Okay, we admit it – even we are becoming a bit jaded with all of the attention being paid to meaningful use. So we thought we’d give ourselves and our readers a break this month and instead write about a topic that gets far too little attention: optimization.
This is the concept of using electronic health records in ways that actually fulfill their intended promises of increased efficiency and improved patient care.
Dr. Neil Skolnik and Dr. Christopher Notte
Often, the mere mention of optimization is met with looks of speculation and incredulity. This is followed with a question like, "Have you ever actually tried to use this thing?" or a definitive statement such as, "Impossible!"
We would argue, however, that if a practice has done its homework and invested in a high-quality, well-regarded EHR, there is no reason to doubt that real advantages eventually can be realized. In fact, if priority is given to optimal use early on in the implementation of an electronic record, government incentive and quality initiatives (such as meaningful use, PQRS/PQRI, etc.), can be far less painful to manage.
Here we focus on a few simple tools providers can use to increase – or at least maintain – their productivity.
Start With the Right Information
The most valuable step in ensuring optimal use of an EHR is timely and relevant education. Unfortunately, this is where many vendors fall short, as most training is done by individuals who do not actually care for patients. As a result, a great deal of emphasis is placed on what each button or checkbox does instead of how to make it through the day as efficiently as possible.
Instead, we encourage all providers to view the use of an electronic record through the lens of a workflow process. From beginning to end, interacting with the EHR should follow a logical progression and make sense to the user. If there is functionality that is unnecessary and only slows the provider down, it should be avoided in favor of elements that streamline the documentation process.
To put it another way, when learning the software, we should always be looking to the goal of an efficiently completed visit.
Preplan Your Visits
A great advantage of an electronic health record can be the ability to look into the future and "preplan" visits. It may be a novel concept to most, but adjusting to this model can greatly increase efficiency in the long run.
As an example, providers might look ahead at which patients will be coming in for a visit and preorder lab tests, in-office diagnostic studies, or routine health maintenance items. This way, the staff can properly prepare in advance and increase the speed of patient flow through the office. This also will reduce the amount of "clicking" and documentation the provider will need to do while the patient is in the exam room.
Avoid Duplicate Work
Most electronic health records include the ability to create timesaving templates or macros that can dramatically increase documentation efficiency. Templates created for common encounters (such as sinusitis, headache, or hypertension follow-up) allow providers to call up a mostly completed note and simply fill in the blanks to make it accurate and specific to an individual patient.
Templates also can be created for unique patients. For example, if Mrs. Jones comes in regularly for a diabetic check but her care plan always remains the same, a template specific to her will greatly decrease the documentation burden each time she visits. Likewise, macros that contain commonly used language can be created.
To illustrate, instructions for a hypertensive patient to avoid salt intake and increase exercise are typically provided. This text can be saved as a macro, and then, with a few keystrokes, can be inserted whenever deemed appropriate.
These invaluable tools are always helpful and well received, though it’s surprising how few physicians actually take advantage of them.
Think Like a Coder
Before taking offense to this section’s heading, consider this: Most of us are paid based on our documentation and coding. While far from a perfect – or even fair – system, it is the current reality. As a result, the way we create our notes should be informed by this fact.
It is important, therefore, to include documentation to support the way you are billing, and an EHR makes this a much easier thing to do.
Once they’re comfortable with the workflow, it is common for physicians to develop a sort of muscle memory – a pattern of documenting that insures all of the required elements for better evaluation and management coding are being hit. It is essential, however, not to fall into the trap of overdocumentation – including history points or exam elements in a note out of habit when they were not actually obtained. This is fraudulent and becomes obvious through repeated abuse.