20 Aug Making the most of your EMR
By: Koren Fay
Medical professionals have traded weighty paper medical records and ball point pens for shiny laptops and small handheld tablets as their primary tools for caring for their patients. Information can now be found and shared with other providers and even the patient themselves with just a few clicks. Many transplant providers mourn the loss of ‘easy’ but elaborate hand written Transplant FlowSheets and argue there are “too many clicks” needed to accomplish a task and we all worry about the effect of computer screens on humanistic factors of the office visit,. However, we would also agree that substantial improvements in timely and clear communication have occurred with the electronic medical record.
So how do you move from the “stupid computer” frustration to “look at what this thing can do!” excitement?
Accept (even embrace) the change. EMRs are not only here to stay, they are becoming a larger and larger part of our everyday lives. By encouraging your team to work WITH the medical record rather than fight it, you will all learn the nuances of the software and can in fact become a leader in its development. This will help to make the EMR work WITH you and for your patients. For example, show your physicians that templated notes can cut documentation time by 80%, increase accuracy, and improve revenue capture.
Do your homework. Attending only a couple of 3-hour training sessions is rarely enough. You need to really invest time on the tool and use it, even try to break it, and find all the hidden buttons and shortcuts. Reach out to your IT team, and ask questions. Meet with them in person. While they may not have the time for new programming requests, they will have the time to answer questions, show you shortcuts and help you think about how to use the system more fully. Its invaluable to reach out to other Transplant Centers that use the same EMR. Find out how they use it. Ask them to share forms and other tools that have been developed within the system. EMR’s are sophisticated enough that often what one IT department has developed can easily be incorporated into a different center’s system. Even ambulatory or inpatient teams at your own facility have likely developed different shortcuts and tools in your EMR that may not only be helpful to you but rapidly adapted. For example, we brought tools that improve waitlist tracking and post transplant lab monitoring from center to center with minimal customization.
Fit the tool to the process, not the process to the tool. This is where many centers and many electronic medical record systems get off track. When you try to impose a new system on top of an old process, staff will likely find a work-around so they can keep doing things the same old way in the new system. This means that they fail to use the EMR to its fullest potential. This occurs not because people are lazy or bad, but because they are too busy and change is hard. If the new process is demonstrably better than the one you have, then, by all means, embrace the change. However, you need to re-engineer the whole process, training, and education of all team members. The new EMR tools will not drive behavior change. Without a thoughtful transition, you will arrive at a process that is more frustrating and less effective. But if the new process is just a different way of doing things or is less efficient, then don’t make the change. Put some minds together: include staff who participate in the process every day and IT people who know the system. Walk through the current process as a group and find the way that the tool can be used within existing processes. Consider the following examples:
- Right now your quality staff most likely has a spreadsheet that they continue to use to enter deceased donor information into, such as serologies, PHS high risk classification, and the OPO that recovered the organ. They need to have this information for reporting purposes, so many hours are spent in UNet pulling data down and entering it into quality reports. In some EMR’s, the coordinators can enter the information into the episode at the time of transplant and in turn, submit it into TEIDI. These data are then available to your quality staff through existing reports, as well as the clinical staff who may need it for clinical decisions. This way you don’t require duplicate entry, and you can maximize the reporting capability of your EHR.
- If your coordinators are tracking a patient’s evaluation testing in a spreadsheet or by hunting through a patient’s chart each time a different question is asked, they are tired and your physicians are frustrated. Instead of relying on these two very time consuming tracking methods, many databases provide a feature that works with your EMR to allow for an electronic checklist to be created. As items are done, they are marked completed, so simply by hitting a button, a coordinator can see a summary of what has been done and what is still outstanding for each patient.
- When it comes time to make the patient list for the agenda for a committee meeting, instead of retyping names and medical record numbers a coordinator can work with IT to create, or use an existing waitlist report and then simply copy and paste that into the agenda.
Look for ways the output of the process can be improved without adding steps or time to the process because of the EHR tool. Staff will use the tool if it fits into their workflow. It is much easier to garner support to switch from a spoon to shovel if one is allowed to continue to dig in the same way.
Two birds, one stone. With budgets that are limiting the staff and the continually evolving priorities of senior leadership, the last thing anyone needs is more items for their “to do” list. So, look for projects that can check off two or more boxes. For example, providers are continually asking for information in advance of the patient being seen for their new evaluation appointment. Ideally this information could be designed so that it populates the review of systems or past medical history section, which would then be available for colleagues to use. Using patient portals, patients may even be able to complete a history and review of systems from prior to their visit (or on a tablet in the waiting room,) which can then be stored in the medical record so the information can be pulled into the provider’s notes in several different sections. By making one change (the addition of the form the patient completes through the patient portal) you have checked off three to-do’s: increased provider and patient satisfaction with an efficient visit, met a meaningful use measure, and increased potential revenue. You have even kept patients engaged while they are waiting to be seen.
In conclusion, maximizing the value of the EMR requires creativity, flexibility, and a willingness to see its value. Often, staff and providers just need to be re-taught the hows and whys, and short cuts, and understand that they must always strive to make the EMR work. However, it will fail if your process of care delivery does not create opportunities to reduce work, enhance efficacy, and make the process less onerous.