Key Insights On Integrating EHR Into Your Practice

Bruce Werber, DPM, FACFAS

   My recommendation is not to import data from one system to another. By treating each patient as a new patient, you have the opportunity to clean the data, update it and ensure that you have minimized errors. If you import the data, you carry over past errors and may not catch new insurance information, address and phone numbers. You also may subsequently miss collecting patients’ cell phone numbers and e-mail addresses.

Making The Transition To Electronic Charting

Now that you have prepared for the practice management portion of your new system, how do you prepare for moving to an electronic chart? First, collect and put in a Word document your most common exam findings.

   For example, in a vascular exam, you can have a preset paragraph that looks like this: “Vascular: +2/4 dorsalis pedis and posterior tibial pulses, positive digital hair, capillary fill time less than 2 seconds, feet are warm bilaterally and symmetrically, no edema, no erythema, no lymphangitis, no lymphadenopathy, no signs of acute infection.”

   All I dictated was “normal vascular” and the system noted the whole paragraph in a macro. I have developed macros for most of the areas required in a typical history and physical examination, or follow-up. I recommend obtaining a charting system that allows the use of Dragon NaturallySpeaking For Medical Professionals Version 10 (Nuance) in addition to templates. By using a combination of templates and voice commands, one can complete a note and have it coded very quickly. Additionally, this ensures that you have put all of the required insurance information into your note.

   The practice can change its workflow to capture all pertinent information. When this happens, the more information gathered, the more potential for having met criteria for a higher evaluation and management (E&M) code then the practice might otherwise qualify for. Additionally, it will help you qualify for a Physician Quality Reporting Initiative (PQRI) bonus from Medicare.

   My recommendation is to train your medical assistant to capture medications, allergies, history of present illness, past surgeries, list of medical problems, review of systems and social history. If your team members have time, they can gather this information the day or two before when they call to confirm a patient’s appointment. At each visit, your medical assistant can document that he or she has reviewed and updated the information.

   When preparing for implementation of an EHR/EMR system, everyone in the office should learn the ins and outs of each system, especially the doctors. The more the physicians are aware of how the system functions, the less pain there will be when one actually implements the system and sees patients.

   This also translates to the bottom line as the unseen cost of implementing systems may be a 20 to 25 percent decrease in productivity in the first three months of implementation. In contrast, if the physicians are present during planning and training phases of implementation, the productivity losses may be less than 10 percent.

   Patience is also necessary for all staff members in the first two to three months as they learn the system and discover shortcuts. I can assure you that once you and your staff understand the system, your productivity goes up and your cash flow improves since the claims are clean and well documented.

In Conclusion

I fully advocate integrating practice management and electronic health record systems. To do anything less will leave your practice behind and your profit margin ultimately will be affected.

   Consider having the ability to complete your note, patient instructions, imaging orders, lab orders and charges prior to the patient walking out of the treatment room. If you can do that, not only will you be happy not to have to think about that note later in the day, you will know that the charges will be submitted to the insurance carrier before you walk out of the office that evening.

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