How To Evaluate EMR Systems For Your Practice

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By Bruce Werber, DPM

   The prospect of converting medical records from paper to an electronic system can be quite a daunting challenge. Not only does it require learning new technology, it will likely require changes in existing processes and a collective mindset that is open and willing to embrace changes that can lead to improved efficiency for you and your staff. The difficulty is finding the correct system for your practice.

   Electronic medical record (EMR) systems store and produce significant quantities of information. EMR technology has grown into a tremendous platform for managing clinical and financial information. The technology enables you to combine text, color photos, medical images, full motion video and voice into one very powerful platform that can precisely and accurately retrieve information.

   When weighing the decision to make the switch to an EMR system, one should start with thorough planning. A master project plan should describe both a strategic focus (the long-term goals and their measurements) as well as the tactical focus (all the details of implementing the first phases). To accomplish this planning phase, you (and the other doctors if you are in a group practice setting) should write down what basic attributes you would like to see from the system. This includes how you want to interact with the system whether it is by talking, pointing and clicking or typing.

Taking A Closer Look At Your Office Processes And Procedures

   Then review how patients move through the office. Start with the initial phone call for an appointment, proceed to check-in and move through the patient’s visit to the treatment room and the subsequent evaluation and diagnosis. Review the procedures for: ordering diagnostic tests (such as X-rays or laboratory testing); reporting and reviewing laboratory and imaging studies; arriving at a treatment plan; writing prescriptions and giving patients instructions; scheduling follow-up appointments and responding to patient phone calls. Then one should review how the procedures, office visits and time are coded and how to record this in the patient’s record.

   It is important to review the mundane repetitive processes that we often take for granted. Take a hard look at office processes or procedures that fall into the “we always do it that way” category. Don’t be afraid to alter the sequence of the procedure/process, make other changes or automate the process entirely. For example, instead of having patients complete their demographics, history and review of medications in the reception area, they could do this ahead of time over the Internet. This is called work process automation.

   Another example of automation is the surgery booking process when a DPM performs a surgical consult and the patient wants the doctor to book the surgery. Normally one might tell the secretary and fill out a form. However, a computer could book a surgery by generating a booking form with the details of the proposed procedure, materials needed and equipment required. The program also can generate the consent, the equipment and materials list for the specific facility, the prescriptions, home instructions, follow-up appointment and whatever else is desired. One can do this just by clicking on the procedure while completing the visit note for the day. It is also possible to avoid writing out prescriptions. One click of the mouse can generate a printout of the prescription as well as faxing or e-mailing of that prescription to the pharmacy.

   The biggest challenge at the work-process level is accurately reproducing a real business process. The major tasks are often the easy part. What can be difficult is automating those pesky exception items and rules. The key to continuous improvement is to measure the amount of change accurately. This can improve work in ways never before imagined.

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