An Administrator s Guide to EHR

Strategies for Success from One Administrator Who has Faced the Challenge

An Administrator’s Guide to EHR

Inside...

you will fi nd 7 strategies that helped

one administrator successfully implement EHR

Be Successful with EHR

Your EHR/PM Business Partner

Debbie Weiss

Introduction

Transitioning to electronic health records (EHR) is one of the biggest challenges you’re likely to face as an administrator. But if you plan well, and if you choose the right partner, you can do it successfully. More importantly, you can emerge at the end of this process with a more efficient practice, a better handle on your business, and with doctors and staff who are glad you made them do it.

Dallas Eye Care Associates implemented Compulink’s Ophthalmology AdvantageTM _{in 2008, starting with}

practice management, then phasing in EHR six months later. Since then, we’ve been able to see more patients per doctor, speed up insurance reimbursements, eliminate two staff positions and cut our print budget dramatically.

The benefits of EHR are numerous, but I know how steep that learning curve can look when you are standing at the bottom.

Here are 7 strategies that helped me

successfully implement EHR.

Strategy #1

Do Your Research

Select a team of key staff and clinicians to conduct the search for an EHR system. Getting others involved early in determining your search criteria, interviewing vendors, and testing software options really helps secure widespread buy-in for EHR.

With your team, compare not just pricing, but the details of what each vendor offers. You really need a solution designed for ophthalmology. That means having ophthalmology-specific templates, but it also means that the system should be able to handle all aspects of a typi-cal ophthalmic practice—without resorting to separate programs. We knew, for example, that we wanted our optical shops and surgery center to be tightly integrated into the system.

You also want to look for a fully customizable solution. Most systems only allow users to make minor modifications to drop-down lists, and that may not be enough. Making the software fit your practice is the key to physician acceptance. Finally, you really want a partner you can count on, one who is committed to your success. With EHR, you aren’t just buying software. You’re buying the support and expertise that will get you successfully through planning, training, implementation, and beyond.

Strategy #2

Keep Your Cost Down

These days everyone is watching the bottom line, so you need to make your investment in EHR a cost-effective one. In budgeting, consider not just the new costs, but also areas where you will save money with EHR (View Table 1 - pg. 2). Here are some other pearls for keeping your costs down: ■ Make sure you choose a well-integrated system in which all the components can “talk” to each other. Not only does it boost efficiency by eliminating double entry, but it also reduces your support and training costs. We never have to worry about vendors playing the blame game, because we have one partner, Compulink, who is able to resolve any problems that crop up.

■ Spread out the cost of new hardware (computers, scanners, server upgrades) over 3 to 12 months. As soon as you decide to implement EHR, start buying a few computers each month.

■ Consider desktop computers rather than notepads or laptops. Many physicians consider a portable device ideal because of the convenience. However, if you have mostly staff users, you may find that portable devices are more expensive up front and more prone to damage and theft. ■ Limiting scanning. It is expensive to pay someone to scan in everything and you’ll find that scanned documents eat up computer memory without being particularly useful. The only things we routinely scan are referral letters and signed HIPAA disclosure forms.

■ If you have a good local IT support company, stick with them. Expect to increase your support hours during implementation, but you don’t need to hire an in-house IT person.

Strategy #3

Get Organized

If you are feeling overwhelmed about how to get from theo-ry to reality with EHR, start with a timeline. From the time we selected Compulink as our partner, it took us 9 months to fully phase in the new system, but we always knew what was needed to stay on target.

We did it in two phases—practice management and optical shop in April; EHR 6 months later, in October. This ensured that our scheduling and billing was working perfectly before we introduced EHR, making the transition very smooth. We also realized the benefits of billing efficiencies right away, which provided inspiration for dealing with the challenges to come.

When do we do this?

Plan to lighten your patient load for 1 to 4 weeks after implementation. Choose a time of year when the office is

normally slow or deliberately cut your schedule in half. After 2 weeks of a “skinny schedule,’ our doctors and technicians were able to ramp back up to normal productivity very quickly. Personally, I think it was ideal to have all the doctors learn the system at the same time, but others might choose to phase in EHR by doctor or by office. Also, allocate time to customize the system early in the process, so that you can have staff trained on the templates they will actually be using.

How do we get the charts into the EHR?

Created a detailed, written process for transferring information from paper charts into electronic records. While this process will likely evolve somewhat in the weeks and months after implementation, is it important that everyone understand it. The physicians need to be involved in deciding what information should be entered (or scanned, if you take that route) and for what types of patients.

Expense Item

How EHR Cuts Costs

Typical Savings

Salaries & Benefits We eliminated 2 positions within 2 weeks of implementing EHR. EHR reduced the amount of administrative support for scheduling and billing I needed, so I was able to restructure and reallocate job responsibilities among other staff. Other practices have been able to eliminate scribes

$50,000 per FTE position, on average (for salary, benefits, employment insurance, etc)

Printing You save on toner and paper when you stop printing test results, making new charts, stop faxing charts back and forth, printing out chart details for surgery center, and many other formerly paper-based activities

30%-40%

Paper

Toner

Supplies Eliminating paper charts also cuts down the need for folders,

labels, and other supplies

20%-25%

Postage Electronic billing and remittances decreases billing correspondence. Patient Web Registration dramatically reduces

the cost of mailing out new patient packets

15%-20%

Transcription EHR should significantly reduce and possibly completely eliminate

the need for transcription

65% +

Rent/Overhead per

square foot If you are nearing maximum use of your office space, eliminating a chart room can free up space for more productive use, such as an

additional lane or testing area.

varies

Figure 1

This diagram shows how we transferred chart data. Each day, technicians transferred the charts needed for the next day’s schedule.

Figure 2

Provides some examples of the kinds of information they were required to enter for each type of patient. When a chart had been entered into the EHR system, the technician put a large black checkmark on the front of the folder, and initialed it.

how we Each day, rts needed

Chart Transfer Protocol

Information to Transfer, by Patient Type

As you can see, in Figure 1 we allowed the checked-off paper chart to “follow” the patient for varying numbers of visits, depending on the type of patient. New information was entered electronically, but the physicians could easily refer to the paper chart if needed. When the pre-set limit had been reached (i.e., 3 visits for a glaucoma patient), the call center stopped pulling the paper chart and sent it to archives.

In the beginning, this system provided intensive training for the technicians, who also serve as scribes in the exam room. After two years, we rarely need to do chart transfers anymore.

Who goes where, and how?

Think about how EHR might change staff responsibilities or patient flow through your office. Since our technician-scribes were already well-versed in coding, we decided to have them post claims electronically right from the exam room, which is how we were able to reduce staff at checkout. Now, our billing staff focuses more on billing or claims problems, not routine claim submission. Another example: Capturing a patient photo and scanning in any needed documents is primarily a front-desk responsibility, but we added a scanner and camera at check-out so that staffer can help if the front desk gets busy.

Strategy #4: Get your staff ready

(A few DOs and DON’Ts)

DO

give the people who will be entering most of the data a lot of practice. Having our scribes transfer charts gave them lots of low-pressure practice time to familiarize themselves with system. Front office staff who had already learned their way around Compulink 6 months earlier were able to help the clinical staff learn the ropes when we implemented the EHR portion.

DO

make it a fun, team-building experience! We brought all the doctors and staff in for a (paid) Sunday training session, with 2 people per computer. The next day, Monday, was a full day of practice entering charts and working each other up in mock exams. Tuesday was our first day using the system with real patients. If you try to get people to learn the system in their spare time, you’ll be disappointed in the results.

DO

take advantage of free, online training. These recorded modules are a terrific, value-added service that Compulink provides. They are an excellent starting point or refresher and are especially useful when you need to get a new staffer up to speed quickly.

DON’T

skimp on live training. Nothing can replace having a live person looking at a screen with you, watching how the patient flow works, and answering your questions on the spot. We had Compulink trainers on site during the entire first week of our implementation and have continued to have them come back every 6 months.

Strategy #5:

Get the doctors on board

At the end of the day, the doctors have to embrace EHR or it just won’t work. Ophthalmologists have to work very precisely within a tiny, complex system (the human eye) and they tend to be just as demanding of the systems around them. I don’t think there is any single exam template that could satisfy every ophthalmologist—that’s why customization is so critical for physician acceptance. To ease our doctors into EHR, I created an entirely new “Doctors tab” that mimicked our old exam sheet. They rarely use this tab any more, but it increased their comfort level with EHR long enough for them to learn how to find everything they wanted in the system. With Compulink, nothing is set in stone. If anything slows the doctors down or doesn’t support their clinical practice, we have the flex-ibility to change it. I’m grateful for that flexflex-ibility every day! I’ve also been able to create customized tabs for different types of workups, such as a glaucoma visit or contact lens evaluation. These specialized templates have everything the doctors want done before they see the patient (and nothing that they don’t want done) so all the technicians need to do is make sure they check or fill in every box. Goodbye, forgotten tests.

Our doctors quickly realized how much EHR benefits them. They have no stack of charts waiting on their chairs at the end of the day, referral letters to colleagues are quick and easy, and they have gained amazing flexibility to look up charts from anywhere and consult with each other on a patient’s chart without being in the same place.

Our biggest hurdle was figuring out a new way for the front office, technicians, and doctors to communicate with each other. Eliminating the paper chart also eliminated the time-honored signal—a chart in the bin—to tell the next person that a patient was waiting. The doctors also didn’t like entering the room without knowing the patient’s name and chief complaint. There are different ways to solve this dilemma, many of them electronic. For us, a simple system of laminated cards, color-coded by doctor, did the trick. The technician writes brief pertinent details (e.g., Jane Doe, cataract eval, interested in multifocal IOL, high IOP) with a wet-erase marker, then erases and re-uses for the next patient.

In many other ways, EHR has been a terrific communications tool. The optical shop, for example, can now check the status of spectacle orders from our lab within the software. And doctors and staff can add to one another’s “To do” lists electronically, eliminating time-consuming phone calls and endless sticky notes.

As you get organized for the transition to EHR, remember that you aren’t in this alone. The right EHR partner should provide extensive help with your transition planning.

Strategy #6:

Project the right attitude

Going through an EHR implementation is an opportunity to be a leader within your practice. Be confident in your decision and don’t allow yourself to lose patience (or take it personally when others do). There will be challenging days, but once you get through them, the rewards are plentiful. I always liken the experience to having a baby—the labor is long and difficult, but at the end of it all, you get to admire that beautiful baby. As we’ve grown in our use of EHR, I continue to remind staff that EHR is supposed to make their lives easier. If they type something more than once or twice, they should find a way to save or automate it so they don’t have to type it the next time. My response to any complaint I get is, ‘Tell me how you want it to work, and I can fix that.”

Think of your EHR implementation as a chance to be creative about how staff members are utilized and how processes are organized in every single department. The “way we’ve always done it,” may not be the best way.

Strategy #7:

Don’t stop after implementation

Although you may be planning for it for months, your “go live” day isn’t the end of the story.

You will continue fine-tuning your EHR system over the first year or more. Paper-based systems have an annoying way of persisting. Long after we implemented EHR and surgery schedules became accessible on the computer, for example, I discovered that staff were still filling out paper routing slips for the surgery center, simply because no one told them to stop.

As you become more familiar with your EHR system, you will be able to explore more complex reporting features and find ways to mine your data for patient marketing and outreach. The possibilities are endless.

That’s one of the reasons we continue to have refresher trainings every 6 months—we learn something new each time. Repeat training can hone in on problem areas and identify ways to eliminate wasted steps, helping you get the most from EHR.

I hope these strategies are useful as you plan your own EHR implementation. I truly believe that EHR is the future of medicine. As an administrator, you hold the power to lead your practice into that future. And if you choose the right solution—one that is ophthalmology specific and customizable to your needs—and a business partner who can provide the necessary support and expertise, you will get through this transition successfully.

Debbie Weiss is Practi ce Administrator for Dallas Eye Care Associates, a comprehensive

group practi ce with offi ces in Dallas and Gun

Your EHR/PM Business Partner

Compulink Business Systems 2645 Townsgate Road Suite 200 Westlake Village, CA 91361 800-456-4522

C

ompulink

provides the industry’s only fully customizable and totally integrated solutions for Ophthalmic and Optometric Practice Management, Revenue Cycle Management (eClaims), Optical POS, Inventory Management and Electronic Health Records. Offering the lowest total cost of ownership and backed by outstanding customer support, Compulink Advantage is used by 3,000+ Ophthalmic practices and 12 Universities to increase efficiencies, improve profitability, and deliver better patient care.

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