MGMA: Overnight EHR roll-outs arent effective

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LAS VEGAS—If EHRs are going to be optimized to increase efficiency and the bottom line, administrators should consider more inclusivity in the implementation process, staff and physician workflows, training time and a phased-in implementation, according to an Oct. 24 presentation at the Medical Group Management Association (MGMA) 2011 annual conference.

While implementing an EHR, “think inclusively,” encouraged presenter Ron Anderson, of CHMB, which provides technology and business services for healthcare providers. He said this involves bringing all the stakeholders to the table—both internally (front office, back office, management and providers) and externally (patients and outside resources, such as labs, device manufacturers, hospitals and business service vendors).

He encouraged the administrators in the audience to start by assessing existing current workflows, which typically includes appointment scheduling, gathering and capturing patient information and the transference of forms—which encompasses everything from patient registration to HIPAA documents to patient histories. Anderson also encouraged administrators to model and review new potential workflow with all pertinent staff members.

As providers review these workflow shifts, Anderson advised:

  • Don’t replicate paper workflows;
  • Strive for “lowest” cost point of data entry;
  • While the nurse does more, the providers should do less;
  • Automate, automate, automate; and
  • Leverage technology as much as possible.

He strongly recommended the use of patient portals and the use of voice recognition software, rather than transcription. “If a typical encounter requires 15 clicks or more from a physician, it’s time to go to voice recognition,” Anderson said. “Sometimes, being too customized just becomes cumbersome to the daily process.” 

He also stressed the importance of training time, which often gets overlooked because of busy schedules. Using MGMA survey data, 39.9 percent of EHR users that were surveyed said they “severely under-allocated time for training.”

Also, a strategic phased implementation is superior, according to Anderson. “Make sure staff and providers are trained on new devices and associated applications prior to going live on new PM [practice management]/EHR,” he said. New applications should be rolled out in phases (first staff, providers last):

  1. PM – front office staff
  2. EHR phase 1 – front and back office staff
  3. EHR phase 2 – all staff and providers
  4. EHR phase 3 – providers at point of care

In his conclusion, Anderson suggested that if a consultant is hired and the implementation goes too smoothly, then all the kinks are probably not worked out. “Overnight EHR/PM big-bang roll-outs are very unlikely to produce good results or improved workflow, and there’s no going back once the paper charts are gone.”

Therefore, he encouraged a strategic approach that requires a great deal of time and effort prior to implementation to optimize workflow and garner some early wins, such as e-prescribing; lab or imaging orders; tasking; referral/consults; and letter generation.