Towards a smooth Electronic Health Records system implementation

August 15, 2008 – 5:16 pm

Laying the foundations for an EHR system implementation at your Medical Practice – The sum of parts approach

Electronic health records (EHRs) are regarded as the technology through which the quality of healthcare could be improved. In due course it is very likely that Electronic health records (EHRs) will become the primary means of clinical documentation for medical practices, thus positively influencing the efficiencies of the organization at the provider and practice levels. However, not all organizations are prepared for the scope and scale of a full EHR implementation.

Let us try to chart out a way that could lay the foundation required for a smooth electronic health records implementation at an individual practice or enterprise; a step by step process that will make the transition easier and dull the impact that the challenges of workflow changes and capital expenditure will throw up, without the required preparation.
Creating and storing your data in a way compatible with EHRs using a scalable system that reduces physician workflow changes and minimizes capital expenditures is the first step on your way to a smooth transition. For example, taking steps like saving transcribed reports in an EHR-friendly way or implementing an electronic central database for viewing of data will prepare the Medical Practice for the inevitable EHR system while also allowing the Practice to meet their current needs better.
This incremental, ’sum of parts is greater than the whole’ approach to an EHR implementation could make all the difference!

Preparing for the EHR system while improving efficiencies immediately could lead you to a variety of strategies under various workflow heads. Let us look at an example that uses three main workflow heads as focal points on the way to a cumulative approach to EHR implementation:

1. Transcription
For Medical Practices that currently use transcription for clinical documentation, we’d recommend specific, easy-to-use formatting of transcribed reports which could be downloaded into the EHR when the practice is ready to make the move. The two levels to this strategy that should be addressed by your foundation system are:

- Simple formatting that allows for basic identification of both patient and provider. The formatting involves placing markers within the transcription that will allow the EHR system to identify the patient and download, say the progress note into the appropriate chart when the EHR is implemented. For practices that already store their transcription electronically in a well-defined format, it is possible to automate the process of the insertion of these markers.
- Making changes that will allow for more information to enter a patient’s chart. It involves the insertion of additional markers or dot codes within the body of the transcribed text that will allow the EHR system to extract specific information such as allergies, problems, medications, diagnoses and lab information, and place them into the appropriate sections of the chart. This step of your strategy will involve some changes for your physician (in terms of their dictation method) and her transcriptionists. As a Practice Manager this might involve a co-ordinated training effort to make sure this step lands right.
Storing transcription in an EHR-friendly way allows a Medical Practice to establish the basis of a complete electronic health record with only minor alterations in workflow, albeit with a cumulative effect. When the EHR system is ready to go live, the stored information can be accessed by the EHR, and the practice can transition much faster with a significant amount of medical data already in place.
Building efficiencies on the Transcription focal point minimizes capital expenditure as a Medical Practice begins building its EHR.

2. Medication Management & Prescription Writing
The next step of our cumulative strategy is a partial implementation of the EHR system, focussed on a specific, commonly performed activity.
Prescription writing and Medication Management is a great focal point to work around on a partial implementation. The benefits will include:

- Legibility of prescription will stop being a bottleneck to efficiencies
- Inter-drug and drug-allergy checking before prescriptions
- Automatic updation of the medication lists
- Drugs can be automatically renewed from the medication list
- Routine information, including correct spelling, instructions, dosage and administration route are all accurately recorded on the prescription using Templates

Using a cumulative approach, the Medical Practice would only implement the prescription module, thus staggering capital expenditure. Additionally, the workflow changes at the provider and practice levels are limited to the task of electronic prescription writing.

3. Repository or Centralized Electronic Database
Physicians, nurses, billing clerks and a variety of other people within a Medical Practice require access to a patient information. Information stored on paper charts is a bottleneck that takes time and effort to ease, thus affecting the efficiencies of the Medical Practice. An EHR system can eliminate the problem of on-demand patient information by providing immediate and simultaneous access to patient information while keeping that information secure through authorizations.
Practices currently using transcription can push Transcribed reports into a “view only” version of the EHR system, meaning that providers and other authorized personnel primarily use the EHR as a central database of data. The implementation would involve establishing a local network with authorized database access to the EHR, serving those who require access to patient data.
The benefit is efficiencies.
Online access to transcribed data from any EHR-enabled computer, will result in higher efficiency thanks to on-demand patient information. This benefit also extends to offsite use, as providers can be enabled to login and view required data. Because of the ability of the EHR system to extract data from the transcribed reports and charts, this partial implementation will not only provide a means to view historical patient data but will also build problem,allergy and medication lists and other chart categories from the information in the cental database or Repository.

As with the partial implementation of Medical Management and Prescription writing, the capital expenditure for software, services, and hardware is staggered and thus lower, since it represents an cumulative rather than a full mplementation.

This cumulative approach is ideal for Medical Practices that are not prepared to take a plunge into a full transition to EHR for reasons of capital, organizational readiness or the immediate needs of the organization. While not an alternative to a full EHR implementation, this sum of parts approach is a way for your Medical Practice to take immediate action on the way to a full scale EHR implementation.

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