As of Jan. 1, 2014, medical professionals were required to adopt and demonstrate “meaningful use” of electronic medical records to keep their Medicaid and Medicare reimbursements. Meaningful use means the EHR must improve quality, safety and efficiency; reduce health disparities; engage patients and their families; improve care coordination and public health; and maintain security of patient information.
Noble goals to be sure, but the transition to electronic is complicated and expensive for many small medical businesses. When weighing the cost and disruption of implementation to the penalties incurred, many doctors opt to just pay the fines. Nonetheless, few would argue that the adoption of EHR for all is only a matter of time.
Whether you’ve already adopted it, tried and given up, or are holding out until the last possible moment, we asked folks who have run the EHR gauntlet and survived … if not necessarily victorious, certainly wiser, to share their tips, advice and workarounds for EHR implementation.
BEFORE YOU COMMIT
1. RESEARCH! Explore the options. “Find a system that works for your office,” says Dr. Cynthia Sayers of EyeShop Optical Center in Lewis Center, OH. “Check demos and ask others. We are an all Mac practice, so our options five years ago were limited to software compatible with Mac. We chose MacPractice and have been very happy with it.”
2. CUSTOMIZE. “Make sure your EHR system is customized to your business,” adds Michelle Wright of DePoe Eye Center in Sharpsburg, GA. “Exam pages can be customized with shortcuts to help the doctor be more efficient.”
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3. INVEST IN HARDWARE AND SOFTWARE. Wright also suggests investing in good scanners. “Everything will need to be scanned.” Additionally, “make sure your testing equipment is integrated with your EHR. For example, the OCT should go straight to the EHR system for doctor review. This saves valuable time,” Wright says.
AFTER YOU CHOOSE
4. SET ASIDE TIME FOR TRAINING. “I have Revolution EHR and they have really informative videos to help you learn the system,” says Dr. Nytarsha Thomas of Visionelle Eyecare in Zionsville, IN. “I made it mandatory for every staff member to watch some of those videos.”
5. SLOW DOWN. “Doctors tend underestimate how long it will take and how frustrating it will be so they operate business as usual during the transition. The schedules the first three to five days should be lightened and some additional technician staffing provided,” offers Jocelyn Mylott, of D’Ambrosio Eye Care in Central Massachusetts.
6. CONSULT OTHERS. “Get with another doctor to learn some tips of the system,” says Dr. Katie McElvaine of Springfield Family Vision in Springfield, MO. “The shortcuts and troubleshooting they have found can be very helpful.” Ask your vendor for other practices who have had success.
7. CREATE SHORTCUTS. Like Dr. Rita Ellent of The Gardens Eye Care in Forest Hills, NY. “To help document certain common findings I created a template that I keep on my desktop. This allows me to copy and paste common findings reducing typing time.”
8. PRACTICE ON TEST FILES. “Running patient scenarios on a test file in the EHR to practice keystrokes and where diagnoses are located has also helped in speeding up the transition,” Dr. Ellent adds.
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9. OUT WITH THE OLD. “Scan your old records into the EHR and shred,” advises D’Ambrosio’s Mylott. “You don’t want to be going back and forth.”
10. PICK A HARD STOP. Choose an end date after a transition period, suggests Dr. Thomas of Visionelle. “‘On Dec.19, 2016, paper records are dead to me!’ Have a meeting about it and stick to your guns,” she says. “It may be helpful to have a week or two transition period of paper in the exam room but each person has to finish entering records by the end of the day.”
STICK WITH IT BUT …
11. HAVE AN EMERGENCY PLAN. “Electronic systems go down sometimes,” says Dr. Ellent. “It’s important to be able to switch gears and keep a supply of skeleton paper charts on hand.”
12. KEEP PATIENT COMFORT IN MIND. “It’s ok to still have some paper,” says Eyeshop’s Dr. Sayers. “Some patients aren’t comfortable with electronic forms, we give them paper and scan it. We jot notes on insurance info sheets to keep track of orders. Having a paper trail is still nice.”
13. DESIGNATE AN EXPERT. “Someone internally should become fluent in the software to build screens and communicate with the vendor, along with creating workarounds. It saves time and you’ll have your own advocate,” says Mylott.
14. HIRE A SCRIBE. “It’s the best money I spent,” says Dr. Selina McGee of Precision Vision in Edmond, OK. “Even if you stick with paper, a good scribe makes you a better doctor.” Win win.
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USE BRIBES OR THREATS
15. INCENTIVIZE. “Have a contest,” suggests Dr. Thomas. “An office I worked for had a contest for a gift card for whoever got the hang of it quickest. Or reward staff with a pizza party or something to thank them for their hard work.”
16. BE TRANSPARENT. “There are people that will resist because it’s inconvenient and unimportant to them,” adds Dr. Thomas. “I tell them why it’s important to me. EHR can’t be lost. They’re safer and more secure. You can easily share them with other doctors. It takes no space; turn the records room into a staff lounge! It’s better for patients and the office. Don’t leave them in the dark.”
17. PLAY HARDBALL. “If they’re still resistant, I pull the ‘this-is-so-important-it-may-cost-you-your-job’ card. They get on board after that,” she says.
This article originally appeared in the March 2017 edition of GO/OD.
