Small practice advice: evaluate all options before you go electronic.

Traditional physician practice management information systems centered their functionality on capturing patient demographic and insurance information, scheduling, billing and collections--the basic financial and administrative tasks of the practice.

Going forward, information systems capabilities need to expand to include medical services documentation, sophisticated clinical-based reporting and the ability to exchange information in electronic format with patients, physicians, pharmacies, government agencies, hospitals, nursing homes and others involved in the health care industry.

The pace of technology continues at an ever-accelerating rate, making it difficult for a practice to determine its approach and anticipate its needs for both the short term and long term. Technology should not be purchased for technology's sake, but rather the practice should have a well-thought-out plan that is customized to meet the specific needs of the practice, its patients and the community in which it provides health care services.

It is not necessary to buy an existing product in its present format, nor is it necessary to make all of the functions in the practice electronic. Proceed with caution, evaluate your current system's capabilities and explore all options in an organized and methodical manner.

Plan on significant disruption

Before taking the first step in going electronic, it is essential that everyone in the group recognize that implementing new technology will be extremely disruptive to the practice. Examples of potential disruptions include:

* Determination of what information to convert to electronic format and the actual conversion of selected information to electronic format

* Vendor selection, product demonstrations and site visits

* Physician and staff training (and retraining)

* Inability to maintain high patient volume during conversion process

* System conversion problems if existing system is kept and a different vendor is selected for the electronic medical records

* Time required to get everyone to buy into the process (anticipate varying levels of acceptance and potential outright refusals)

* Inability of vendor and practice to keep promises and stay on the timeline

Many practices haven't implemented or use only limited electronic capabilities. Based on the direction that the industry is taking, an avoidance strategy is not an option. Irrespective of a practice's situation, it will have no option but to proceed in developing a strategy for transitioning its operations to electronic processes.

A well-thought-out transition process, identifying the disruptions in advance and sticking to the plan will result in a favorable outcome.

Why go electronic?

The primary reasons for going electronic include:

Patient demand

Patients increasingly request to interface with their physicians electronically. Anecdotal evidence suggests that two-thirds of patients will pick a physician with electronic access over one that chooses not to communicate with patients electronically.

Improved workflow and access to information

In various practices where I have evaluated document flow and medical records operations, the equivalent of 1.5 FTEs to 2.0 FTEs per 5.0 physicians is spent looking for charts, test results, correspondence and other forms of documentation. Not only is time lost due to rework and ineffective processes, the waste of human resources negatively impacts patient care.

Nurse triage 

Many practices that triage patient calls do not feel comfortable discussing medical issues with the patient unless they have a copy of the chart. Getting a chart and connecting with the patient in a timely manner is problematic, which is resolved by having access to electronic medical information.

Quality assurance and risk management

Paperwork has the potential to be rife with errors related to legibility, location, misfiling, test results reporting and maintaining current status of information. Electronic methods for storing medical information allow for flags, algorithms, practice guidelines, drug interactions and other safety measures to be automatically checked and enforced. Instantaneous access to accurate medical information will lead to error reduction and higher quality.

Reduced costs

Although one of the main selling points expressed by EMR vendors relates to the potential reduction in medical records staff, chart storage and transcription costs, this is often offset by higher equipment costs, license fees and a staff trained at a higher level to maintain the system. Additionally, if the practice chooses to patch two different systems together, each time an upgrade occurs on either system, there are costs associated with maintaining compatibility between the systems. If the outcome results in pre- and post-implementation costs being virtually equal, with better patient flow and enhanced revenue, it should be considered a success.

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Is full EMR implementation required?

Although EMR services and products improved significantly in recent years, converting a practice to a full-service EMR product is not always essential. However, if a practice chooses to forgo EMR implementation in the short term, it should still evaluate all processes in the practice and convert as many to an electronic format as possible.

This strategy may work well for a smaller, single-specialty practice that operates in just one or two locations. Options other than full EMR implementation include:

Transcription

Transcribed medical information is already stored in an electronic format. Practices with a solid patient base with high visit continuity between the physician and the patient can effectively see patients using recently transcribed information and may not have to pull the chart.

Diagnosis and medication sheets

Practices can store basic prescription, diagnosis, allergy, immunization, HEDIS and drug interaction information in a simple template that can be accessed from the group's electronic database. This, along with transcribed records, often provides sufficient information to treat and triage patients effectively.

Medical information & education materials

Through its own Web page, the practice can provide a series of links for patients to check confidential test results, obtain medical education materials and gain access to other medical information.

Patient scheduling

Practices may post appointment availability on Web pages to allow the patient to identify openings prior to calling the practice. This involves showing open space and a few tips on what type of appointment to request. Patient information related to booked appointments is blocked out and shown as unavailable. This speeds up the telephone transaction and reduces the burden on the registration staff and the telephone system.

Patient registration

Just as customers can go online to purchase an airline ticket or apply for a credit card, practices can take advantage of similar technology to allow patients to update demographic and insurance information online.

Payer communications

Aside from electronic billing and payment remission, many payers allow practices to submit documentation, check on claims status and exchange messages electronically.

Communications and information exchange

When properly set up, e-mail can be an effective means for physicians, nurses and the billing department to communicate with patients. Care should be taken to ensure that the patient understands that serious medical conditions should not expect resolution by e-mail.

These items are all part of a fully integrated EMR, but an EMR is not required to take advantage of these strategies. Implementing these items will offer the practice the opportunity to communicate more effectively and improve efficiency within the practice.

These items also offer a transition strategy to EMR as it allows the staff and physicians of the practic to become accustomed to electronic methodologies.

Critical success factors

Whatever strategy is selected by the medical group, there should be a well-designed implementation plan and buy-in from the critical stakeholders. Moving to electronic processes requires a huge commitment of time and money. The following issues are essential to success:

Physician leadership

Make sure the physician leaders fully understand all implications of the strategy selected and give them enough authority and power to see the process through to the end. Once a strategy is selected, there is a need for flexibility to make changes. Individuals within the practice cannot opt out. Disruptive behavior should be dealt with promptly.

Conversion and implementation costs

Management should be prepared to present all hard costs associated with each option to include software, hardware, system conversions, licensing fees, training and site visits. Additionally, cost estimates related to intangibles such as downtime, conversion snafus, slower patient flow and other impositions on the practice's staff must be factored into the overall costs. Be prepared to succinctly show the return on investment to the practice's governance group.

Vendor selection

Each practice is faced with tough decisions about whether to remain with its current vendor, select a different EMR, patch to the existing system or select an entirely new system. All things considered equal, it is preferential that the practice management system and the EMR system be from the same vendor. This avoids disruption each time one of the vendors supplies the practice with a software upgrade or makes changes to the software.

Although price will be a critical factor in the selection process, cheapest is not always the best. It is more critical to select a vendor that demonstrates clinical experience and offers the practice objective feedback from other customers who have used the vendor's products.

Visit at least three other practices of the same specialty that have been using the product for a minimum of one year. This does not preclude the practice from considering new vendors or technology, but due to the high capital and human resource cost of this decision, the practice should proceed with caution. If a less-experienced vendor is selected, pricing should reflect that the vendor will be learning side-by-side with the practice.

Make sure both the practice and the vendor commit to reciprocal timelines and performance expectations that include consequences for non-compliance before the final selection is made.

Do not expect instantaneous results such as improved workflow, staff acceptance, physician compliance and expense reduction. Transitioning to an electronic workplace is a journey that will vary based on many factors. The key is to recognize that it is essential to "go electronic" and that the eventual configuration will be beneficial to the practice.

Electronic avoidance is not an acceptable strategy. Likewise, it may not be necessary to proceed at warp speed. There are many options available in the health care industry and the group should take the time to select the strategy that best meets its own specific financial, operational and clinical needs.

Be smart, go slow and do it right.

IN THIS ARTICLE ...

Learn the steps and missteps that can occur when a small practice ventures into the world of electronic medical records.

To discuss this article and other issues about implementing technology visit the Technology Implementation Network at www.acpe.org

Rick E. Weymier, MBA, FACMPE, is director of clinical consulting and physician services at VHA, Inc., a nationwide network of community-owned health care organizations and physicians. He is based in Irving, Texas and can be reached at 972-830-0298 or at [e-mail].

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By Rick E. Weymier, MBA, FACMPE