Survive or thrive: Making EHR work in the practice

Take-home:

Implementing and maintaining an electronic health record system requires constant auditing and training, but it can also improve efficiency throughout the practice.

By Nancy Groves; Reviewed by Tom Burke

Implementing an electronic health record (EHR) system in a large, multispecialty eye-care group can be challenging, but the benefits outweigh the negatives, said Tom Burke, chief executive officer, Ophthalmic Consultants of Long Island (OCLI).

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Burke shared suggestions for making EHR work in an ophthalmic practice, based on OCLI’s gradual rolling implementation effort-by location and specialty-that began in July 2012 and will eventually integrate 11 offices. This group has 32 physicians and 400 staff, however, and the equation would not necessarily be the same in a smaller practice.

Charting functions

EHR can address many aspects of the medical practice, including essential tasks such as charting, which, when performed manually, has an estimated 15% misfile rate and 7% loss rate.

“We’re reclaiming valuable space for clinical uses by using offsite storage and scanning of charts,” Burke said.

OCLI has phased out paper charts entirely except for research encounters and one recently purchased location.

“The practice saves time and money by contracting with a company that allows us to manifest our charts via their portal, transports those charts back to their storage facility, and provides scan on demand service directly into our EHR system,” he said.

To use the charting function of an EHR system efficiently, Burke suggests performing all chart abstraction for the staff in advance of upcoming visits and having the charts picked up and removed before the appointment, depending on the physician’s preference.

“In many cases, doctors preferred to hold onto the physical chart for one or two more appointments, and we accommodated those requests,” he said.

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He also advises loading as many of the historical images as possible from your diagnostic devices in advance to reduce last-minute requests while seeing the patient.

EHR is also invaluable for documentation, and using this feature helps physicians become more aware of nuances, Burke said. OCLI has a provider approval queue in its EHR system that the doctors review regularly, as well as a quality assurance review.

“By reviewing the chart after it has been created electronically, the provider has a more complete understanding of what the scribes and checkout staff are doing as far as data entry and subsequent claims submission,” Burke said. “While reviewing the electronic record in the exam lane or in their queue, they can have more hands-on input for accurate data entry and documented support for their level of coding, the addition of modifiers used, and other tasks.”

Claims submissions

The central business office performs daily reviews of diagnostic testing, in-office surgical procedures, and exam claims posting, including modifiers. The claims are scrubbed just prior to submission.

“This error checking in advance of submission leads to a cleaner claim submission, resulting in reduce ‘days sales outstanding’ and accounts receivable work for other billing department team members. This gets your money into the practice sooner and with lesser cost of correction work after the initial submission,” Burke said.

“Efforts to reduce clinical claims adjudication are paying off. The time wasted on pulling records, obtaining a translation of the handwriting of the physician or anyone else who was in the chart is much reduced now with EHR,” he added.

The big clinical advantage over time is that each department learns the needs of the other, Burke noted.

“Our staff and the billing department understand the records more fully because they can see the entire record and they’re learning from it,” he said. “We’ve been able to comply with requests much quicker; we can turn around documentation requests from payers much faster now that we have EHR system.”

Offline and offsite record access

Describing the impact of the EHR on the practice’s business continuity, he noted that the offline record reproduction and appointment booking software system the group uses is particularly helpful during situations such as a recent power outage at one site during planned downtime due to the installation of a new generator. Patients could still be seen using paper records produced from PDFs of their prior exams.

Remote access to the electronic records is a popular feature for physicians and staff who are working offsite.

“Records and images can be made available while traveling, for presentations, for studies, for treatment experiences. In case of a snow emergency, we’ve got records and contact information all ready for everyone. It’s much easier than it was in the past,” Burke said. “We’ve got image review and consultation with referral sources, which has been very helpful and is good for networking in your community.”

Going digital

If your practice is considering an investment in EHR, Burke recommends going completely electronic.

“Avoid inefficient paper-electronic hybrid systems,” he said. “There are higher costs trying to maintain two, and you also tend to lose or mix records, and that can be very difficult for the practitioner and certainly for the staff members who are trying to provide the records to you in an efficient and timely manner.”

He emphasized that implementing EHR entails a transition period that can be difficult for everyone.

“It’s a teamwork process,” he said. “You have to train, retrain, audit, and retrain again. Your staff and administrators are going through a lot with this, as are the providers. It requires a ton of patience.”

While OCLI has invested heavily in EHR and found it advantageous, is it worth it for a small practice today to make the leap?

“We find that not only do we think is it worth it but other practitioners in our community have made that decision. They feel it’s worth it as well,” Burke said.

Some practitioners have decided against EHR, though, often because they intend to quit practicing medicine in a few years and feel that any penalties they incur before then will be manageable.

Tom Burke

P: 866/733-6254

E: tburke@ocli.net

This article was adapted from Burke’s presentation during a symposium at the 2104 meeting of the American Society of Cataract and Refractive Surgery. Burke did not report any relevant commercial relationships.