EHR Optimization – There is so much to do, where do I start?

Optimizing a new EHR/PM system often feels like trying to swim up a waterfall. And while challenges persist, at times, you may feel like you are drowning.

You happen to have a supply of buckets – or tools available to help you – underneath this waterfall. Where would you place the first bucket?

In this kind of overwhelming environment, the inclination is to place the bucket wherever the loudest complaints are coming from. But, the better response is to place the bucket over our heads so we can breathe easier — taking a step back to gain perspective of the true priorities and those other tasks that can be made simpler or even unnecessary[i].

One common error is to try to cover 100% of the task list at each optimization meeting. On the surface this appears like great goal, but the downside means you are also simultaneously working on the dozens of other tasks, which can ultimately lead you right back into the waterfall. And, without disciplined optimization, leadership will typically step in and re-prioritize the tasks to solve the angriest complainer’s problem first while still not addressing the root cause of the issue.

Optimization takes:

  • Strong leadership
  • Discipline
  • An understanding of project management, healthcare and providers
  • Knowing the intricacies and politics of leadership – as well as the sensitivity and urgency that will allow the team to start to show results

Once results start to happen weekly, and at times daily, the results will stem the complaints and the constant reprioritization of efforts.

 Are you ready to truly optimize your system?

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[i] The One Thing by Gary Keller & Jay Papasan: “What’s the one thing you can do such that by doing it everything else will be easier or unnecessary?”, April 1st, 2013. Hudson Booksellers
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EHR Optimization – It’s All About The People

Although the word “optimization” is used synonymously for both EHR Optimization and EHR Customization, they mean two different things. For example:

  • Customization is akin to adding your own code and has its place. Meaning, if an optometry practice needs an inventory module, one can be added through a third party, or by programming your own module.
  • Optimization is all about implementing the built-in feature set of the EHR and using it to its best potential by embedding it into the operations of the practice.

Said another way, optimization is central to improving the way the people use the EHR because, after all, it can’t do anything without people.

Each operation within an EHR can often be done by several different types of people, and in many cases, certain tasks are performed by multiple people. To create efficiency, the ideal state is to create a single touch component.  However, when trying to translate the paper world or a previous EHR to a new EHR, a translation is often not the solution – but a complete rewrite is required.  Such as:

  • What gets routed to a physician or nurse’s in-basket or a scheduler?
  • Who is required to sign-off on a positive vs. negative lab result?
  • What licensure is required to do each task and assigning the correct level to each task?
  • Who should be able to place orders?
  • How are duties assigned based on licensure, compliance & EHR security templates?
  • How can the physician workload be reduced by allowing staff members to work at the top their license?
  • How can work be automatically sent to the appropriate person?

Aligning the people to the new processes within an EHR will take every optimization project to new levels. Doing this captures the highest levels of efficiencies, brings a greater understanding to each person’s area of responsibility and improves the quality of life for all.

Are you customizing or optimizing your EHR?

Optimization: The Key to Improved EHR Satisfaction

By Drew Nietert, Director, JHD Healthcare Partners

EHRs are pervasive, with 78% of all office-based physicians using one –even though most are unhappy with their EHR.  The widespread use of poorly implemented EHRs has created a range of issues that are likely to keep providers, administrators and IT up at night:

  • Increased physician dissatisfaction, with complaints such as:
    • Needing to work longer hours at home and on weekends to complete documentation
    • Staring at a computer instead of making eye contact with the patient
    • Too much clicking and too many screens to go through
  • Physicians and staff inventing workarounds that compromise documentation
  • Inability for leaders to understand and get accurate data
  • IT is not able to keep up with the challenges the EHR has introduced
  • Decreasing revenue from decreasing volume

The key to overcoming these, and other, EHR issues and getting a good night’s sleep is Optimization. When done well, EHR optimization will:

  • Improve the quality of life for providers
  • Improve documentation
  • Improve coding accuracy
  • Reduce risk of audits and audit penalties
  • Improve provider utilization , which leads to higher revenue
  • Improve practice performance on risk contracts
  • Increase severity calculations such as HCC scores

Taken together, all of these equal a better profit margin and happier doctors – two things every healthcare executive longs for.

Optimization is the path to get you there.

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JHD Healthcare Partners is an advocate for the provider. Our goal is to improve the physician’s quality of life while increasing their income. 

In our experience, the single greatest source of complaints from providers is the EHR – and it doesn’t matter which EHR is implemented. Too often, the EHR is implemented in a dramatic all-hands effort, and then work stops. But the initial implementation is just the first step for the EHR. Clinical operations need to adapt work flows to the EHR architecture and the EHR, wherever possible, needs to be customized for each specialty.

The People Side of EHR Implementation: My Night in the ER

 

Juanisha “Juan” Johnson, Senior Managing Consultant, JHD Group

As millions of people do each year, I recently found myself in need of some care. Tired, sick, and barely able to breathe with a throat so swollen, I ventured to a nearby emergency room. But this isn’t a story about overcrowding or multiple-hour waits.  I came in feeling sick but left feeling ill for people working a system that needed a remedy.

People are important. You see, they are the component that can exact change for your organization. My daily work is as a Senior Managing Consultant, guiding organizations through the process of EHR implementation and optimization.  At the JHD Group, our methodology for success as it relates to EHR Optimization consists of four pillars:

  • system set-up,
  • processes,
  • governance, and
  • you guessed it – people.

At every level of a healthcare organization are people who will make or break your EHR implementation, your patient care, your business. It also doesn’t take a neurosurgeon to know that the more people understand and feel that they can master their roles and grow into other ones makes for the kind of employees who stick around, who feel that your business is their own.  In many senses, it is.

Late this particular Thursday evening, I was relieved to find the ER waiting room blessedly uncrowded.  I was in so much pain and was having significant issues breathing. I was triaged and then, again, breathed (what little I could) a sigh of relief that I was taken to the back, where I waited. And waited. The nurse came in, did an evaluation, and then told me the doctor would be in. I waited 30 minutes. When the physician arrived, he said he wanted to order a strep test, and told me the nurse would be back in to do that. Another half-hour goes by and the nurse arrives to conduct the test. More than two hours after my visit began, the physician finally confirmed what I told them while being triaged: that I had a case of strep.

Now, I am in no way suggesting that a physician should simply take the advice of his/her patient – thorough evaluations are always necessary — but this experience was a good example of some important take-aways with EHR optimization and implementation:

  1. Staffing. The importance of enlisting the right people to your organization and its mission can not be underscored enough. Putting people in places where their skill-sets are well-used, valued, and sharpened can be key to keeping and growing them. If your healthcare institution is looking for more efficiency and streamlined processes, start with the people.
  2. Training. Was this R.N. trained in a standing order that patients presenting with my symptoms should have a strep test?  Is his office supporting him with top-of-licensure training that not only allows him to grow as a medical professional, but also encourages him to perform tasks that would free up much-needed minutes for the physicians? RNs, LPNs, medical assistants – these are all professionals who can make the daily usage of EHRs something that positively impacts patient care.
  3. Improved face-to-face time. When properly utilizing people and their interface with technology, it can actually free a physician up to get that much-needed face time. More face time improves patient satisfaction and allows the physicians to do what they are best at: treating patients. Physicians often say laptops or pads get in the way of their patient interface. Could an R.N. or medical assistant help with the technology piece so that the patient gets all the benefits of both EHR optimization and old-fashioned person-to-person interaction?
  4. People living the processes. Optimization is something that has to be practiced every day. The care teams should be able to work within a process that is streamlined for everyone’s sake. Good work flows should decrease the time physicians need to document a visit, thereby increasing productivity. Properly investing in the people who are a committed part of that efficient approach is part of what makes the practice a success.

Easy fixes like standing orders (finger pricks for diabetics, throat swabs for those with sore throats, EKGs for cardiac patients) are not only intuitive, but they also enable and empower clinical staff to perform at their best and to do the patient care that they desired to do when they made a commitment to the healthcare industry. Physicians are freed up to focus on other parts of care, and patients have shorter wait times and a more efficient visit. These are the kind of things we of the JHD Group work with clients on, as we do our “boots on the ground,” “at-the-elbow” training and process implementation.

How was my sore throat?  After a round of antibiotics and a visit to an ENT specialist, it was fine. But my visit to the ER that night confirmed what many of us preach all day long: the people component of your processes, whether it’s EHR implementation or ongoing care, is one of the most critical and important – it’s where your focus should be to effect change. Get the human part right, and ensure your machines support that.

Does your healthcare organization put its focus on people to maximize efficiency?  Tell me about it by leaving your own comment.