Effective workflow analysis should precede EHR implementation

Failing to conduct a workflow analysis, which shows how users deal with paper and computer records alike, can only doom an EHR implementation. Here's how to address workflow.

WORCESTER, Mass. -- Electronic health record (EHR) systems can create efficiencies beyond what many solo ambulatory-care physicians and small group practices can imagine. The key to a successful EHR implementation, however, is a complete workflow analysis and tune-up -- and it takes place long before flipping the switch.

An effective workflow analysis includes reviewing electronic information processes, typically covered by the EHR vendor or consultant's implementation plan. But the human side of information processes is just as important, an aspect of workflow analysis that physicians frequently overlook. This starts with an assessment of employee skill sets, said Dr. Mark Jacobs in a presentation at the Massachusetts Health Data Consortium's HealthMart 10.

Jacobs is a practicing internist in Smithfield, R.I., as well as the vice president of primary care for the Boston-based Caritas Christi Health Care system, and he spoke from experience, having spearheaded the transition of more than 1,400 Caritas Christi physicians from paper to EHR workflows.

Understanding which staffers need training, and how much, will help the whole office better meet the challenge of learning an EHR system. Physicians should down with each of their employees and ask them the following five questions, even if the answers seem obvious or they might think it's impossible to find people who would answer no to any of them:

1.  Do you know how to turn on and log into a computer?

2.  Do you know how to type?

3.  Do you regularly use email?

4.  Do you know how to access the Internet?

5.  Can you use a sophisticated phone system?

"You need to assess the skills of everyone in your office. This is not just about the provider," Jacobs said. "Employee value may change. Someone incredibly valuable in the paper world, your nurse of the last 20 years, may be a disaster in a paperless, electronic office."

Those who can't type should be trained in voice-recognition software right away, Jacobs said. Beyond basic skills, staff training in the EHR system should comprise at least an eight- to 12-hour course, with additional home study. Without that, a practice risks "huge losses" in productivity from inadequate training, he said.

Ensuring that workflow analysis, meaningful use align

Physicians in the midst of a workflow analysis should ask vendors to demonstrate how their EHR system can actually achieve Meaningful use -- which fields need to be filled out, for example, as well as how clinical summaries should be completed to meet federal requirements. These steps can be built into the new workflow, Jacobs said.

Someone incredibly valuable in the paper world, your nurse of the last 20 years, may be a disaster in a paperless, electronic office.

Dr. Mark Jacobs, vice president of primary care, Caritas Christi Health Care

During training sessions with EHR vendors, Jacobs added, physicians should be aware that the vendor's objective -- making sure that its software satisfies meaningful use rules -- isn't necessarily the same as theirs: documenting care quickly and effectively en route to using the EHR system meaningfully.

With this in mind, doctors should pepper the vendor with questions about how to document care quickly and completely. At this point doctors who aren't good typists should ask questions about using such features as drop-down menus, macros, templates for conditions that recur frequently among their patients (especially for specialists), and hooks into voice-recognition products. Learning these workarounds during vendor training -- while patient care is still being documented quickly -- will foster better, faster workflows.

Finally, once the EHR system is up and running and the workflow is working -- well, there's one more productivity drag: coding. Physicians should not get bogged down in finding International Classification of Diseases or Current Procedural Terminology codes during patient visits when they can't recall them. The temptation is there in EHR systems, with their empty, glaring fields needing to be filled out, but it should be resisted, Jacobs said.

"Don't get hung up," Jacobs said. "Make a little mental note of it, and complete it later."

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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