MGMA In Practice blog

The recent release of the final meaningful use requirements moves electronic EHR incentive money one step closer for medical practices. But before you worry about meeting the "core" and "menu set" requirements, first identify which EHR stage of adoption you're in – purchasing, implementing or optimizing – so you can make smart business decisions along the way.

MGMA recently interviewed Margret Amatayakul (known as Margret A), author of Electronic Health Records: Transforming Your Medical Practice, 2nd edition, to get her perspective on how EHRs have changed and what she hopes for the future.

Margret A has a long string of certifications: MBA, RHIA, CHPS, CPEHR, CPHIT and FHIMSS, but don't be intimidated.  If you don't have an EHR, the book provides a step-by-step process for preparing your practice. If you do, the book helps you optimize its use.

MGMA: What drives your passion for EHRs so much that you wrote a book dedicated to them?

Margret A: My passion derives from my early interest in combining healthcare and business as career interests, and especially using information technology to improve effectiveness and efficiency. Between grammar school and high school my parents sent me to the Illinois Institute of Technology to learn computer programming – using keypunch cards and a gigantic mainframe!

MGMA: You've always been on the forefront of this technology. In the past 10 years, what are the greatest changes to EHRs that you've witnessed?

Margret A: In the past 10 years, products have matured, but true users have become ever more sophisticated in their desires – with the result that vendors have a difficult time addressing new and unsophisticated users and those who want much more.

Of course, within the last couple of years, federal promotion of EHRs and offer of stimulus money have created the impetus for those who have been reluctant to use and/or spend. I've been through four decades of applying information technology to healthcare, and I suspect it will take at least another decade for EHRs to become ubiquitous. Today, some practices are recognizing that EHRs are becoming a cost of doing business; I hope it will become the benefit of practicing quality healthcare. 

MGMA: In the book you cover everything from a vendor demo sample schedule to sample layouts of EHR workstations. Which portion did you enjoy coaching readers on the most and why?

Margret A: I am a very firm believer that success with an EHR follows an 80/20 rule. Eighty percent of success from EHRs comes from planning and addressing what I call the "people, policy and process" issues. While I like to work with technology, I find that you can take any solid EHR product and, with a great job of preparing users, redesigning workflows and solid training, achieve great adoption; just as it is has been widely observed that a "superior" product can be poorly implemented with few using it successfully.

MGMA: Which phase do you think presents the most challenges when adopting an EHR: the prepwork, the implementation or the optimization? Why?

Margret A: Each phase has its own challenges, and they are also dependent upon each other. Many of my clients think that once the vendor selection process is over, the rest is easy. I remind them that not only is the implementation the real work, but if they have not done sufficient prep work, the implementation and optimization phases will be even more work.

Probably the most challenging aspect of adopting an EHR is gaining physician engagement throughout the entire process – from spending time studying and defining requirements to reviewing templates and decision support rules thoroughly and monitoring results. One of my physician clients observed that his colleagues often understand EHRs at the intellectual level, but do not appreciate them at the intestinal level until they use them. The problem is, such lack of preparedness results in loss of productivity, shortcuts and, hence, less than desirable use of the system in the end.

MGMA: Selecting the "right" EHR for the practice can be overwhelming. What advice do you have for administrators in this situation?

Margret A: I've suggested why I believe a practice should plan thoroughly, but do not get into "analysis paralysis." EHR is a big investment, and I understand that practices want to get it right the first time. However, getting it right has a lot less to do with the product than the process of educating oneself about EHRs in general, implementing change management and constantly pushing oneself to use ever more of the system.

MGMA: This book is great for practice administrators, but also includes information for physicians. How will physicians benefit from the information?

Margret A: Many have written or spoken about the importance of managing change, addressing workflow and process redesign and educating users. There are still many physicians who believe they can turn over the process of selection to an administrator, have the vendor implement the product in a week, and expect the EHR to be sufficiently intuitive that they do not need to spend time being trained how to use it.

But a tool that is becoming close to being a medical device (something being discussed today by the FDA and others) should be treated with the respect of medical devices. Hopefully, the book also emphasizes that an EHR impacts all stakeholders in the practice – administrators, front and back office staff, nurses and physicians.

Another favorite mantra of mine is that an "EHR is not about automating the chart; it's about automating and using information to improve health and healthcare." To get the most out of the EHR, physicians must learn to push information-related processes to staff and patients, with the result that staff will free up time for physicians to use the EHR most effectively, and patients will be more engaged and compliant with treatment, wellness and prevention regimens. EHR has been said to be technology that creates a clinical transformation – and I truly believe that.