EHRs: Solution or problem for your front-office staff?

The use of electronic health records (EHRs) changes how front-office staff handles patients, from scheduling to billing. Medical Economics adviser Frank Cohen discusses problems with EHR systems and whether he believes vendors will make better functionality a reality.

Q: How have EHRs changed the front office workflow at a medical practice?

A: What has changed is the difference between shuffling papers and playing around on the computer. I’m not impressed with the level of efficiency that EHRs bring to a medical practice. We weren’t ready for it.

Let’s take a look at appointments. Rather than patients calling the practice, they could go online, pick a date, and schedule the appointment. But the problem is that rarely works. The patient wants to talk with someone. So you spend money to get an EHR and you have these capabilities, but people don’t want to use them.

Q: How is the check-in process different?

A: With EHRs, theoretically, when the patient walks in, they will check-in at the kiosk. That works for patients who are computer literate, but there are many people who are not. If my mom or dad had to depend on that, they would never see the doctor. 

If that kiosk works properly, that may be a tremendous benefit because the check-in staff has no contact with the patient and no paperwork gets moved around. The vendors will tell you that these are all the great things the EHR can do. But my experience has been that works sometimes, but most of the time it doesn’t.

Q: How do EHRs impact other areas of the patient encounter?

A: Most patients wait way too long, and an EHR doesn’t do anything to fix that. You can’t rush the physician. In the EHR method, the staff still has to escort the patient to the room. They still have to take their vitals. But instead of writing them on a chart, they enter them into the computer. What do you think is faster? 

EHRs slow down the patient visit cycle, and they cost productivity.

Q: Do EHRs provide any improvements to the workflow process?

A: The clinical documentation of EHRs converts this into a paperless encounter, and that’s a good thing. In the physician’s workflow, instead of them looking through all of the paperwork, the computer program contains all that. While the EHR provides the physicians a greater ability to review data simultaneously, it doesn’t increase the efficiency of the clinical encounter at all. 

In the coding and billing part, a lot of these EHRs will code these visits automatically, based on the checked boxes the physician used, and they hit a button on the screen and it submits. That’s pretty great.

Q: Do you believe vendors will address workflow issues?

A: I absolutely think they will. Theoretically, all of these processes work really well. But when theory hits the road and you’re dealing with real people, things tend to be different. 

It’s critically important that before a practice makes the decision to go to an EHR, they take the time to do a current workflow map. Look at where they are now, and then work with the vendor to create a new workflow map of how things should be. Heaven help the practice that gets an EHR and thinks it’s all going to work just because the vendor says so. They’re going to be in real trouble.

Frank Cohen is senior analyst with The Frank Cohen Group, LLC in Clearwater, Florida, and a Medical Economics editorial consultant. Send your practice management questions to medec@advanstar.com.