Four Questions to Guide Your Clients about EHR Selection and Implementation

Many physician practices are justifiably ambivalent about putting in an EHR.  From resistance to change to the upfront costs with uncertain returns, many of your physician clients are fighting the push to implement an EHR.  Indeed, using an EHR will not necessarily save the physician time and Medicare EHR Incentives of up to $44,000 per eligible provider may not cover the complete cost of an EHR implementation.

With so many questions and even more confusing answers, it may be tempting to stay away from the whole matter and stick to your billing business.  However, the EHR decision is one of the most important and vexing issues that your clients face.  Their decision on EHRs will affect their practice and your ability to serve your clients.  Consider the following questions as you advise your clients on this important issue:

1.    Is the practice ready to use an EHR? – In the rush to collect the $44,000 Medicare incentives, many practices overlook whether they have the time or resources to implement an EHR.  From time needed to pick the right product to moving patient information to the EHR, EHRs will require physician involvement and may require additional resources to make the transition.  This level of commitment should be understood upfront.  Otherwise, the goals and plan for the EHR can become distorted or impractical.  For example, a number of practices have tried to implement EHRs during their busy seasons, or with reduced staff levels.  In other cases, EHR plans have not addressed a lack of computer skills among staff and doctors.

2.    What are the practice’s expectations for an EHR? – Like anything else, expectations drive the selection of an EHR.  Set expectations too low, and the practice can end up with a product that does not have the features needed.  For example, the ability to annotate an image is critical for an ophthalmology practice, while pediatric practices need a strong immunization management feature.  Practices employing mid-level providers or using collaboration among doctors, nurses and staff to serve patients need an EHR with workflow management tools.  The guiding principal is to set expectations based on what your practice needs to be efficient and effective and not just based on your current paper-bound operation.  For example, tracking future treatment orders should include tools to help the practice manage patient contact and not just record the order information.

3.    Will the client practice be able to take advantage of the EHR incentive money?  – Many practices are still not clear on what they need to do to qualify for the EHR Incentive Payments.  Indeed, a disturbing number of practices may have attested to meet the MU Measures without actually fulfilling the requirements.  As a practical matter, implementing an EHR does not mean that the practice has attained the measure standards.  Some EHR systems calculate the various measures, but many EHR products require the doctor to check a box for each measure even though the information may not have been gathered.  For example, the doctor may check a box that the patient allergies were recorded, but actually recording the allergies is on another screen.  Another challenge is attaining the Meaningful Use Measures for 90 days in the first year and consistently afterwards.  The key issue is that many practices are not allowing enough calendar time to attain their practice goals and Meaningful Use.  Make sure that your client practices give the doctors sufficient time to ramp up to the measures and not focus in on the measures at the expense of accurate records, patient service, and/or physician productivity.

4.    What is a practical plan to implement an EHR for the practice? – Many practices reasonably assume that the vendor will drive the EHR implementation effort.  That is not in the interest of the practice and not really a service that the EHR vendors provide.  EHR efforts must be structured and driven by the physicians and the practice.  Physicians cannot cede control of practice operations or clinical decision making to any outside party.  Additionally, the practice needs to establish the process that will allow the doctors to build confidence in the EHR as well as become familiar enough with the EHR to work with the EHR while serving a patient.  Unfortunately, many physicians attempt to use the EHR without proper training and preparation.  Failing to adequately prepare leads to poor patient and physician experiences.

In the cacophony of voices and messages about EHRs, there are too few sources of rational thought about approaching EHR projects.  By asking a few key questions, you can help your clients understand the scope of the challenge and help them put sufficient analysis and resources to achieve their goals and serve their patients.

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