Effective Ways to Optimize Use of EMR Systems
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September 15, 2011 8:30 AM
According to the 2010 National Physician Survey, 16.1% of physicians use electronic records instead of paper charts in their main patient care setting. (In 2007, this number was 9.8%.) While we see improvement in the adoption of EMRs over the three-year period, these numbers are not stellar by any means. There is a big difference between implementing an EMR and effectively using the system to enhance the way that care is delivered. The 2010 survey also indicated that 34.1% of physicians use a combination of paper and electronic charts — twice the number that use EMR alone.
What is the incentive and how does one encourage more effective use of EMR systems once they are implemented?
Consider the following scenario:
Dr. JD is a busy primary care physician in a six-physician group. He sees an average of 35 patients per day and provides full-service care, managing a practice with a complement of patients with chronic disease as well as providing pre-natal care and assisting with surgery at the local hospital. He, with his colleagues, implemented an EMR three years ago and after a traumatic initial six months, he enjoys using the EMR system and would not return to a paper-based practice. His partner led the selection of the EMR, but after it was implemented he stopped, and currently there is no one with specific responsibility for EMR maintenance and sustainment. He documents all clinical notes in the EMR and views lab results in the system; however, he has not been using the prescribing capabilities of the EMR: they are too complex and time-consuming, he does not have a printer in the exam rooms, and he does not want the additional paper expense because prescribing through the EMR uses a full sheet of paper for every two drugs prescribed. As a result, he handwrites the prescriptions on a piece of paper and copies and pastes the list of medications from one encounter to the next. In addition, he finds the referral process through the EMR to be cumbersome, as it does not create a narrative note that is well formatted. He has developed a workaround where he copies and pastes the necessary information from the EMR into a Word document and notifies the staff with each encounter which documents should be attached to the referral when it is sent to the specialist consultant.
What's wrong with this picture? You would expect more automated processes to be in place in this practice after three years using the EMR. In addition, you would expect core functionality such as prescribing and referral management to be optimized, working, and standardized throughout the practice. However, I can guarantee that if you look at the 34.1% of dual paper/electronic practices, this is exactly the type of scenario that you will find. Why does Dr. JD not complain? He is busy, overloaded, and has developed workarounds that give him some benefits of the EMR (remote access from home, integrated lab results, quick note review) and although not perfect, he can manage and still maintain his marriage, see his children, and take the occasional vacation. The practice does not meet on a regular basis to discuss EMR or practice optimization and he is able to maximize his chronic disease incentive payments by using the recall and template function in the EMR. Dr. JD is actually quite satisfied with the status quo. Why should he change?
What are the keys to optimization in this practice?
- The practice does not appear to have a goal and vision in terms of where they want to go from a workflow and clinical management perspective. Someone needs to be designated with taking the lead in terms of change and optimization of the EMR even if this role is share by more than one person.
- Processes are not standardized within the practice. Different referral processes are inefficient and costly to maintain. The leader should identify which processes are a priority by discussing with physicians and staff and should set up a schedule to get everyone on the same page.
- Bring the vendor back for some advanced EMR training for physicians and staff. There is a cost involved, but this is much more effective than trying to muddle through.
- Consider setting up education sessions as a practice where everyone gets together once a month with the EMR and discusses how they are using the system so that there is a capability to learn from one another.
- Measure your progress. Use the reporting feature in the EMR to publish intra-practice progress reports. There is nothing that incentivizes change more than feeling that you are being left behind by your colleagues.
What are your thoughts? Click on the “Comments” link below.
Originally posted on Canadian EMR
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