EHR Next Chapter: A “Tool” in the MD’s Medical Arsenal
Some of the Commonwealth’s premier experts in health information technology and electronic health records gathered recently at MMS headquarters to take part in the day-long continuing education event, Electronic Health Records Next Chapter: Best Practices, Checklists, and Guidelines.
“The EHR revolution is not new,” said Jeff Loughlin, project director of the Massachusetts eHealth Collaborative, while opening the morning session about EHR best practices and pitfalls. “Along the way, we have seen a lot of failures, primarily because a lot of expectations were put on the EHR to solve the problems of the medical practice,” he said, “rather than using the EHR as one other tool in your arsenal to improve work flow and provide better care.”
To help attendees make the most of this tool, physicians representing small, medium, and large practices weighed in on lessons learned from their EHR experience to date:
Don’t Fear Switching
Today, many physicians are deeply worried that the EHRs they adopted a decade ago no longer suit their needs, said Eugenia Marcus, MD, FAAP, pediatrician and chair of MMS Committee on Information Technology. She can relate, having learned and implemented three different EHR systems since beginning her quest for the paperless office in 1996. “Switching is not that hard,” she said. “Every word of the record does not need to carry over.”
During Marcus’ transitions, staff were responsible for making sure critical information, such as demographics and medication lists, was transferred immediately. But high school students to copy over the rest of the material over a long time period.
Use EHR to Improve Patient Satisfaction
EHRs do far more than simply house patient records, noted Hugh Taylor, MD, a family physician at an 11-doctor practice with three sites throughout the North Shore. In fact, out of the 17 functions Taylor listed that his EHR performed, the last four had little to do with practicing medicine.
“The EHR does many things that don’t affect the clinician so directly but are extremely important to how the office runs,” he said. Examples of these functions included scheduling, confirming insurance coverage, coding and billing, and tracking patient flow. That last item pulls double duty in Taylor’s offices, he said, by helping the practice inform patients when doctors are running behind and of how long they may have to wait. This data is also used to help the practice strive to improve its Press Ganey patient satisfaction scores, he said.
MDs Need Not Do All Documenting
Larry Garber, MD, and his team at Reliant Medical Group, where he serves as Medical Director of Informatics, pulled together a list of which individuals should do the documenting in the medical record, in order of preference, to promote optimal efficiency. “It doesn’t have to be just one person; it can be a combination of people,” he said.
The top choice of documenter, however, isn’t a person at all, but the computer itself. “Whenever possible, reuse data that you’ve already got,” he said. “Let the computer do as much work as it can.” (As a caveat to the pitfalls of copying and pasting, Garber noted that it’s a practice policy that physicians are responsible to review and update any information in notes they create.)
Next, Garber recommended letting patients populate some of their own data. Even triage nurses speaking with patients on the phone can contribute to the record, placing them in the third spot of preference. “What a great place to take history without tying up an exam room,” he said.
Rounding out the list of preferred documenters were medical assistants, doctors assisted by speech recognition, doctors assisted by transcriptionists, doctors typing, and scribes typing. When it comes to accuracy, Garber noted that physicians who use a combination of typing and speech recognition tend to produce the highest-quality notes.