Adopting EHR Sooner Rather Than Later

Why associates should step forward and take the lead in their practice’s EHR implementation

By Steve Hass, OD

Some physicians may be intimidated by transitioning to an electronic health records (EHR) system. And although few are excited by the prospect of giving up their paper records, most realize conversion is inevitable. Making the leap sooner rather than later means practices can take advantage of programs such as the meaningful use incentive. It also makes them more attractive to accountable care organizations and may help them avoid potential Medicare or insurance penalties down the road. A fully implemented EHR system also adds value to the practice, by making the practice more appealing to a potential buyer and building a perception among patients that the practice is high tech.

Taking on Technology

EHR is a great opportunity for a new doctor in the practice to take charge and demonstrate worth. Frequently, veteran members of the practice tend to be a generation removed from the associate ODs they hire. They also may be less tech savvy, and therefore overwhelmed by the task of transitioning to a modern records system.

Senior doctors have an established patient base and practice management duties, which consume their time. New associates usually can spare more time away from patient care to oversee the selection and implementation of an EHR system. This project will keep the new associate engaged in improving the practice, while still allowing him to build his own patient base.

Practice management consultants often advise new associates to increase their value by bringing something new to the practice, such as fitting specialty contact lenses or providing low vision therapy. I’d argue that the successful implementation of an EHR system may be just as valuable to a practice as an additional optometric subspecialty.

My EHR Story

I was once the new associate OD in a 90-plus-year-old multi-location practice with two veteran practitioners. The task of evaluating, selecting and implementing electronic records fell to me. I spent a good deal of time evaluating what I considered to be the top three or four systems available. I visited booths at conferences, and made use of in-office demos provided by various software vendors.

Once I chose a software package, I upgraded office computers as needed. I found that in exam rooms, it’s much more efficient to have a dual monitor set up. I now keep my EHR on one screen, leaving the second available to view fundus photos, visual fields, OCT scans, and so on.

I also took the lead in training the staff. Most of the practice’s staff had been with the practice for more than a decade. There was a good deal of institutional memory to overcome: things had been done the same way for many years, and no one wanted to change. It was very important to get the staff on board with the idea of electronic records. Remember, it’s not just patient charts that are changing. EHR software platforms are integrated into the business side of things as well. Your staff will have to relearn how to do almost everything, from managing inventory, placing orders, scheduling, and so on.

I spent a good deal of time preparing the staff for the transition. My vendor was very helpful in providing training leading up to our “go live” date. We created several fictitious patients, so doctors and staff could practice all the routine tasks that the software would soon require of them. Such a dramatic change can certainly be a stressful experience for staff members. Before we went live, I was worried that one or more employees would resign out of frustration but no one did. In the end, by putting some effort into staff training, the transition was much smoother than I anticipated.

It was after the first year that the transition really started to pay off. When patients began returning for their annual exams, the efficiency of the software became apparent. The ability to “pull forward” the previous year’s findings and edit only what had changed led to a drastic reduction in the time needed to document findings.

Tips

Here are some tips that may help you succeed in implementing electronic records in your practice.

Practice visits. Visit other practices that have already made the move to EHR. Once a practice has used one of these systems for more than a year, they’ll have learned a great deal about their chosen system’s strengths and weaknesses. Ask to observe a colleague’s practice for a few hours. This can be a source of valuable information when choosing an EHR provider. Be sure to bring one or two of your support staff. There are aspects of these software programs that the doctor rarely if ever uses, for example, creating optical orders, submitting insurance claims and managing inventory. Having a staff member evaluate these functions will be valuable in your decision-making process.

Get Scanning. Any established practice that’s still using paper probably has shelves and shelves of manila folders, or possibly entire rooms dedicated to their storage. The thought of scanning thousands of sheets of paper can be overwhelming. It’s a process that doesn’t have to be completed overnight, but it is a vital long-term step in transitioning to an EHR system. Develop your own process for choosing what records to scan and when to do it. You may want to have the paper chart on hand for an established patient’s first visit after your transition to EHR. Scan the old records after you see the patient. This allows you to spread the task over time while avoiding wasted time scanning the records of lost or inactive patients.

Limit your volume. For the first week or so after we went live, we limited our patient volume. This allowed for a smoother transition and ensured that patient care wasn’t affected. It’s worth cutting back temporarily to avoid the stress of a back-logged schedule and disgruntled patients. And rest assured, it didn’t take long to return to ‘full speed’ after the transition.

Choosing a Paperless Trail

My practice chose a highly customizable cloud-based system, which was ideal for a multi-location, multi-doctor practice. We were successful in meeting the meaningful use requirements and received the full incentive payments for all three doctors.

EHR is a project that a new OD should seriously consider tackling. Although electronic records have their challenges, we’ve been very happy with our experience, and would never go back to paper. nOD