This document discusses optimizing the use of electronic health records (EHRs) for efficient practice administration. It notes that simply digitizing paper records is not enough - workflows must be redesigned to realize benefits. The author conducted a literature review which found that analyzing processes and capabilities can help practices realize clinical and financial improvements. A survey was designed and distributed to small practices using major EHR systems for over a year to provide insights into usage trends and outline best practices for adoption and efficient EHR implementation.

1. Author: Noelani Fox
noelani.fox@gmail.com
Efficiency Gains Through Health Information Technology: University of Texas
Health Information
Technology Institute
How to Optimize Administrative Processes and Enhance Value Grateful acknowledgement
http://www.lawtechtv.com/.a/6a00d8341e18e853ef011572126139970b-800wi to Dr. Diane Kneeland
Review of Literature
Workflow Redesign Improves Efficiency
Abstract
Analyzing operational processes and system capabilities can help your practice realize clinical and financial
How can the use of an electronic health record be optimized for efficient practice administration? By improvements.1
identifying ways to maximize return on investment in an EHR, providers can be encouraged to embrace a difficult
transformation to computerized practice, leading to benefits to the practice, to the healthcare delivery system, Installing an electronic health record is not just putting paper charts in an electronic format. It involves
and to our general population. I am specifically interested in how system potential is unrecognized and rethinking the way medical care is delivered, and offers the opportunity to improve quality and increase
underemployed by practices, how operation is improved through trial and error, and what questions to ask to efficiency. A medical office is a complex operation with distinct processes. Invariably, in order to realize the
determine if the EHR use is being optimized. I searched for efficiency, evaluation, audits, and analysis, and found potential benefits of an EHR, workflows will need to be altered. Key principles of patient accessibility, simplicity,
very little relevant to optimization. Of the dozen articles I found, much of the research on efficiency focuses on the safety, comprehensive documentation and delegation of duties significantly influence process redesign. Planners
functionality of components, and not efficiency of human operation. My intent is to distribute a survey to need to gain a solid understanding of the tasks needed to accomplish the goals of the practice. Advance analyses
small ambulatory practices, including at least three to five offices for each of the major vendors. Participant of workflows such as patient pathways, processes involved in scheduling, referrals and prescription refills, and
qualifications include use of their system for at least one year, to minimize the transition period effect, and less http://leansigmainternational.com/wp-content/uploads/2009/06/lean-sigma.jpg http://www.insyte-consulting.com/files/images/Six_Sigma_Phases-DMAIC.gif complete revenue streams, help identify procedures to be customized. Determining what information is needed,
than five providers in the practice. I designed the survey based on my experience in office management and the at what point in the care process, and the reason why, allows for the creation of routines in which the right
financial perspective, and the extensive background gained in the UT HIT Certificate Program. Analysis of a personnel obtain and input that data to maximize system capabilities. Efficiency dictates that the most highly
survey of this type can provide insights into usage trends, and outline best practices for adoption and efficient
implementation. Future research will include investigating clinical use of EHRs, in order to optimize quality
gains through effective use of computerized physician order entry and clinical decision support systems.
Efficiency Survey Questions skilled and expensive person in the practice, the physician, should only do what no one other than a physician
could do. Automating manual checks and balances contributes to an efficient, safe and profitable organization.
Clinical tasks can be mapped and diagrams developed to capture the workflow and dependencies of events as
they relate to business activities, regulations and patient requirements. The best value can be obtained when
General Characteristics
testing and redesign is considered and addressed early in the planning stages, to save time, money and effort
down the road.4,5,6
How many doctors in this practice? ______________________________
What specialty (if any)? _______________________________________
What type of EHR system do you use? ___________________________
How long have you been computerized? _________________________
Perceived Benefits of the Electronic Health Record
Urban, suburban or rural area? _________________________________
to the Practice, 2005
Pre Implementation
Mean Rating
6.00
Was your implementation planned as a big bang or partial introduction? Big bang Partial 4.00
2.00
phtt://w4.stern.nyu.edu/sternbusiness/spring_2007/qualityControl.jpg 0.00
Did you have a change champion? Yes No
Review of Literature Improved access to medical record…
Did you use a consultant’s services? Yes No Improved workflow
Misuse and Underuse of EHR systems Do you feel all stakeholders (front desk staff, nurses, technicians, doctors) were fully involved in the redesign of Improved patient communications
Information is vital to the provision of high-quality care, yet too often, improving information systems is not seen as a priority.1 processes? Yes No Improved accuracy for coding…
Were internal/external interoperability needs considered? Yes No Improved drug refill capabilities
The US government is the largest single payer of health care costs in our country, and as such is leading the way toward reform
Were downtime situations planned for and practiced? Yes No Reduced medication errors
of our system. Although their motivation is controlling costs, the means to do so involve quality improvements, “cutting the
Improved charge capture
fat”, and a side effect will inevitable include improved health of our population. As a direct provider of health care, the US
Department of Veterans Affairs developed and implemented a electronic health record system in the mid-1990’s. They are now Improved clinical decision making
a leader in the field of quality improvement, consistently outperforming the private sector. Measurement of adherence to Post Implementation Improved claim submission process
practice guidelines shows that VA patients receive recommended levels of health care 67% of the time, whereas only 51% of
non-VA patients receive these levels of care. However, the presence of an electronic health record does not improve quality in Reduced medical records staff…
and of itself; in many practices where an EHR is in use, very little health benefit is realized, as currently implemented. Most Do you complete most of your tasks in the same way as you were trained? Yes No Reduced medical records storage costs
physicians cannot determine which patients have what conditions, who is due or overdue for key screenings, how well these
conditions are being managed, and where they can improve care.2 Have you devised shortcuts? Yes No Reduced transcription costs
A 2005 survey found that there is considerable variation in the patterns of use of clinical support functions of electronic health If so, what shortcuts have you found? Reduced medical records…
records to manage health care tasks; in fact, this survey found that 16% of physicians with e-prescribing capabilities still ___________________________________________________________ Improved physician recruitment
manually generate their prescriptions. However, great strides are being made by some early adopters to maximize full use
of clinical support functions; this suggests an opportunity to examine adoption paths, characterize success factors, and How did you discover them?
determine whether some paths are more likely than others to lead to success. 3 _________________________________________________________________ Based on a five-point scale ranging from 1 (no value) to 5 (very important value)
How soon after implementation did you first evaluate the system? <3 mos ~6-9 mos >1 yr Medical Groups’ Adoption Of Electronic Health Records And Information Systems, Gans, D, et al, Health Affairs, 2005; 24,(5): 1323-1333
How often are evaluations performed? Monthly Quarterly Annually
Do you feel that feedback results in changes? Yes No
To the system or to workflows? ______________________________________________
Electronic Health Record Financial Benefits per Do you feel clinicians document and code for maximum revenue? Yes No
Physician or Nurse Practitioner Do you feel the vendor supports your increasing facility with their system? Yes No
Are your clinicians generally satisfied with the system? Yes No
What is the biggest benefit for the clinicians? ____________________________________________________
What is the biggest drawback? _______________________________________________________________ http://www.sunyatagroup.ws/tikiwiki_2-0/img/Sunyata_Images/effectiveness-efficiency_model-a.jpg
Are your front office staff members generally satisfied with the system? Yes No References
Average About What is the biggest benefit for the front staff? ____________________________________________________
Revenue
gains from
$33,000 What is the biggest drawback? _______________________________________________________________
1. In the dark--the case for electronic health records, Litvin, C. B. N Engl J Med, 2007; 356(24); 2454-2455.
increased
visits 2. Health Care as If Health Mattered, Frieden, TR, Mostashari, F, JAMA. 2008; 299(8): 950-952
, $2,654 What was your biggest motivation for implementing an EHR? ___________________________________________
3. Medical Groups’ Adoption Of Electronic Health Records And Information Systems, Gans, D, et al, Health Affairs, 2005; 24(5): 1323-1333
What steps are you taking to increase efficiency? ____________________________________________________
4. Don’t Minimize EHR Disruption, Manage It, Hastings, MT, Medical Group Management Association Newsletter,
Efficiency What would you have done differently in implementing your system that would increase efficiency? http://www.mgma.com/WorkArea/DownloadAsset.aspx?id=28888, accessed July 4, 2010
savings, $13
,144 _____________________________________________________________________________________________ 5. Importance of Testing for Usability When Selecting and Implementing an Electronic Health or Medical Record System, Corrao, NJ, et al, Journal of
Oncology Practice, 2010(6,3); 120-124
What capabilities have you discovered that you were not able to perform with a paper-based system?
6. How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings, Lorenzi, NM, et al, BioMedCentral
Increased _____________________________________________________________________________________________ Medical Informatics and Decision Making, 2009, 9:15
coding What was the impact on communication among key clinicians such as physicians, nurses, and lab technicians? 7. Implementation of an electronic medical record system in previously computer-naïve primary care centres: a pilot study from Cyprus, Samoutis, G,
levels, $16,9 et al, Informatics in Primary Care, 2007;15; 207–16
29 _____________________________________________________________________________________________
How about between clinicians and practice manager/front end staff? 8. Take note(s): differential EHR satisfaction with two implementations under one roof, O’Connell, RT, et al, Journal of the American Medical
Informatics Association, 2004; 11(1); 43-49
_____________________________________________________________________________________________
9. Safe Electronic Health Record Use Requires a Comprehensive Monitoring and Evaluation Framework, Sittig, DF, et al, Journal of the American
Medical Association, 2010; 303(5): 450-451
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