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What Money Are You Leaving On The Table Because You

Don’t Know What's In Your EHR

Think Ahead

If there is a possibility that you will need to report on data, decide carefully where to put it in your EHR Think about upcoming reporting requirements like

Meaningful Use, PQRS and other clinical quality measures

Start small and use an iterative process Use a PDSA cycle to identify problems before you roll

out to the whole practice LISTEN to feedback and concerns Adjust, but be prepared to set a rule and follow up on

it

Think Ahead

If there is a possibility that you will need to report on data, decide carefully where to put it in your EHR

WHO is going to record the data?WHERE are they going to record it?HOW will you confirm that the process is

being followed?WHY is this workflow necessary?

Think Ahead

What goes into the EHR must come out of the EHR-or does it? Unstructured data

Free text-allows for variation Potentially easier workflow at time of care Makes reporting very difficult Will not be able to capture all info on reports

Structured data Consistent format Consistent location within the EHR Much easier to capture on reports

Workflows to support process Different workflows based on how the information is obtained Interfaces, fax server, paper Scanning documents and also entering data as structured

Think Ahead

Maximize the use of the EHR standard reports and registries

Run existing reports to get a baseline on what it is capturing and where it pulls data from within the system

Understand how the EHR “closes the loop”, for instance Meaningful Use metrics, Clinical Decision Support alerts

Change workflows as needed

Identify the Issues

Technical vs. Social/User Issues

Technical examples Network/computer hardware/infrastructure EHR Software installation/configuration EHR design – is it the right software for your type of

practice?

Social/User examples Users don’t know how to use the software Users don’t want to use the software Users don’t use the software consistently Workflows are absent, poorly followed or inconsistent

Identify the Issues

There is rarely just one issue

The fix is a combination of changes

IT issues

IT inefficiencies are VERY expensive to live with Slow software, dropped connections, lost data all make

documenting slow and painful Sometimes just replacing old/outdated hardware will

save many dollars in the long run Check to see that you have printers, scanners, cameras

everywhere it makes sense

If you are having problems with connectivity, speed, backup, etc. seek help – these are complicated issues and can cause major problems if not addressed

User issues

Try to identify the root of non-compliance Are the workflows good? Are the workflows well documented? Do people understand why they must use the EHR? Are the providers “on-board” with the EHR?

Who is non-compliant? Providers? Clinical Assistants? Front Office

User issues

When workflows are problematic MUST be well documented Training should be accompanied by written instructions Standing orders and practice policies must be written

and available to the users

When people are non-compliant More training More education Listen to them – are they unable to comply because of

bad workflows or uncertain instructions?

EHR Vendor

Engage your EHR vendor

Even if it is challenging, try to work with them

Communicating a technical problem effectively is a skill Work on this skill! The better you are at communicating with your EHR

vendor, the better results you can expect Some techs are bad, don’t be afraid to ask for another

person Be friendly and polite – you will catch more flies

Approach to Change

Change is hard – take a small-ball approach

Don’t try to fix everything at once Identify the root cause of the problems Create a list of problems and prioritize them, even if

they are interconnected Look carefully at the problems individually Are they technical or social in nature? i.e. is there a

problem with the EHR itself, or a problem with how the EHR is being used? Perhaps a little of both?

Questions???