APMA News - May 2012 - (Page 72)
Small Business 101
From the American Academy of Podiatric Practice Management, the voice of practice management for the profession.
By John Guiliana, DPM
Don’t Derail EHR Implementation
This is the year of the electronic health record (EHR). To receive maximum incentive money for EHR adoption, as well as to prevent deep payment adjustments in 2015 and beyond, providers must implement a certified EHR in 2012. At the same time, the daunting task of conversion to ICD-10 is looming, so getting EHR challenges out of the way now is crucial. My most valuable mentor taught me mistakes are inevitable—just don’t repeat them. So learning from those who have gone through the process already is a vital way of shortening your learning curve. Don’t stare at the obstacle you’re trying to avoid unless you want to crash into it. It’s easier to identify obstacles in advance and develop strategies to miss them. Thankfully, there seem to be a finite number of obstacles. If a practice doesn’t avoid them, the EHR ride doesn’t just get bumpy. It gets derailed. search for that chart entry for confirmation of what you hand prescribed last time. Then you will have to rewrite it on that paper pad again and scan or note it once again. And you will still miss out on the EHR autochecking your prescription against patient allergies, drug interactions, etc. And let’s not forget about the meaningful use criterion you’re sidestepping.
Obstacle #3: Practice, Practice, Practice
You and your EHR must be bosom buddies by the time you see your first patient. This advice applies mainly to those going electronic for the first time, but a lack of familiarity can derail anyone. Trained repetition generates familiarity with navigating the system; nothing less will do. Depending on your trainers, numerous, dedicated, supervised sessions, replete with increasingly realistic test patients, will give you the muscle memory you need to reach for the right buttons. There is nothing more frustrating than knowing what you want to do but not knowing how to make the system do it— all while you’re an hour behind and counting. You learn by doing, just like in medical school and residency. Your go-live day is not the time to figure out where the lab results are, or how to renew meds, or how to create and modify templates.
Obstacle #1: Chart Preparation
Incomplete charts are the biggest obstacle to timely adoption of EHR. Remember the key principle of working to the highest level of licensure. If you need to take on the role of clerical staff, filling in the medications, allergies, and chronic medical conditions—especially during a patient visit, when you should be concentrating on clinical matters—that means someone else in the office did not fulfill his or her responsibilities. And that’s a waste of your time—the costliest time. Save three minutes on each visit, and you will go home an hour early at the end of a 20-patient day. Conversely, spending extra time with each patient will put you hours behind by the end of the day, especially if you are taking five to 10 minutes to fill in data. Have your staff add chart data to the EHR the day before or the morning of the visit. Have staff pull the paper charts on patients who will be coming in later. Instruct them to routinely extract the critical information you will need for proper context and decision making and put it in the electronic chart. That information includes chronic conditions, medications, allergies, labs, etc. Staff must be well-trained and integrated into the entire EHR process from the beginning.
Obstacle #4: You’re Good, But You’re Not That Good
Lower your EHR stress by reducing your volume of patients for the first several weeks. Even with proper preparation, you still will fumble and be slower than usual. Do yourself and your staff a favor and build in some wiggle room to account for the learning curve. You can always add more patients to your schedule if you have done a stellar prep job. Shoot for a 25-percent reduction in patient volume for two to three weeks following your go-live date.
Obstacle #5: Be a Cad, Take Advantage
Make the best use of shortcuts the system offers you. It is foolish to not take advantage of features designed to make your life easier. Speak to users who have learned how to save time by using the system’s tools more efficiently. Macros, hyperlinks, and templates all take time to set up, but by doing so, you greatly reduce your downstream workload. Longtime users of the software can often teach these tricks to you (peer-to-peer) better than the software trainers can. n Contact Dr. Guiliana at Jguiliana@aappm.org.
Obstacle #2: e-Prescribing
The debate still rages over which is faster: writing on a prescription pad or clicking checkboxes. You are multiplying your downstream workload by a factor of four with every script you write by hand as opposed to e-prescribe. You still have to scan the paper into the chart, or note it with a text entry you have to create—unless you’re okay with taking a major treatment action you fail to document. Come refill time, you will have to
72 APMA News May 2012
Table of Contents for the Digital Edition of APMA News - May 2012
APMA News - May 2012
92nd House of Delegates: Advancing Education and the Profession
Special Section: APMA Educational Foundation
Being a Residency Director: What’s in it for You?
DPM versus MD: Letters to the Editor
JCRSB Update: May 2012
ACO Update: Are Commercial ACOs Getting a Leg Up on their Medicare Brethren?
APMA By the Decade: 1952–1961
Profiles in Progress: Medical Staff Leadership
2011 Podiatric Practice Survey: Determination of Income/Salary for Employed Professionals
Master Your Practice at the National
Annual Scientific Meeting Preliminary Program
Annual Scientific Meeting Registration Form
Annual Scientific Meeting Sponsors
Federal Advocacy Forum
APMAPAC Chair Report
Small Business 101
APMA All Stars
Worthy of Note
List of Affiliated Organizations
Dates to Remember
APMA News - May 2012