Software Solutions/EHR

EHR Protocol: Set Up Consistent Rules to Maximize Benefits

By Ryan C. Wineinger, OD

Creating staff protocols for use of your electronic health records allows you to get the most out of the system.

With optometric offices increasingly adopting electronic health records, use of these systems often is not as well thought-out as it should be. Doctors and staff at the same practice may have different ways of inputting information or may save the same kind of information to different places in the software. My office, which uses OfficeMate ExamWRITER EHR technology, is able to ensure top performance of our system by establishing consistent rules for use of the EHR. When it comes time to input information, there is no need to guess how the information should be inputted or where in the system it should be placed. Here is how we get the most out of our EHR by sticking to an established protocol for use.

Garbage In, Gospel Out

Most people are familiar with the expression “garbage-in, garbage-out.” A more fitting expression for an office without a consistent protocol for inputting EHR information might be “garbage in, gospel out.” In other words, you can’t rely on the information the computer displays or produces if you don’t have an accurate system in place to capture accurate information. The system won’t be able to give you the hard facts about your practice and patients without accurate information in its database. If information is not inputted accurately, then you can run the risk of missing a potential diagnosis or thinking your practice is doing better financially than it actually is.

For example, let’s say a borderline glaucoma suspect who has elevated pressures and a suspicious looking optic nerve comes in. If your staff doesn’t have an accurate workflow plan for inputting health history, wouldn’t missing that patient’s family history of a mother with blindness from glaucoma change your plan for that patient?

Review All Stages of Patient Flow

When looking at implementing workflow change to create an efficient electronic record interaction, all aspects of the practice need to be reviewed and accounted for. If you overlook the patient hand-off for example (from doctor to optician) that communication could reduce your capture ratio. So, when the electronic record produces a report that says your capture ratio is 5 percent, don’t take that number as gospel, look at the way the system is capturing that number and why it displays the results that it does.

Accurate Information Drives Revenues

There are a few different areas where you can look at EHR-powered revenue generation, chief among them medical billing. In a workflow environment where accurate information is inputted into an electronic record, that system should be able to display every time a patient has had a special test done. You should easily, with the click of a mouse or tap of a finger, be able to see when a patient is due for another test or ensure you billed that office visit at the correct level. Another area where a lot of practices have been able to benefit revenue-wise from electronic records is direct-to-patient marketing based on previous buying habits.

If you want to do a high-end level frame trunk show, electronic systems allow you to mine your patients for certain aspects of their previous buying experience. For example, if you are doing a trunk show for frames that have a starting retail price of $500, you would probably have a higher capture ratio if you only market to patients who have purchased a frame in the past from your practice around that value. This patient data mining can help to both increase the capture ratio of the marketing program, but in the end, hopefully reduce the overall cost, as well.

Train New Staff on Protocols

We rely on our EHR and practice management system vendor, OfficeMate, to help us train staff on consistent use of the EHR. I would encourage every person who has a system, is looking for a system, or is just dreaming about a system to ask your current vendor about the training they provide. Most high-quality systems have an entire training module laid out with most of that training able to be done at the employee’s own pace with online webinars and courses. Why try and reinvent the wheel by formulating a plan to train new employees on your system, when the vendor should be the expert and more than likely has a significant amount of tools that take very little work from the practice to help train new staff?

Strive to Train All Staff on All Aspects of EHR Data Inputting

In our office, we make an effort to have every member in the practice trained to enter information in specific areas of the electronic record. Now we have staff who are more skilled in the optical dispensary part of the record and other staff who are more skilled in the examination part of the record. Ideally, I like to have all staff trained to input information in all areas of the system. When all staff members have the knowledge they need to consistently input information in all areas of the EHR, you eliminate practice silos and create a better informed staff capable of providing a better patient experience.

By definition, an OD’s job interacting with the EHR system is different from a support staff member’s. But when it comes to inputting data, a similar workflow should be followed. Like anything in a successful business, it comes down to communication and training. So, an office workflow on data entry should be communicated to staff in terms of the exact steps that need to be taken each time information is added to the system. Ideally a practice should have a workflow handbook that teaches every staff member to capture data in the same process and record that information in the same place within the electronic record.

Ensure All Images Make It Into Patient Records

We use the ordering tool in our ExamWRITER to help ensure that all images and or tests get reviewed. The tool allows either a doctor or a staff member to order a test then send that order to the appropriate staff person for testing. For example, a doctor could order a visual field within the EHR and then send that order to a staff member. The staff member can see that order, then send it to the doctor for review. Once the doctor reviews that visual field and finishes an interpretation and report, the order can be sent back to a staff member to ensure the image is captured into the system appropriately. Once that process is finished, the staff member can mark it complete. All of this is kept in a log and is track-able.

Make It Easy for Staff to Remember With Intuitive Processes

We don’t have sticky notes posted around the office to remind us how to use the EHR. But we have tried to make processes like our input history forms, EHR layout (templates) and product selection in the optical intuitive and logical.

Create Security Protocols

Most good electronic records have both role-based security and an auditing log. Role-based security allows an office to allow some people in certain parts of the record and not others. ROB Editor’s note: Role-based security in accessing your EHR system is more than a luxury–it’s a federal HIPAA requirement.

Examples of a couple of areas where you may not want all staff members having access to: secure financial reports, electronic prescribing of medications, documentation of certain areas of the examination. Additionally, most good systems can put a time restriction on how long they can be logged in and inactive. That time frame might be different for a smaller office that keeps most staff members at their own computers. Larger practices might put that time out period at one minute while others might put it at 10 minutes. The certification of medical records to participate in the electronic health records incentive program has dramatically improved both office security and audit logs. Certification required significantly higher security levels than most eyecare offices needed, but we benefited in these additional levels as we now have a large number of tools to keep our EHRs safer than they were before the certification process.

Consistent Use of EHR: Action Plan

Create a system that makes as much sense as possible and train all staff (ODs and non-ODs) to capture and input information in the same manner.

Create a pre-exam workflow, exam workflow and post-exam workflow and ensure that each staff member knows their role in that workflow and can capture information and input information the same way every time the same scenario comes up to encourage accurate information inputting.

Teach the importance of accurate information resulting in better output of data from the system. Once staff members understand the logic behind the need for accurate data input–that doing so will allow the system to generate better information for them in turn–they are more likely to be thorough and consistent inputting information.

Related ROB Articles

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Personalize Patient Care with Help from Your EHR System

Combine EHR System and Recall Software to Make Patient Recall More Effective and Profitable

Ryan C. Wineinger, OD, is co-owner of Wineinger Vision Associates in Shawnee, Kan. He can reached at: rwineinger@gmail.com.

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