From Medicare/Medicaid incentives to EHR industry ads, it is hard to cut through the hype and determine if your practice is even ready to try to select and implement an EHR.
Implementing an EHR is a transformational exercise for any practice that requires redesigning every aspect of charting, clinical workflow and interaction with patients. However, in too many cases, practices approach EHR projects without considering the organizational commitment needed to succeed.
Governance and management
Individual practices have a wide range of coordination levels among the physicians. Some multi-doctor practices consist of solo physicians practicing behind a single sign. The practice may have silos for each doctor containing staff that is solely dedicated to a particular physician with physician specific forms and procedures. In other situations, the practice may have varying degrees of coordination and cooperation among the doctors. For example, doctors providing the same exact services may insist on different procedures to schedule surgery. If we approach EHR implementation to accommodate significant differences in operational and even clinical style ( not substance ), the practice may be disappointed in the results and pay additional money for the EHR.
From a technical perspective, we can implement a different set of clinical forms, workflows and structures to accommodate the specific EHR vision of each doctor. However, the technical ability to have different strategies and approaches could hurt your practice and even risk qualifying for the Medicare EHR incentive. For example, if some doctors want to use a patient portal, while other doctors do not, the practice may have difficulty getting the patient portal information to the right patients and offer them access to their clinical summaries (a Meaningful Use requirement.) In other cases, using different sets of clinical forms may complicate or prevent production of patient lists based on clinical conditions or even reporting quality measures (both Meaningful Use requirements.)
Therefore, a practice should establish the EHR initiative as a practice level project and insure that the doctors have a process to decide as a group on the appropriate clinical and operational aspects of EHR implementation. The EHR project should be driven and supported by management focused on clinically based strategies as a group to make the most of your EHR investment.
Physician support
In many practices, some physicians take the position that they will not change their way of serving patients to adopt an EHR. Indeed, we have some doctors delegating the EHR decision and responsibility to clinical staff or office managers without true engagement from the doctors. As a practical matter, we need a clinical basis for the EHR project that can only be provided and directed by doctors.
Without physician engagement, a practice should not even begin to look for an EHR. Indeed, a small practice of one to three doctors should not even consider an EHR project unless all of the doctors will support and be involved in the project. For mid size practices, the support of all doctors, except one or two physicians, will be needed for the EHR process. For larger practices, a committee of involved physicians will need to be empowered by the management team to define the strategies and perform the various design and evaluation activities to support the EHR effort. As important, large practice efforts require the support of the majority of physicians with the management authority to compel all doctors to support the EHR initiative.
Active physician support is a basic requirement to insure that clinical and practice staff have the encouragement and support to invest their time and effort to successfully transition to an EHR as well as solve the problems and challenges that will inevitably be encountered. Otherwise, the practice may encounter resistance and problems that will destroy the EHR initiative from within. For example, some of the doctors in one practice refused to support EHR implementation since they thought the initiative would fail eventhough these same physicians voted to approve the project. The management team had to confront the physicians to get the project back on track.
Without supportive physicians and management to empower the transition to an EHR, a practice is better off working on creating such support rather than barreling headfirst into an EHR process that will lack the physician involvement needed to assure clinical relevancy and effective execution.
Ron Sterling is founder of Sterling Solutions, which guides medical practices in the use of technology to improve patient services and practice operations.
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