New EHR Implementation? Involve Your Physicians

By: on September 27, 2017

Selecting a new electronic health records (EHR) solution for your small practice is a critical decision and requires significant planning. Eliminating paper records or replacing your existing EHR might look like a winning move for your staff, but if you don’t have buy-in from the physicians at your practice, you’ll run into significant hurdles.

Regular physician participation (Source: American Medical Association)

Let’s review the three important aspects of an EHR system:

Clinical documentation: The creation of a digital or analog record detailing a medical treatment, medical trial or clinical test.

Computer-based physician order entry (CPOE): The process of a medical professional entering medication orders or other physician instructions electronically instead of on paper charts.

Clinical decision support (CDS): Provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care.

In this article, we’ll help you understand why physician involvement is such a critical step when moving to a new EHR solution.

We’ll focus on three aspects of EHR system building—clinical documentation, CPOE and CDS—since these functions consume most of the medical practice’s time spent in the EHR.

Why Physician Advice Is Necessary

Small practices have a tight budget. They might say to themselves: “It’s expensive to implement an EHR, so why pay to consult a physician specialist during the configuration process? And if we’ll eventually work the kinks out, why waste time and money on clinical documentation ahead of time?”

But remember: A failed EHR implementation is much more costly than any investment that adds a little time and cost to your implementation.

To be successful in implementing a new EHR solution or updating the existing one, small medical practices must ensure constant physician engagement during the complete process.

Physician advice is essential for the following reasons:

  • They know what will actually get used. Since modern EHR solutions are highly configurable, practices need to make accurate and appropriate decisions for final adoption and acceptance. The continued involvement of physicians in EHR selection, configuration, implementation and training aids in better adoption across the practice as a result of their specialty-specific knowledge.
  • They can see the bigger picture—both inpatient and outpatient. All features of the new EHR system need to be integrated with each medical specialty in both acute (inpatient) and ambulatory (outpatient) care, which requires detailed specialty-specific physician input.
  • They can smooth out the workflow. Capturing accurate and coded information along with a smooth workflow requires the expert judgement of a physician. Also, EHR system analysts and implementers require frequent physician feedback regarding screens and workflow during implementation.
  • They can’t be avoided. All other medical staff members—such as nurses, therapists, nutritionists and pharmacists—will be interacting closely with physicians as they use the EHR.

As a small medical practice, moving to a new EHR solution might be one of the riskiest, time-consuming and expensive endeavors you will undertake. If you’re aiming for better patient safety, reliable medical care and quick ROI from the new EHR implementation, engage your physicians to make a planned and thoughtful implementation.

How to Involve Your Physicians

Above, three key components of any EHR were laid out—and these are the areas in which you should involve your practice’s physicians.

Clinical Documentation

Engage speciality-specific physicians to review clinical documentation for precise information capture and correct workflow.

There are several benefits of accurate and specialty-specific clinical documentation by physicians. Depending on the type of EHR deployment process, specialty-specific physicians must be familiar with all the documentation and workflow requirements in different departments such as ambulatory (outpatient) and acute (inpatient) care, emergency and labor and delivery.

Allscripts templates

Small practices and physicians must ask the following EHR-building questions:

What documentation templates do we want to use?

Templates save a lot of documentation time as well as capture and store all coded findings. However, if not designed intuitively for the physicians that use them, they can disrupt a patient’s interview flow and eventually slow down the practice’s efficiency. Therefore, clinicians must decide in advance whether physicians will develop and use their own templates or use pre-existing ones for convenience.

What boilerplate text should we set?

Other than fixed templates, EHR systems enable clinicians and physicians to refer to previously inputted text, phrases or paragraphs as the starting point to treat new patients by editing and adapting the old text. Physicians should be consulted to make these intuitive to their style.

What speech recognition tools can we use for documentation?

Speech recognition tools available today are much more efficient and feature lower error rates than tools from a few years ago. Physicians can use these tools to develop new documentations or edit the existing templates or preformed text—so they must feel comfortable with the solution.

Computer-Based Physician Order Entry (CPOE)

Ensure that physicians related to all your specialities get a chance to edit the order sets for CPOE.

CPOE is an important component of any fully featured EHR solution and consumes considerable physician time. As a result, physician engagement during EHR configuration is critical. Similar to clinical documentation, CPOE also requires a specialty-specific physician review for an efficient workflow.

Physicians generally require a lot of time to consult their medical staff and then get approval for order sets so that the EHR can be built. Small practices and physicians must ask themselves the following EHR-building queries related to CPOE. Remember, this isn’t an exhaustive list, but can help trigger the thinking process:

Do our order sets cover routine orders that are applicable for most patient admissions (such as diet, vitals, activity, admitting and attending doctors)?

First, physicians must consult and try to build as many order sets as possible that can apply to most medical admissions. Then they should focus on building order sets for specific medical conditions.

Do our order sets cover common conditions (such as sleep, constipation, nausea and pain)?

Order sets save a lot of physician time by helping to standardize the medical practice, eliminate variations in patient care and eventually lead to consistent and safe patient care. Physicians should be consulted to ensure these are set comprehensively and accurately.

Is each order set’s evidence base documented?

Aside from saving a lot of physician time, order sets enable medical practices to standardize processes and introduce evidence-based treatment. Though every patient is unique and requires personalized treatment, removing the non-patient related variations (through documented evidence-based order sets) makes overall patient care safe and reliable.

Zynx order sets (Source)

For example, medical practices often use solutions such as ZynxOrder that provide several evidence-based order sets that help improve inpatient outcomes by decreasing practice variations, risks and uncertainty.

Clinical Decision Support (CDS)

Invite your physicians to edit and approve CDS in order to ensure decisions are thoroughly vetted ahead of time.

Just like CPOE, clinical decision support (CDS) is an important component of any EHR solution that physicians dedicated lots of time to. CDS helps clinicians with tasks such as prescribing medications and reducing gaps in patient care.

It significantly affects the usability of EHR solutions, which is why it requires detailed physician inputs during configuration. In a layman’s language, CDS is an application that analyzes data to help practices make clinical decisions.

Kareo clinical decision support (Source: Kareo)

A CDS can be in the form of lists of medications or labs, while others display latest lab values or patient results when new orders are inputted. Small practices and physicians must ask themselves the following EHR building queries related to CDS:

Has the order of items in CDS lists been reviewed?

Physician review is required in all items present in the CDS lists—from antibiotics used for different treatments to drop-down lists in clinical documentation—to increase the chances of cost savings and introducing best practices.

What type of data can the EHR solution automatically display?

Generally, display of previous diagnostic test results reduces the ordering of new tests. Physicians like to view data linked to clinical documentation while patients want to avoid unnecessary costs. Since every EHR solution has different features and capabilities in the CDS domain, specific physician inputs are critical.

What advice does the EHR solution provide on lab and diagnostic studies?

Regarding the most suitable study to order in a specific medical situation, there are medical technology providers who can offer CDS while advanced medical practices can develop their own CDS. The process can be time consuming and may not get addressed even after implementing the EHR solution for quite some time. Hence, physicians must be involved in the order configuration and review process.

Conclusions and Next Steps

Whether you are shifting from paper records to EHR or modifying your existing one, the whole process is long and requires huge efforts on everyone’s part. Clinical documentation, CPOE and CDS are three crucial areas where physician involvement can produce better results and long-term benefits.

To remain competitive, it’s essential for small medical practices to be aware of physician engagement techniques and develop a plan to adopt them.

In addition, for a free consultation with a software advisor on new EHR software requirements, call us at (844) 686-5616. Or, to receive custom price quotes in your inbox, fill out this short questionnaire and we’ll email you the details.

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