Study Workflow Problems

Identify actual (and perceived) sources of inefficiency, delay, duplication of effort, or wasted time that you hope an EHR can help alleviate. It is a useful exercise to calculate what these workflow issues may be costing you in time and money. Some examples include:

Time spent on the phone regarding medication changes or prescription refills
Delays due to trouble finding paper medical records
Delays in locating laboratory or other clinical results performed outside the practice
High costs associated with transcription of medical notes and other documents via a transcription service

As you examine workflow problems, it's important to be realistic about what computers and software can really do. No software program can do everything or even perform routine tasks that it hasn't been designed to do. For example, reports that include lab results can't be generated unless the lab results have been entered into the database. Similarly, alerts and reminders won't be generated unless someone has programmed them into the system.

It is also important to look critically at how features or functions of EHRs can save time or improve efficiency. Some that at first blush promise to be efficiency gainers in reality turn out to increase administrative costs. For example, e-prescribing software that prints to a printer and then must be faxed to the pharmacy could be more work -- not less -- for your practice. E-prescribing is truly efficiency gaining only when the prescription can be sent electronically to its place of fulfillment, the PBM or the pharmacy. This scenario cuts down on paperwork and filing, especially when done within the context of a full EHR.

It is critical to identify the features and functions that are of actual importance and likely to benefit your medical practice. The right features make it more likely that the right things will be done consistently, and that quality results will be routine instead of haphazard.

Resources:

The Practice Redesign Guide -- A compendium of redesign information from the AAFP that provides ideas and tools to make the practice of tomorrow a reality today.

Strategies for Better Patient Flow and Cycle Time -- This article from Family Practice Management can help you identify problem areas in patient flow and strategies to address issues. Although published in 2002, the issues and strategies hold true.

IHI.org Patient Cycle Tool -- This tool from the Institute for Healthcare Improvement helps you look at the total time patients are spending in the office, with the goal of minimizing wait times and maximizing time spent with the physician.

High Performance Physician Institute -- The High Performance Physician Institute exposes physicians to solutions developed by colleagues which address pressing issues such as accurate coding, regulatory compliance, payment for work done, detailed documentation, streamlining workflow, and prompt payment with fewer rejected claims.