Optimize the EHR: Better Workflow Means Better Work-Life Balance

Chad Anguilm, Director of Professional Services, Medical Advantage Group. Medical Advantage Group is a wholly owned subsidiary of The Doctors Company.

Today, physicians have access to more data than ever before, and complying with new quality programs and pay-for-performance initiatives requires doctors to aggregate that data in various ways. Physicians and their office staff now spend a significant amount of time sorting through data in order to satisfy all the checkboxes—leaving them overwhelmed and dissatisfied.

But there are tools that can streamline patient care and payment workflows in the electronic health record (EHR). By dedicating time and effort up front to optimize the EHR, physicians can get relief from administrative tasks, reduce duplicate entry of data, and save time by not having to search for records in multiple places. Effectively maintaining an EHR is an ongoing process—the industry offers near-constant improvements—but the reward is a better work-life balance.

Enhancing the EHR means focusing on these four top areas:

  1. Building a direct data interface. When all patient data, from both within the practice and from outside sources, is routed through the EHR in a structured format, a physician has all the information required at the point-of-care when treating a patient. The interface can include data from lab tests, radiology, and health information exchanges (HIEs); devices like blood pressure cuffs and health trackers; and other outside vendors.
  2. Organizing patient data to provide a central point of access in the EHR. Immediate and organized access to complete patient information can help reduce unnecessary office visits, imaging, and labs tests.
  3. Establishing predefined care alerts to guide physicians through the treatment portion of the visit. The parameters of each alert should be set by the physician, based on the Healthcare Effectiveness Data and Information Set (HEDIS) or other quality metrics or quality-based programs the doctor participates in. By setting up alerts that are triggered by the receipt of structured data instead of being manually triggered, a practice can see more patients and provide customized treatment plans without running recalls or prepping charts prior to the patient’s arrival. Setting up alerts is a one-time effort—then, armed with the right tools, the physician can rely on educated decision-making at the point-of-care, when time is of the essence. At a minimum, the EHR should identify gaps in care and alert the physician in real-time as to what the patient needs.
  4. Integrating population health management reporting tools that allow the physician to see gaps in care or future care needs based on gender, age, and medical history, such as foot exams, immunizations, and colonoscopies. These tools—offered in many EHRs through the EHR vendor or a clinically integrated network (CIN)—analyze data from the EHR, HIEs, payer claims systems, and lab and radiology facilities, so that a physician can make decisions based on the patient’s longitudinal medical record. This offers the ability to bill for services during the office visit, send campaign messages (such as for a flu shot or annual physical) to patients, and report data in a useful format to referring physicians. In addition, a clinical rules engine takes action based on what is documented in the chart. For example, when a patient is diagnosed with asthma for the first time, it automatically recommends a medication and a follow-up appointment.

Getting Help in Optimizing the EHR

When optimizing their EHR, physicians would benefit from working with an experienced consulting team that understands the tools available as well as the flow of the practice. An outside firm with wide knowledge and perspective on the industry and various EHR systems will be most aware of the optimization opportunities available. The firm might also be able to use economies of scale to integrate the EHR systems of multiple practices within a physician organization, physician-hospital organization, CIN, or accountable care organization through a HUB or HIE—increasing the flow of data or decreasing cost. The EHR vendor will often be involved in the optimization process, but an outside consulting firm should lead the project.

Many EHR vendors offer a complete EHR solution but are ineffective at optimizing workflow during implementation. And once the EHR is implemented, an inexperienced office manager may be charged with managing the vendor relationship remotely to ensure the full functionality of the EHR. At this point, the office manager or physician may not be aware of the full capabilities of the EHR and may not be equipped with the questions to ask a vendor to determine if the vendor can help the practice get the most out of the EHR—or if it’s time to hire a consulting firm. Here are the questions a practice should ask the vendor:

  • What local laboratory/radiology/report interfaces are available in the area that may help streamline the flow of data in and out of my practice?
  • What data can be submitted electronically through a commonly accepted file for incentive programs like PQRS, Meaningful Use, and other payer-directed programs in order to decrease duplicate entry?
  • What devices such as trackers, kiosks, or EKGs connect directly to the EHR to decrease manual entry?
  • What inbound interfaces can be set up to accept ADT data, structured data from other physicians, or vaccine registries?
  • What type of remote access capabilities—such as smartphone or tablet apps or web-based accessibility—are available in order to complete tasks without being tied to the office?

Maximizing Workflow to Minimize Work Time

Ultimately, when an EHR system is optimized, physicians can focus their time on caring for patients and maintaining a good work-life balance.

Take the example of Michael Little, MD, a pediatrician in Clinton Township, Michigan. Dr. Little was staying at his practice until late at night to enter data due to an inefficient EHR system that caused him to take notes by hand and then enter them manually into the EHR. By working with an outside consultant to redesign workflows, optimize templates, and complete a HIPAA analysis, Dr. Little reduced the amount of time he spent entering data from 30 minutes per patient to 2 to 3 minutes. He now has more direct face-to-face interactions with his patients and no longer stays late to update his charts, providing him more time at home with his wife and small children.</p

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.


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