September, 2016:

Improving Provider Efficiency and Satisfaction through EHR Optimization

The system has been “live” now for many months or even years, millions of dollars have been invested in the system, and the physicians have attended their training on how to use the system. Yet their struggles continue long past the initial learning curve; charts not getting closed/completed for days, physicians working late hours to deal with notes, letters, follow-up results, phone calls and the list goes on. What is the solution to help your providers?

A system optimization plan may be the answer to help solve these issues and probably many more. Optimization should be a proactive venture as it is not “break-fix” or implementation of features not included with the initial system roll-out.  So, just what is optimization?  Basically, it is the act, process or methodology of making something (i.e. design, system or decisions) as fully perfect, functional or effective as possible.

There are many ways to go about the optimization and multiple tools to assist with the process. An organization should identify a few (approximately 3-4) clinics that would act as a good pilot for the project.  Workflow re-evaluation is an extremely important part of this undertaking.  Have your optimization team member focus on each step of the process from patient check in all the way through check out. Look for unnecessary steps being done.  Are there any bottle necks preventing patients from getting into an exam in a timely manner?  If there is information needed from the patient, send it to the patient thru MyChart and have it completed prior to the visit.   Are there any functions being done by the clinician that could be done by the nursing staff?  Is there anything being printed that can be eliminated?  Are those lab requisitions for the in-house lab really necessary?  Work with the providers to find out what part of the system or visit is slowing them down.  Are they having trouble placing orders, finding lab or imaging results or is the slow-down with the note creation, or is it just that never ending in-basket.

Make use of any and all productivity tools that may be available to you, such as Pulse or PEP – Provider Efficiency Profile. Pulse is the personal dashboard to measure how efficiently the clinicians are using the system.  It will also offer links to targeted training materials to help providers improve in particular areas (i.e. orders or note completion).  Also, the organizations project team can make use of the Pulse scores to pinpoint areas where additional build or training may be needed.

The Provider Efficiency Profile (PEP) offers invaluable information regarding provider usage in the system. You will be able to see how an individual provider compares to others in the same department or specialty in respects to number of number of new patients being seen, how much time spent in the In-Basket, time on notes, letters and orders and much more.  It will also show how much time is spent in the system when not actually seeing scheduled patients, so you can really drill down on the amount of time doing work after hours.

On a recent engagement we used all of the examples mentioned above to evaluate key areas that providers maybe struggling with throughout their day. After thorough evaluation of all information gathered  in person with a provider and a deep dive into the Pulse and PEP information we formed multiple deliverables to assist with provider efficiency among them:

  • Creation of education sessions for providers focusing on in-basket, ordering workflows and note creation
  • Development of tools to assist with workflow processes i.e. smart sets, standardized “speed” buttons for LOS, diagnosis
  • Learning home dashboards created for the providers with tips, short-cuts and how to for certain functions, links to standardized documentation (i.e. sports physical forms) as well as general help topics
  • Roll-out of synopsis for focused problems such as diabetes, hypertension, thyroid diseases and others

While the impact of a few of these have yet to be reported or assessed, there has been a great deal of positive provider feedback on the first several training sessions that were held. Almost all attending felt that the material presented will help with their speed in the office and with patient care and satisfaction.  Additional training sessions and expansion of the optimization initiative is currently being under taken.

If an ambulatory optimization project is in the works for your organization, don’t forget a little PEP will go a long way in helping your providers be more efficient with time in the system and ultimately lead to a more satisfied patient.



Nancy Gagliano -MD Joins Culbert Healthcare Solutions’ Leadership Team as Chief Medical Officer

link here

Transcriptions & EMR Documentation

A common question in the industry these days is, “Will an EMR system replace Transcription”? The answer is no. It will reduce the number of dictated reports, but it will never replace it completely. Most providers now accept the EMR system and use the tools from within it for documentation. But there are a handful of providers who, despite starting out using the EMR system, have went back to using a transcription service for their dictated reports.

Many providers that choose to use the transcription method do so because charting in the EMR is seen as too time consuming, the EMR templates are not user friendly, or the type of normal visit versus a complicated visit is too hard to capture in a template. Lastly some prefer transcription because they’re able to keep the face to face interaction with the patient and not worry about the computer.

With this in mind, many institutions have an inbound transcription interface setup where the transcription report will leave the transcription service and file into the EMR InBasket. From there, a pool of secretaries who monitor the EMR InBasket for that department, will make any edits to these reports, cleaning it up before forwarding it on to the provider via the InBasket. Once signed off by the provider, the report will file into that visit encounter for that particular patient.

Another question that has been asked frequently is “Could we replace the transcription with voice recognition software”? Maybe, if the license cost per user is low for the VR software, the infrastructure is able to handle large amounts of voice data across the network, and that the equipment used by the end user is of high quality. Voice recognition software has come a very long way. There are many VR programs out there which have a medical dictionary database, providing easy grammar and spell check. However, the downside of VR is if the physician can’t get to a certain rate of accuracy, it’s not worth letting him use the VR system. The time he or she would spend editing garbage would be better spent using the EMR templates or transcription.

To summarize, neither transcription or traditional EMR documentation is going anywhere any time soon. We look forward to continuing to see advances in voice recognition software and how EMRs adapt to this growing contender in EHR documentation.