MGMA In Practice blog

By Rosemarie Nelson, MS
Principal, MGMA Health Care Consulting Group

Lately, health care reform news has been focused on the definition of "meaningful use," which detracts many medical groups from the reality of implementing an electronic health record (EHR). As a consultant, I help health care professionals figure out how to implement their EHRs almost every day. I've worked with more than 300 medical groups and vendors to know that an EHR project absolutely must start with the end in mind.

If administrators and physicians can't answer these three questions, it doesn't matter what "meaningful use" is because you won't successfully implement any EHR.

• What do you want the EHR to do for your practice?
• What problem(s) or issue are you trying to resolve?
• What must it deliver for your providers to use it?

For example, in one practice some of the enthusiastic, "just do it" physicians began documenting patient encounters with their EMR, but none of the nurses were trained to use the EMR. This created a lot more work for the physicians and made them think the system was the wrong one.  But once the nurses were trained and engaged in changing some workflows that had been around since the days of "Marcus Welby, MD" they had a smooth running office.

Waiting to improve operations hurts your practice's profitability and reduces your chance for a successful EHR implementation.  Start analyzing and preparing for your EHR now with these five steps:

1. Measure what success means to your practice.
   Is it eliminating the paper chart for patient encounters? Is it accessing test results electronically? Is it e-prescribing? Is it improved access to clinical information? If you articulate your end-game, you'll have defined "success" in your medical group.
   
2. Examine workflow.
   Moving to an EHR requires significant planning and resources within the group. It can be a disruptive force to nursing support staff because when it is done well, it requires change in workflow to achieve the operational benefits the EHR can deliver. Ask yourself what you want to achieve and chart your existing workflows with this free spreadsheet tool, which can help determine where an EHR can eliminate waste and reduce cycle time in each process.
   
3. Redesign workflows to eliminate redundancy.
   Are there steps in your process that simply aren't necessary? Does a piece of paper get photocopied for later convenience? Are staff members holding information (forms or charts) for periods of time that create constraints on completing coincident work?
   
4. Reduce cycle time.
   Your analysis can become as sophisticated as tracking time to completion for each step in the process.  Remove waste for the patient and your operational effectiveness by reducing time to completion for each task.
   
5. Focus your EHR selection.
   Now that you've identified what your successful EHR implementation and what efficient processes look like, carefully evaluate how the EHR can deliver upon that vision.

Fellow consultant Cindy Dunn and I will be speaking at the MGMA seminar, Mastering Your EHR Implementation on Aug. 22-23 in San Francisco. In addition to sharing best practices in the application of technology to medical office operations, we will ensure that when you leave you will:

• Understand the significance to a successful implementation of people and process
• Identify practical and efficient ways to implement an EHR
• Evaluate and select EHR vendors and products with respect to your project criteria

So don't wait for definitions and don't bank your investment on a stimulus plan. Your return on investment can be significant if you re-engineer your workflow and select and implement and EHR to achieve your end-game.