EHR Best Practices: Making the system work for your practice

Functionality and expenses are the two biggest sore spots most physicians feel regarding their EHR choice-Medical Economics found that 70% of doctors feel that their EHR system wasn’t worth the cost or effort. By now, you are aware of your EHRs perks and problems. But there may still be more ways to maximize your system, with the goal of doing business more efficiently. Your staff may need more training, and your workflow processes may need to be evaluated to work more in your favor.

Here are tips to fine-tune your EHR to fit seamlessly into your practice workflow:

Attesting to Meaningful Use

Use the quality metrics dashboard provided by your EHR vendor
Many vendors have a dashboard that tracks quality measures. Follow the instructions provided by the vendor to ensure proper documentation. George Ellis Jr., MD, FACP, a participant and Medical Economics chief medical adviser, says his practice was able to attest to Stage 1 of Meaningful Use 100 days after his go-live date simply by following the instructions provided by his vendor, athenahealth.  

Consider joining a health information exchange
Of the 17 core objectives in Meaningful Use Stage 2, three involve the exchange of electronic health information. This has been a concern for providers because many EHR systems lack interoperability. Health information exchanges (HIE) give members access to a centralized electronic repository where they can send and receive patient continuity of care documents.

Connect with local hospitals and providers to exchange information
Many physicians site exchanging electronic health information as their biggest concern when attesting to Meaningful Use Stage 2. One solution is to contact your local hospitals and other healthcare providers in your area. Start building a small network with them and discuss other data exchange opportunities.

Documentation is key
If you accept Meaningful Use money, then you may be audited. A failed audit means giving back incentive money.
A primary reason practices fail these audits is because they do not have the documentation to support their attestation numbers. Read more about preparing for an audit on page. 14.

Plan ahead
Even if your EHR hasn’t been upgraded to MU2 requirements, it’s never too early to start thinking about the necessary changes to workflow that will require of your practice and your staff.

Establish PQRS reporting

The Physician Quality Reporting System (PQRS) is an incentive program available through the Centers for Medicare and Medicaid Services (CMS) for monitoring the way practices manage some of the most common preventive services and chronic illnesses.
Attesting using an EHR system should be easy if you work with your vendor to pick the measures you want to attest to, because it should automatically populate through your EHR’s quality dashboard.

Protecting patients’ health information

Ensure Health Insurance Portability and Accountability Act (HIPAA) compliance
Completing a security risk analysis is the biggest risk for practices attesting to Meaningful Use, according to Mark Norris, the chief executive officer of Medical Records Services, Inc. Consider hiring a consulting company to conduct a security audit on your EHR system. This analysis should be  done annually to ensure HIPAA compliance.

Be cautious when allowing patients to view your computer screen
When showing a patient an X-ray or lab result on your computer screen, make sure no other patient names or information are visible to the patient.   

Patient engagement

Encourage patients to visit the patient portal on your website
The portal allows patients to access their records, schedule appointments, pay bills, and update their contact information. Meaningful Use Stage 2 will require that at least 5% of a practice’s patients access their health records through a patient portal.

Practices can create brochures to help patients log on to the portal the first time, but they may need to dedicate additional time and resources to help. Ellis says one member of his staff is responsible for showing the patient portal to patients each shift.

“This management tool can help streamline administrative functions before, during, and after a patient encounter. The patient portal takes some strain off the front desk by decreasing telephone calls and copying laboratory reports, because patients have access to these documents online,” Ellis says. “My portal helps me reduce the number of interruptions between patient visits.”

Include patients in the EHR process
An EHR system changes the way physicians interact with patients during an examination. Recent studies show EHRs can interfere with the physician-patient relationship. So it’s important for providers to be conscious of their interaction with patients in the exam room to ensure they don’t miss any nonverbal cues from patients. A recent study by Northwestern University found that physicians spend one-third of their time looking at their EHR, whereas physicians using paper charts spent only 9% of their time looking at them. If possible, try to position your computer so it is off to the side, rather than between you and the patient.

Determine patient satisfaction
Conducting a patient satisfaction survey can help you determine the level of impact that has had on your practice. Judy Bee, a practice management consultant, recommends keeping patient surveys simple. Don’t include more than 10 questions. Use the feedback to improve the services at your practice.

Evaluating productivity

Process analysis
It might take your practice 6 to 9 months to return to its previous level of productivity. Your goal should be to improve productivity, though many practices have had problems with that. If you were careful about documenting your workflow process in the beginning, it should be easier for you to look at your major processes to evaluate whether they are working more efficiently.

Determine:

• how many steps each process contains,

• what forms to use,

• what staff members are involved in each step,

• what information gets collected at each step, and

• what end result is expected of each step.

Tap your super users
Communicating with your designated ‘super users’ on a weekly basis is a good way to keep issues on your radar. It could be overwhelming if there is no structure to log staff issues and complaints about the EHR system, so rely on your super users to help your staff with issues, and field those concerns that need to be brought to the vendor.

Improving system maintenance

Using templates with care
Your vendor can assist you with creating templates for your most common patient visits, such as physical exams. However, it is important to use templates only as a starting point. You should be able to customize your template during each patient visit, to capture relevant information. Using templates can be a way to make visits and documentation more efficient, but you also want to avoid the appearance of cloning, or copying information from one patient chart to the next because of identical fields.

Expanding to tablets and kiosks
Accessing your EHR system via a tablet or mobile device will give you the freedom to review patient records and lab work out of the office, or anytime you aren’t sitting in front of your computer. With some EHR systems the mobile version is limited, so make sure you check with your vendor about the differences in services before you invest in buying tablets for your entire staff.

A patient check-in kiosk in your waiting area can help your office run more efficiently by allowing patients to update their own records, reason for coming, and payment information before they see a physician. Not all EHR systems have kiosks available. Some run through tablets mounted to a display. Others are full systems that can be costly.

Check with your vendor to weigh whether the cost of a kiosk is worth the increased efficiency.

Revenue cycle management

Vendors offer costly, yet efficient revenue cycle management (RCM) services that streamline insurance eligibility, collections, and coding claims to ensure the billing process goes as quickly as possible. However, some of the standard features of your EHR system can help you develop your own efficiencies using RCM.

The first place to start is with pre-visit verification. By “batching,” or verifying eligibility for multiple appointments through a clearinghouse prior to appointments, you can reduce your practice’s denial rate by up to 50%. Also, if your system can verify a patient’s insurance within 24 hours, you can make sure patients with new insurance policies are still covered before their appointments.
Automating tasks that don’t need your staff’s expertise can save time and money. By implementing online bill pay and e-statements, you can shorten the revenue cycle by making it more convenient for patients and spend less money on printing paper invoices.

Continue to vet the vendor and system

Evaluate your vendor
What are the systems’ strengths? What are its weaknesses? Does the system function the way the vendor promised that it would? When an issue occurs, how quickly is it resolved? What updates, if any, will be necessary for your practice to achieve Meaningful Use and transition to ICD-10? Is the vendor prepared for those updates? These questions will help you determine necessary improvements and help you better communicate those issues with your vendor.  

Communicate with your vendor
Consultant Derek Kosiorek, CPEHR, CPHIT, compares entering a relationship with an EHR vendor with a marriage. “You need to select a partner with whom you can get along and trust, communicate openly, and who will have your back when times get tough,” he says. Your vendor will likely be in constant communication with your practice during the go-live implementation, and may even send in-person help. But don’t let communication end there. Create a spreadsheet listing problems that occur with the system or any additional templates your practice needs to improve workflow.