One of the major reasons that health care providers resist implementing an electronic medical record (EMR) system is the belief that using it will decrease provider productivity, reducing the number of patients they can see and therefore reducing practice revenue.
However, an EMR that is designed around a streamlined workflow can enable providers to work faster and more efficiently. Having an EHR and vendor that can give you ongoing visibility and insight into efficiency and productivity is essential to improving performance. For example, we’ve found that providers who utilize our recommended workflows, customized by specialty, complete with care pathways and templates, document 16.7% more quickly than those who do not.
We’ve come up with five best-practice recommendations for improving provider productivity from the insight we glean surveying both our most efficient providers, and the recommended guidelines and updates from various medical societies, like the AAFP.
1. Start on time. Consider the idea that if a provider can cut just 30 seconds from each patient encounter, it enables that provider to see an additional patient every day. Naturally, some patients require more time, but they can be balanced with those who require less time. But all of this is for naught if a provider starts late. In fact, not only should providers start on time, but they should have two patients “front-loaded” to get the day off to a running start. You should also give patients an arrival time ten minutes before the first appointment, so they’re ready to go when the provider is.
2. Have cross-trained staff that can handle intake and documentation. Cross-training staff so they are capable of filling in for different providers at different times on a variety of tasks leads to a smoother patient flow, less chaos, and fewer frustrations. Providers’ workflow preferences need to be communicated upfront and clarified often so that stronger, more flexible relationships with their support staff will develop. Providers need to be flexible, too, and be willing to work with whichever staff member is available at any given time, rather than always relying on one person.
It is also important to have more than one staff support person available right from start of the day, in order to help providers stay on time — especially when the schedule is full. One important task that staff can assume is inputting some patient documentation. Handing off some of this responsibility would enable providers to spend more time with patients and still have documentation completed by close of business.
A simpler, more efficient workflow that aligns the right tasks with the right stages on the intake process helps ensure more efficient handoffs of tasks among administrative staff, clinical support staff, and providers. And constant visibility into patient status, location, and stage of visit — which ought to be available via your EMR — can also make it easier to stay ahead of the game and hand off tasks more efficiently.
3. Document encounters in real-time, but be cognizant of time and detail. Completing patient documentation is an important component of running a successful practice.
There are important benefits to completing documentation by close of business, but some providers are overly zealous about completing it in real-time — something that an EMR makes much easier to do. However, complex documentation may take more time to complete than is good for your patient flow. You should consider putting off finishing documentation in real-time when necessary, and hand off more of the documentation to staff, in order to reduce patient wait times.
Knowing which data fields you need to fill in your EMR will also increase efficiency. Just because there are a lot of fields doesn’t mean you need to fill every one of them in. Don’t get bogged down by information overload. You should also look for an EMR that automatically provides pay-for-performance or quality rules so that as you document patient encounters, you know you’re capturing the data that will ensure that additional revenue.
4. Close all patient encounters at the end of each business day. As I just discussed, providers shouldn’t try to complete complex documentation that consumes a lot of time while trying to see patients. They should, however, try to close all encounters by the end of the business day. This requires completing as much documentation as they can during the day without holding up the flow of patients, leaving themselves just the wrap-up of complex documentation at day’s end. Not only does closing encounters clear the decks for patients coming the following day, but it also moves the encounter into the administrative phase, where it can be billed. The sooner encounters are closed, the sooner billing can be done, and the sooner the practice will get paid. It’s that simple. And, as mentioned previously, the providers’ ability to close encounters on the same day is the leading indicator of the overall efficiency of a practice’s patient workflow.
5. Route documents appropriately and delegate effectively. Handling charts, faxes, lab work requests and results, and so on is time-consuming in a busy office. Providers should hand off to staff as much of the responsibility for handling routing documents as possible. Providers will always need to review and handle certain types of documents, of course, but staff should be able to handle administrative forms and routine negative test results without the physician involvement.
But the practice staff is busy, too, and routing documents in a timely and accurate manner is a demanding process. This is an area where the right EMR vendor can make a tremendous difference. Not only can the EMR system ease the burden of preparing and sending documents, but some EHR vendors provide document handling services that, in effect, relieve both providers and staff of the burden of opening and sorting mail, receiving faxes and lab work results, and routing all this documentation to the right place. Without the onerous burden of routing paperwork, providers and staff can concentrate on boosting patient throughput and efficiency, and thereby increase both revenue and patient satisfaction.
Improving all of these areas of your practice workflow is highly desirable, but the fact is, you can’t improve what you can’t see or measure. Having an EMR vendor that can give you ongoing visibility and insight into your practice’s efficiency and productivity is essential to performance improvement.
Brian Anderson is a family physician and senior manager, clinical content, athenahealth. He can be reached on Twitter @bandersmd. This article originally appeared on the athenahealth CloudView Blog.
