In this sixth and final article of this series, we address fine tuning to get the most out of your practice and the electronic medical record program installed.
Establish a baseline
Great! You have a system installed. How well is it working for you?
If up to this point you followed the steps outlined in the prior articles, the practice is hopefully humming along, with everyone in the practice using the system properly. If not, why not? Even with well running systems, though, optimization is an on-going process, worth periodic inspection to ensure areas that can be fine tuned are.
First and foremost: if all the physicians and nurses are not using the product, there is no way the practice can achieve optimal return on investment, nor can it provide optimal safety and quality care for the patients. First priority for the practice should be getting everyone to use the system.
You have already started capturing some baseline data: How long are patients waiting in the waiting room? How many patients are filling out data from home prior to arrival using your practice’s patient portal? Are your staff having to do any duplicate tasks (paper plus the EMR)? Now that people are comfortable with the system, it is time to evaluate methods to move from baseline to better outcomes.
What is your highest priority?
Now with a practice baseline established for administrative, financial, and clinical areas, where are your highest priorities? Where would you get the most improvement from a process redesign or optimization?
Say, for example, that only 10% of your patients utilize your practice's patient portal. How long do the patients stay in the waiting room using a kiosk or tablet PC entering or updating information, when they could have done the same thing from home? Being able to reduce waiting room crowding, improve patient satisfaction from speedier visits, etc. would suggest that helping motivating and encouraging remote access would be of benefit and worth the effort (decreasing the time your front office staff had to spend in less productive endeavors). Automating the front desk check-in process via a kiosk also can help productivity, avoiding “lost” patients, ensuring demographics and insurance information is current, and measuring waiting times accurately. Even increasing the numbers of patients using the web services to 50% may save considerable time for your front office staff. Example: in a three physician practice, with a typical volume of 6 GYN patients per hour each, in 8 hours x 3 MDs x 6 patients x 0.4 = 58 patients out of 144 that day who are not requiring significant interaction with the staff. Even a minute interruption avoided for each equates to an hour of productivity regained by someone up front.
Are all of the work processes you are doing still the right ones to be doing? Are you printing documents to shuffle around the office, or using the messaging or communications feature built into the EMR?
A thorough review of how you are doing the day-to-day activities will give you an idea of where improvements are possible.
Penny wise, pound foolish?
Who is responsible for your maintenance and upkeep of servers, PCs, etc.? Are you, the physician, doing your own maintenance? If so, instead of a $30/hour worker keeping things humming, you have a $200+/hour worker doing the tasks. Similarly, picking any of the higher salaried people in your staff to do tasks that can be outsourced or automated does not make financial sense. You certainly need to be aware of the more sophisticated requirements of IT support in a medical environment, with HIPAA security and privacy requirements of business associates first and foremost to remember.
Formulate a regular review process to look at all areas your EMR touches. Keep the patient portal enhancements in mind, as well as the flow for your nursing staff. Keep the messaging between the front and back staff in mind, for scheduling, phone calls, or electronic messaging. Are there better ways to (securely) carry on the work? Are there newer or better ways for remote access? Are there alternative devices (as with the iPhone) now available that may improve remote access to the system, or better data entry for certain portions of the application?
If you and your staff don’t have the time to perform these evaluations, consider outsourcing that function as well. The vendor from whom the system was purchased, consultants that helped with implementation, or those specializing in these matters, can help in performing the requisite review tasks.
The implementation of an EMR is but one step in a continuing journey. Continued assessment of the system, how it is being used, and ways to improve are just as much a part of that journey as the selection and implementation phases, and will ensure the best return on the substantive investment in time and effort that has gone into this project.
--Michael J. McCoy, M.D