EMRs can earn their keep

But efficiency won’t happen unless you do your part.

By Vanessa Caceres, Contributing Editor

When an ophthalmologist wants to improve practice productivity, the use of electronic medical records (EMRs) may not be the first thing that comes to mind.

Even though more and more practices are getting on the EMR train to stay in compliance with meaningful use, EMRs are often characterized as time-consuming. One study published last year even found that the stress from incorporating EMRs affects physician burnout.¹ Another study published in 2014 that focused on pediatric ophthalmologists in an academic medical center found an 11% decrease in clinical volume after EMR implementation.²

You reap what you sow

Despite the findings and anecdotal stories, there are ways to ensure you’ll get a productivity bang for your buck with the EMR system you choose to use. An American Academy of Ophthalmology (AAO) survey found that among 492 of its members with an EMR in their practice, 42% reported increased or stable overall productivity.³ The AAO’s Medical Information Technology Committee will survey members again soon to see how that trend has changed, said Michael V. Boland, MD, director of information technology and assistant professor of ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore. Dr. Boland is the lead author of the AAO survey results relating to EMRs.

Another study in the American Journal of Managed Care found that greater EMR use and greater delegation were independently associated with higher productivity levels.⁴ Productivity, however, requires a good deal of work coordination, says study lead author Julia Adler-Milstein, PhD, assistant professor of information, School of Information, and assistant professor of health management and policy, School of Public Health, University of Michigan, Ann Arbor.

Achieving productivity

Here’s what experts recommend that you do to achieve enhanced productivity with your EMR.

BEFORE YOU BUY

1. Ask the right questions. Approach your search for an EMR vendor like a matchmaking process, Adler-Milstein recommends. As in your search for the right mate, you’ll want to ask potential EMR vendors the right questions to ensure their system boosts your productivity.

Some potential questions follow, courtesy of the sources for this article:

• What input did ophthalmologists give you in designing your system?

• Could I get the names/contact information of some other ophthalmology practice clients?

• What can you do to customize this system for my office?

• What’s your ICD-10 program?

• Does the EMR have a drawing feature?

• Can I access my EMR on my iPhone, iPad, and so on?

2. Find out if the EMR system is cloud-based, recommended David Goldman, MD, Palm Beach Gardens, Fla. A cloud-based system has less risk of viruses and is easier to update, says Dr. Goldman.

3. Check for online resources to guide you through the EMR selection and implementation process. The AAO has a whole website dedicated to EMR selection and implementation (http://www.aao.org/aaoe/ehr-central/index.cfm). So do other societies in other specialties, said Adler-Milstein. Regional extension centers exist in various parts of the country; Adler-Milstein characterizes these centers as the federal government’s “Geek Squad” for EMR implementation. Find regional extension centers in your area at http://healthit.gov/providers-professionals/regional-extension-centers-recs. These centers can provide overall information and advice to help you get more familiar with EMR use.

4. Analyze your practice’s workflow—and look for an EMR that can match it, suggests Lesley Kadlec, MA, RHIA, director of health information management practice excellence, American Health Information Management Association. By assessing the order in which certain staff members see patients and the tasks they perform, you can get a clearer sense of how your EMR needs to work — and then ask for that capability from your EMR vendor.

“There’s a lot of work upfront to define your current workflow,” Dr. Boland says. “You have to be clear with your vendor and say, ‘Here are the steps we want.’ It’s a lot of self-reflection.”

5. Physicians in group practices should plan where to document certain information. For instance, come to an agreement that certain areas on each patient’s EMR will cover medical history or slitlamp exam results. “It’s partly to know where to look for information and where to put things in,” recommends Michael F. Chiang, MD, Knowles Professor of ophthalmology and medical informatics and clinical epidemiology, Oregon Health & Science University, Portland.

6. Decide in advance how you will copy and paste material from the EMR. With the click of a button, it’s common to copy exam results from a previous EMR entry, Dr. Chiang says. But, doing so might pull forward items that are not part of the current exam, leading to extraneous information put into the chart and possible confusion. Plan with staff in advance the specific information allowed into future EMR information fields.

ONCE YOU HAVE THE EMR

7. Give your practice six weeks to three months to get on track as you implement EMRs. Although research points to a short-term dip in productivity, practices appear to recover and improve after that brief dip, Adler-Milstein says.

However, “behind that average is a lot of variability,” she says. Take for instance the case at Oregon Health & Science University. In 2006 after EMR implementation, patient volume dropped 3%-5%, Dr. Chiang says. In fact, that drop in volume held on for a couple of years. Also, the university found that about a third of the time, physicians had to complete documentation during their off-hours, adds Dr. Chiang.

8. Start small. Dr. Goldman and staff, on its first day of live use, used the EMR on two patients. The next day, the number grew to four. By adding more patients gradually, the practice went to full-throttle relatively quickly and without much struggle, he says.

Another helpful idea is to have staff pre-load as much patient data as possible after-hours or during times when they are not with patients, Dr. Boland says.

9. Identify bottlenecks. Because EMRs require highly interdependent work, you may find that there’s a consistent area where documentation gets held up, Adler-Milstein says. Plan with staff how to correct that bottleneck. For example, if a physician is a slow typer, perhaps the practice could hire scribes to make that part of the process more seamless.

10. Focus on the positive. Achieving productivity with EMRs isn’t just about filling in patients’ charts and finding the right billing code faster, Dr. Boland says. EMRs allow physicians to access information from offsite and lets staff avoid the challenge of reading messy handwriting; it’s easier to feel confident about the technology’s potential.

“Even if I’m at the zoo with my kids on the weekend, I can refill a prescription through my iPhone for a patient,” Dr. Goldman says. “It’s made my life easier.”

And then there’s the patient

Physicians in a multispecialty practice, can view all of a patient’s medications via the EMR to tailor any prescriptions appropriately, Kadlec says.

And another consideration: Keep in mind the ultimate goal of using EMRs, which is not just to stay in regulatory compliance but also to improve patient care, Kadlec says.

Looking ahead

Despite grumbles about EMRs, ophthalmologists are in the catbird’s seat to effectively use the technology. It may take better collaboration among policy makers, physicians, and EMR system designers to help all physicians to navigate efficiently with EMRs going forward, Dr. Chiang says.

Dr. Goldman uses his EMR to send thank-you notes to referring physicians and also, via an EMR feature, to see what other physician-users are prescribing to patients with the same condition.

He believes ophthalmologists will use EMRs in more innovative ways as they get comfortable with the technology.

Says Dr. Chiang: “Once we get a critical mass and think outside the box, we can get creative with how we use EMRs.” OM

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