Emailing Documents Instead of Printing

Any forms that have to be distributed throughout the practice are ‘printed’ as PDF files and emailed, instead of printing memos and physically handing them out. This also allows the sender to keep a record of what has been sent. I have also used this to scan and email important documents to myself, which can then be shredded, so I don’t have to drag paperwork home from the office.

Document Repository

The redundancy and security of our servers makes them ideal to store private (for an individual’s use only) and public (for use by all staff members) documents. Some of the doctors use these to backup important personal or financial information. Large documents that are frequently updated, like employee manuals, can be accessed electronically without the need for wasting massive amounts of paper at the slightest change. It can also be used for important timely documents such as a practice-wide Influenza Pandemic plan.

‘All Hands’ Alerts

Previously, someone would have to call the satellite offices to try to locate a missing chart or document. Now an alert is sent to everyone in the practice via the network. This has significantly cut down on hours spent on this process.

Security Issues

Prior to setting up our practice-wide network, we had a rag-tag collection of PCs which were unsupervised. Any employee could send email or access the Internet with impunity. Now that the amount of bandwidth needed for our EPM and EMR is critical, unauthorized use of this resource is a problem. Our administrator can access email or Internet usage and determine its appropriateness. It is important to note that employees should be instructed that use of practice computers is not considered personal and is subject to scrutiny.

Batch Scanning of Paper Documents

Temporary workers help handle the load of documents which need to be scanned into the EMR system – these include laboratory data, personal documents, or medical records from other physicians. The batches are then processed by clinical techs, from whatever location they may be at, and placed in the appropriate patient files.

Public Outlook Folders

Our executive secretary posts the doctors’ social schedule, meeting schedule, and on-call schedules. The clinical supervisor posts announcements, memos, and meeting minutes. The doctors have also posted any articles of interest to others for viewing. Our marketing director posts ad tracking data, as well as advertising proofs for review. Our EMR committee has a shared task-list folder for sharing progress on template changes or other projects.

Confidential Documents

Our bookkeeper and business office personnel can send certain critical documents electronically with password-protection.

Computerized HVAC Control

We installed this system at our ambulatory surgery center. It tracks temperature and humidity throughout the building and plots these on a graph. Our nurse administrator can optimize the system depending on the use of the facility, and can even remotely monitor the system from home if there is a problem at night or over the weekend. We have been able to run the building much more efficiently, recouping half of the system cost already from energy savings.

Networked Devices

Expensive peripheral devices such as color laser printers can be shared among employees, making them more cost-effective. Newer diagnostic equipment is frequently network-ready, so reports can be accessed from anywhere in the practice without having to print and fax, saving paper costs on both ends. Cameras are also networked so images can also be seen electronically instead of using expensive photo paper.

Employee Intranet Portal

This is basically an internal website for staff members only. What started out as a simple way of communicating within the practice has grown into a myriad of tools, from critical ones to fun ones:

• Practice Wiki – from the Hawaiian word wiki meaning ‘fast’, a wiki is a simple website that can be easily edited by many different users. We use this to post manuals and how-to’s for every kind of task or project.
• Employee blog – this is a website managed by our marketing director and keeps the staff up to date on practice news. Employees can also post news of interest to their colleagues which makes it a great morale booster.
• Security cameras – these networked cameras can be accessed by physicians and supervisors. Buildings can be checked on remotely during off-hours or during periods of bad weather. They can also be used for theft deterrence.
• Doctor scheduler tool – supervisors can check all the doctors’ schedules at a glance to determine optimal staff scheduling.
• Work order system – our staff utilizes an online work order system for department-specific issues. Examples include printer cartridges needed at a particular location, a leaky faucet at a satellite office, or a new employee who needs orientation, security codes, or time card access. These ‘orders’ would then be distributed to the appropriate department (physical plant, clinical supervisor, IT staff, HR staff, etc.). In the past, this required phone calls or paper messages which would invariably get lost.
• EMR Bug Tracker – this is a tool used to post problems or ‘bugs’ with the EMR system. These can range from misspelled words to a template that crashes to a wish list item. Our IT department can prioritize these on the fly.
• Various auditor tools – these are used by different supervisors to monitor things such as schedule changes, use of the EMR medication module, coding audits, or triage workflow, to name a few.

Tweet This Post

© Emedikon LLC for Medical Practice Trends.com, 2009. | Permalink | 3 comments | Add to del.icio.us
Post tags: computer network, electronic medical records, EMR, practice management system

Feed enhanced by Better Feed from Ozh

One Bad Apple

Since one single naysayer can drag down everyone else down, it is important to intervene early. A managing partner may have to interject if it turns our that another physician is working to prevent project implementation. It’s also a good idea to tell your patients about the practice’s upcoming move to electronic records; they’ll be more patient when the practice hits the expected little bumps along the road.

The majority of project managers would cite the ‘people factor’ as the primary cause of project failures, particularly those of the scope and magnitude of electronic medical records implementation. Usually the causes are traceable to ineffective planning and training.

A transition over to EMR can be a stressful situation for some people – this is particularly true if they’re having to learn the system while caring for patients in a live work setting. It’s usually a good idea to specify some key personnel as the go-to people, and these should always be available at the different locations and within the various departments.

Audit Your Training Process

One way to determine if your staff is ready for EMR is to conduct training audits. For example, one practice asked the office coordinator to conduct a course which taught employees to use the upcoming EMR system. These training sessions were held each week. Everything seemed to be flowing well. However, when the launch day arrived it became obvious that some employees didn’t have much skill using the new system.

Unfortunately, their training process didn’t include an audit or a way to evaluate effectiveness on the individual employees. Sending employees to EMR ‘class’ is a good idea in general, but this doesn’t guarantee they’ll understand how to use the new EMR system afterward. Tests should be conducted, and grades issued based on performance. Also bear in mind that skills fade after long periods of inactivity.

Ideally there are ample opportunities for staff to develop and practice new skills during the workday. It’s a good idea to offer after-work tutorial classes as well. Remind your staff that successful implementation is a team effort, and you understand how hard everyone is working to reach this aim. Bottom line: trust, but verify, that everyone is prepared to make the big switch to EMR, with an effective training audit process.

Tweet This Post

© Emedikon LLC for Medical Practice Trends.com, 2009. | Permalink | No comment | Add to del.icio.us
Post tags: electronic medical records, EMR, EMR training, healthcare IT, HIT

Feed enhanced by Better Feed from Ozh

The employees will well understand that a new EMR system will have a profound effect on the practice. They’ll also realize the pressures they are facing at work, and some anxiety is to be expected. Administrators and doctors should understand the top concerns which staff will raise when discussing EMR implementation. And sometimes staff will present with some resistance to the plan.

In our practice we use an integrated EPM/EMR platform but we didn’t switch on the EMR module until we were humming along with the EPM system. Only after the staff were well trained and we had converted all of our useful data from our old EPM system did we attempt to go live with EMR.

We created a group of ‘super-users’; these people were the first trained on elements of the new system, and had the responsibility to bring  the rest of the staff up to speed. Peer-to-peer learning is the most effective, even among physicians. Your super-users should be representative of the various departments, including IT, office staff, compliance, front desk, administration, and clinical.

At our practice we also created an EMR committee that was authorized to hold meetings when necessary – these individuals had run with the project since its inception, and some had put in long days and weekends. They ended up with some decision-making power, as well as the added responsibility that comes along with it. Confidence in the project began to grow from that point on.

Some of the most important staff players include:

Coding/Billing Specialist

This person should have a voice in the initial software selection process. Having their expertise helped to minimize the hiccups we experienced when we switched from our old practice management (EPM) system to the new one. On their recommendation, we performed a trial run on the new system prior to completely abandoning our old system. This allowed our IT specialist to verify that the posting and billing were being performed correctly. Someone technically proficient with coding and compliance issues will be invaluable when your EMR  system goes live – to prevent under- or over-coding and ensure HIPAA compliance.

Clinical Staff

Although not as vital during conversion of your EPM system (unless you are using an integrated system), their participation will be key to the success of the integration of the EMR into the practice. Therefore, it is important to for them to be involved in the early stages of planning; it is helpful for them to have an appreciation for what the non-clinical staff does on the EPM side and how the EMR will fit into the scheme of things.

IT Specialist

This person should be involved from the beginning, even prior to choosing the EMR software. If a practice cannot initially justify the expense of a full-time IT specialist, at the very least an IT consultant should be retained. Because we knew that conversion to EMR was just part of our overall strategic technology plan, we felt we could easily justify hiring a full-time IT specialist. In fact, due to this person’s expertise in such areas as software licensing, internet communications, and hardware networking, the changes that were incorporated into the practice saved enough to cover part of his salary.

Front Desk Staff

They provide valuable input from the perspective of the end-users of the EPM. Their tasks include check-in, check-out, posting of charges, and scheduling. Their critical job prior to the EMR rollout was to help test the design of the posting process at the time of patient check-out. Once we went live with EMR, they had to learn to post the charges electronically in real-time. Having time to get the bugs out of this process helped support our decision to postpone implementation of EMR until the staff was well acclimated to our EPM system.

At our practice the doctors empowered the EMR committee with authority to manage and plan the EPM/EMR integration. Managing partners continue to meet regularly with the administrator for status reports. They also meet with IT to continually tweak the system to improve efficiency. Bottom line: the overall success of the project will depend on the cooperation and involvement of everyone at the organization.

Tweet This Post

© Emedikon LLC for Medical Practice Trends.com, 2009. | Permalink | No comment | Add to del.icio.us
Post tags: EHR, electronic medical records, EMR, EMR implementation, EMR training, healthcare IT

Feed enhanced by Better Feed from Ozh

For subjective-objective-assessment-plan (SOAP)-based patient care, the first generation of electronic medical records (EMR) systems worked well. Medical specialties which are primarily text-oriented tended to fare better, as compared to graphic-oriented specialties such as ophthalmology. At our practice we have used an EPM since 1983. But although this software met our needs for billing and scheduling, we were still accumulating stacks of paper records which required an increasing expense just to store the paper.

As we considered a change to an electronic medical records system, our practice compared the expected costs for paper records storage to the costs of converting to a new system. We fully understood that we’d have to become more efficient to make the transition cost-effective.

System Implementation Costs include:

* Infrastructure
* Consulting
* Software
* Hardware
* Tech Support

We also included the cost of additional work-hours which will be spent training people on the new system, along with data entry. In most cases a practice uses both the old and new systems concurrently until the entire conversion is complete. In the meantime, there could be some redundant tasks.

The primary factor in our decision to switch to EMR was based on the need to reduce the growing mass of paper we were storing. And it didn’t hurt to hopefully ride the wave of financial incentives from the government for EMR implementation. Meanwhile, there was the opportunity to proactively implement new HIPAA privacy and security guidelines in a way that would work best in our practice.

System Benefits Include:

* Improved Communication
* Better Efficiency
* Improved Compliance
* Enhanced Documentation
* Justifiable Coding
* Improved Integration

At our practice, the business choice came down to the belief that we could recoup our investment in approximately five years. This calculation was based on the savings of projected storage space costs, along with reduced needs for printing expenses and services. The journal Health Affairs found that the average primary-care practice recovered its costs in 30 months.

It is more difficult to measure the value of change to job efficiency and changes in staffing patterns, but we are monitoring these factors to accurately measure returns on our investment. Some studies have shown reductions in medical records staffing of 0.25 – 0.5 full-time equivalents (FTEs) as well as significant savings in dictation costs.

The overall trend seems to be toward a world where EMR is the norm. Insurance companies and government are placing more pressure on health-care providers to standardize medical records, and EMR could soon become obligatory. Costs are dropping as more businesses adopt the technology; soon even the smallest practices may find it cost-effective to ‘go paperless’.

Tweet This Post

© Emedikon LLC for Medical Practice Trends.com, 2009. | Permalink | 3 comments | Add to del.icio.us
Post tags: digital practice, EHR, electronic medical records, EMR, EMR implementation, HIPAA, information technology, paperless practice

Feed enhanced by Better Feed from Ozh

First, understand that a wireless network isn’t actually totally wireless. Something must be plugged in to something else somewhere. Also consider that a wireless system has several layers of associated expense.

You should work with a wireless consultant – preferably someone with experience installing wireless networks properly. A system that is implemented incorrectly will yield poor performance. Our practice chose to go with a Cisco-certified wireless network engineer. If you aren’t able to find someone with these rare qualifications, at least go with a consultant who specializes in network installation.

An expert consultant will use special equipment to map radio frequencies within the building. This will help to determine where to put the antennas. Our consultant’s team took several days to spread the antennas out on tripods, finally producing a map which illustrated the radio frequency overlay and a list of recommended placements.

If you plan to use cordless computers, you’ll have to use long-lasting batteries with plenty of back-ups available. Unless you’re using a special battery charger dock, this can’t be managed on the laptops. You may need to carefully plan your clinics, keeping in mind that the typical battery only holds a charge for about three hours.

Have a clear understanding of what is in your building. Is there lead in the walls? How about metal in the ceiling? These sorts of factors can either improve the signal through reflection, or degrade it overall. Are other wireless signals being broadcast in the area? Even microwaves and phones can have an effect on the signal, and most wireless networks are operating on a frequency which is on a spectrum in widespread use by other devices. The object is to prevent interference.

Be sure to keep a budget. One medical practice decided to use laptop computers connected to 24-inch monitors. This let both the patient and doctor see the monitor at the same time. However, this turned out to be costly – laptops are typically the priciest devices. Usually regular desktops are the most cost-effective solution.

Are you thinking about installing the wireless network yourself? Some network solutions on the market work well for e-mail and Internet, but might not quite cut it for operating your electronic medical records (EMR) system. There are two main reasons for this:

* Consumer wireless access points generally use a signal fixed on a higher strength than a usual laptop wireless card. This may sound good, but actually means that a laptop could detect a signal which is more powerful than it can actually return, resulting in a broken connection.

* If you require more than one wireless access point, there could be a conflict. Just walking from one side of the office to the other with the laptop could cause your session to drop, requiring another login after a possible loss of data.

Regardless of your final choice for wireless EMR implementation, make sure your team is on-board. And try to justify all purchases and keep an eye on costs. Refrain from indulging on the latest gizmos when you can – instead, stay focused on serving your patients in an efficient but cost-effective way.

Tweet This Post

© Emedikon LLC for Medical Practice Trends.com, 2009. | Permalink | No comment | Add to del.icio.us
Post tags: electronic medical records, EMR, paperless office

Feed enhanced by Better Feed from Ozh