staff complaints. Although a fair amount of grumbling is expected in the early days of an implementation, practice leaders should take note if it doesn’t stop and if the same complaints are made repeatedly by numerous people. Slone said looking at employees’ relationships with other technology will give practice leaders an idea of whether there is a problem with the system or whether certain employees might require additional training.

Employees who are quick to adopt other technology, such as social media or mobile technology, for example, should have a reasonably easy time learning to use an EHR. It’s possible that users may not know about certain shortcuts and functions that could save them time, or the system is just not a good fit.

Slone said routine surveys of physicians and staff can help leaders determine how things are going, or find new goals on which to focus. Those surveys also can expand to patients to see if the technology has led to an increase in patient satisfaction. “Sometimes happier patients lead to happier staff,” she said.

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