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Been there, done that: Tips for migrating to EHR
Our practice, Ophthalmic Partners of Pennsylvania, PC, is a multi-subspecialty group of 11 ophthalmologists with service locations in the metro-Philadelphia area and southern New Jersey. As of March, all patient encounters are being managed and documented through our electronic health records system. This conversion to EHR is a journey that took more than 18 months and is in many ways ongoing.
Through this experience and my past work as chair of the EHR Subcommittee for the American Academy of Ophthalmic Executives, I have had the opportunity to identify some of the most frequent questions that ophthalmologists ask about the process.
The right system
Whenever I speak on the subject of EHR, I am inevitably asked, “What system do you use, and are you happy with it?” We use NextGen and have found it responds well to the diverse demands we place on it. However, this does not even begin to address whether the same system is right for your practice and your particular needs.
EHR will fundamentally alter the way you see patients, so you need to spend time looking at enough systems to find the best fit. Go-live is not the time for physicians to realize that the EHR presents clinical data in a way they find too cumbersome. Take a couple of representative paper charts with you to the product demos and make sure you are satisfied with the electronic equivalent of the various things you currently document.
The right price
How much your system costs to purchase and maintain will likewise be practice-specific. First and foremost are the software licensing costs, often priced on a per-provider basis. Does the pricing take into account part-time providers and allow you to transfer licenses from one doctor to another?
Next are ongoing maintenance costs, usually calculated as a percentage of your software costs. Future software upgrades should be included, and there should be a cap on how much the maintenance costs will increase in future years. Spend some time reading the fine print and negotiate the most favorable terms you can, as you will be living with them for the duration of your contractual relationship with the vendor. Device interface costs are usually separately priced per device with their own maintenance fees.
Finally, there will be hardware costs such as end-user computers and scanners, even if you are going with a hosted solution that relieves you of the obligation to purchase expensive servers.
Certification and Meaningful Use
The new federal requirements for EHR incentives (and later penalties) being offered through the Medicare and Medicaid programs are complex and require many more paragraphs than this article allows. However, a key threshold requirement for participation is use of a certified system.
This certification is not only product-specific, but also version-specific, so make sure the version you are using to collect and report on your Meaningful Use data is on the government’s “Certified Health IT Product List,” found at http://onc-chpl.force.com/ehrcert. On this website, you will obtain your EHR product’s certification number to submit along with your data for the EHR incentives.
Tablet vs. desktop computers
Our original intent was to use portable tablet computers, and we have the wireless access points to prove it. We found, however, that the tablets were difficult to use whenever we had to type any sort of text rather than select from a drop-down menu or pick list. Also, because we use terminal sessions to access the system, this added another layer of complication.
Fortunately, we test drove just one tablet and returned it before committing to desktops for our exam rooms. I highly recommend this type of testing before you purchase in bulk. In the end, we did away with worries about battery life, charging stations, tablets walking off and smaller screens.
Paper chart limbo
The most vexing part of EHR conversion may be how to manage paper charts in that limbo period before all active patients are seen electronically. We began by abstracting the last paper visit into the EHR (technicians) and scanning the chart in its entirety for each pending appointment (medical records staff). Once the patient was actually seen for an electronic visit, the patient’s status was converted from “Paper Chart” to “EHR” within our practice management system for easier reference going forward. If this seems like more than you are willing or able to take on, consider abstracting select data and scanning key pieces of the chart, if at all.
Staff and physician training
The added benefit of data abstraction as discussed above is that technicians gain proficiency and muscle memory before the first EHR patient ever walks in the door. Generally speaking, however, staff training should be broken down by department and customized accordingly, if possible.
We used a “train the trainer” approach, meaning that a core group received extensive training directly from the vendor and then trained the rest of our end users. As for physician training, scope and scale depend on whether they will be using scribes.
Drawings
This is where EHR technology just cannot compete with paper yet. No matter how good the drawing capability may be, it is rarely as fast as drawing on paper. Consequently, some of our physicians are still drawing on paper and scanning it into the patient’s electronic chart. Other physicians report that they are drawing less as a result of being able to access diagnostic images through the EHR and being more descriptive in the impression and plan. If drawing is a critical component of your documentation, spend the necessary time shopping for this functionality in your EHR selection process.
Device interfaces
Device interfaces are intended to make your diagnostic equipment interact with your EHR, such that images are directly accessible from the patient’s electronic chart for easier viewing and interpretation. In addition to (or in place of) what your EHR can offer, there are a number of standalone image management products available that can work in tandem with your EHR. Again, the key is to put your options through their paces. How easy is it to send the image from device to system? How easy is it to pull up and view the images? Where will the interpretations reside?
If approached with reasonable expectations, thoughtful planning, sufficient time and the right resources, EHR conversion can be successful. The above tips are just that — snapshot suggestions that I hope you find useful for some of the most common EHR concerns.
Julia Lee, JD, is the executive director of Ophthalmic Partners of Pennsylvania, PC. She can be reached at 100 Presidential Blvd., Suite 200, Bala Cynwyd, PA 19004; 484-434-2784; fax: 484-434-2793; email: JLee@oppdoctors.com.
Disclosure: Ms. Lee has no relevant financial disclosures.