It’s time for the next installment in my series of posts looking at the long list of EHR benefits.
Eliminate Staff
The idea of eliminating staff is a really hard one to talk about. Often the staff in a medical office becomes a family and so it’s really hard to think about losing a staff member in order to pay for the EMR. In fact, it’s incredibly common for staff in a clinic to fear an EMR implementation because they’re afraid that their job is in jeopardy.
From my experience, it’s incredibly rare for any existing staff to lose their job during an EMR implementation.
There are two main reasons why it’s unlikely that someone will lose their job because of an EMR implementation. The first is that most healthcare organizations have a natural employee attrition. When this happens the organization can just choose to not replace the departing employee. This is one way to save money on staff without having to actually fire any employees.
The second reason that people don’t lose their job to the EMR is that those people get reassigned to new jobs. For some people this can be nearly as bad as losing a job, but for many it’s basically a shift in job responsibilities. This shift can often be welcome since the EMR implementation can free them up to do work that they always wanted to do and never were able to do before.
The areas of healthcare that I’ve seen most affected by an EMR implementation is medical records, transcription, billing, and the front desk. We’ve already written previously about transcription and EMR. The front desk and billing can be affected, but generally stays close to the same from what I’ve seen. A lot of this depends a lot on what type of staffing you had before the EMR. I have seen some organizations implement an EMR and save money on front desk and billing staff.
Medical records (or HIM if you prefer) is usually the most impacted. Certainly they still have an important place in the office for things like release of records and other records management functions. They also have to continue to deal with the legacy paper charts. However, their days of finding, organizing and filing charts are over when an EMR is put in place. In some cases the chart organizing and finding gets replaced with things like scanning into the EMR. In other cases, there isn’t as many medical records staff needed.
Many who are reading this post are probably balking at the idea of eliminating staff being a benefit of an EMR implementation. They’d no doubt point to the EHR backlash that we see from many doctors who complain that an EMR makes them much slower and takes up too much time. This is an important item to consider when evaluating the benefits of an EMR in your organization. It’s not much of a benefit to save other staff cost if the doctor spends twice as much time per patient.
However, on the other side of the coin is those doctors who swear by the efficiency their EMR provides them. I’ll never forget this older OB/GYN I met who told me he would NEVER use an EMR. Two years later that same OB/GYN was proclaiming his love of EMR. He described how he wouldn’t be able to see nearly as many patients as he did each day without the EMR. He acknowledged the slow down that occurred when they first implemented the EMR, but once they adapted to the EMR workflow they were able to see most patients.
No doubt Eliminating Staff can be a mixed EMR benefit basket depending on your unique situation. Although, this is true with almost every EMR benefit we’ll cover in this series. This can be a tremendous benefit of EMR or it can also be an expense as you find you need to hire more staff.
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I’d be interested in knowing how many practices switched to an EHR as a last resort after they reduced their staff?
My first major PC client, many years ago, was a government office that had to drop almost all of their clerical staff or lay off their professional staff. Many of these professionals were one of a kind specialists, who were essential to their work.
That’s when they most reluctantly decided to think about using PCs on everyone’s desk. They never looked back.
Having a large filing room staff is obscenely expensive and inefficient, even worse in a practice that has multiple locations and where patients have to go to different sites for different doctors. The paper records are never where you need them WHEN you need them, and faxing doesn’t work well either. An EHR can be a huge improvement in a practice. A doctor I talked to yesterday has begun to see how much easier it makes things for him to be able to login at any time, even remotely, to check things and do follow-ups.
Carl,
That is an interesting point. I could see that happening in a few cases. I’ve seen the EMR used when the doctor wanted to really simplify the operation and basically run it by themselves. Then, they used the EMR to automate many other parts of the office. I think they call it a micro-practice.
R Troy,
Reminds me of a previous post in the series about Accessibility of Charts: https://www.healthcareittoday.com/2013/01/10/ehr-benefit-accessibility-of-charts/
And that was that doctor’s point yesterday morning to me. BTW, I’ve been at numerous appointments where the patient shows up, but the records did not. Even in the same building. Far worse when offices are not together.
Ron
There is no doubt an EHR generally makes sense, yet if they were really efficiency drivers, practices wouldn’t have to be forced to use them.
In smaller practices I haven’t seen a loss of staff, but I have seen a drop of the transcription service.
I usually recommend to NOT drop the transcription…at least not until things settle down.
Docs don’t realize how much an EHR pushes the work load onto them, until the have that workload pushed onto them.
The chaos that ensues during the implementation of an EHR, especially a poorly planned implementation, can be less painful with extra staff around.
I remember few years ago when so many vendor sites had an ROI calculator where staff reduction was an important part of the calculation as a justification for EMR. As I consult with various EMR vendors, I don’t find a single vendor using ROI as a ‘tool’. Of course, there are two reasons – one being that Providers are not trained to think ROI. The second is that experience has shown that even in successful EMR implementations, staff reduction rarely happens exclusively because of EMR. As John rightly says, there may be other reasons for staff to leave.
What Providers should focus on is improving their workflow, reducing inefficiencies and working with staff to improve patient experience.
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EHRs should decrease the need for staff across the practice. No more pulling charts, filing charts, creating charts (with labels, stickers, pouches, clasps, and hole punching). Automated filing of lab reports and transcriptions. Faster prescriptions. More efficient interoffice communications between doctors and staff. Faster prescribing and streamlined prescription refill processes. Speedy order creation and more efficient tracking of outstanding reports. Quicker chart review. The list is endless. With these benefits, many practices either eliminate staff, lose staff through attrition, or grow without having to hire new staff.
Only in large practices or hospitals do/did you have dedicated file staff.
For smaller practices this isn’t an issue.
On the ROI topic, there is no ROI to an EHR.
There can be improved processes, but no ROI.
Don’t confuse this with the PM. A PM can surely show an ROI, but most practices are already on a PM prior to going EHR.
Also, I don’t count firing people as a return on investment.
Even a small practice should benefit from a full EHR solution, with prescription writing being faster, doctor note taking hopefully faster and far more legible, less time and effort and more accuracy in billing. In a large practice (I’m thinking of just one pediactric practice I know of), they do have a huge amount of space devoted to their files, and a large dedicated staff for handling those files. Everything there moves in slow motion while they handle the files, and doctors take a lot of time trying to find the info they need in all the paper. Bills are often a mess, and appointments are always slow and behind schedule.
Yes, loss of staff is not good for the staff. One would hope that some people would be trained to maintain the EHR, and that some would spend time scanning the old records into the system, and that layoffs would be mixed with people’s retirement or just moving on.
R Troy is missing the point – I agree with John Brewer, small practices do not have ‘a large dedicated staff’ for handling files. Everyone multi-tasks.
Second, while file handling aspects of the workflow are slow, which is where EMR helps speed up things, with EMR, the ‘slowness’ typically shifts from front office to ‘middle office’. What I mean by that is, a lot of providers (bear in mind, there are super users and providers that are very good at computer, but I’m talking about the average non-techie physician) are slow with EMR which means the overall workflow is still slow, you are unable to see more patients. Not because of front desk inefficiency, but now because of the EMR that slows physicians down.
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I’m quite aware that small practices don’t have dedicated file staff. But I’m also aware that in small practices the non-clinical staff still has to be larger because of the large amount of paperwork that comes with paper handling and manual billing along with paper prescriptions, and that doctors take a lot longer to look up patient info from paper files then from a well designed EHR.
That is, of course, a very important issue – a well designed EHR. It also needs to be well implemented, and everyone well trained. Of course, some doctors and / or their staff are not computer litterate, and that slows things down greatly during appointments. An EHR won’t help them much at all. But I look how even doctors like that struggle to find the records they need in thick paper files with their poor handwriting, plus the prescriptions and patient instructions they slowly write out but that patients and pharmacies can’t read or misread.
I also think about how these same practices – small to large, handle things when their patients are hospitalized. In real life, the hospitals don’t get the info they need and often make a mess out of treatment, and the doctors don’t get the lab results and treatment info. The doctors waste piles of time trying to get this info one way or another. Being stuck with paper and no data exchange does slow them down; it’s just not always obvious.
@Chandresh – True
@R Troy –
“Even a small practice should benefit from a full EHR solution”
Should being the key word. You can apply this same theoretical “should” to businesses across the spectrum:
– Quickbooks “should” benefit a small business making it more efficient in billing and bookkeeping
– Spreadsheets “should” benefit companies in organizing and displaying data.
…yet many still don’t use either of these to make their business operate better.
Let me re-state: I wouldn’t run a practice without an EHR, BUT if EHRs were such a benefit, practices would have been on them years ago.
The well designed issue is the major problem, followed by poor implementation, lousy leadership from the docs who should be the head cheerleader, etc.
In the paper file world, if poor handwriting was really an issue, and docs actually got sued over it, I’m guessing that would change…I haven’t studied this issue.
Even when on an EHR, with the convoluted ready, fire, aim process that has gone on to develop this industry, most hospitals still don’t have any better access to the digital files than they did to the paper files.
John,
Very true. Far too much bad design and implementation, far too many bosses and / or doctors who have no clue on handling medical records or an EHR, who hand it off to overworked office managers who want nothing to do with it either, and worse. As to bad handwriting, lots and lots with that. Illegible prescriptions, unreadable patient instructions, records that the doctor who wrote them can’t read.
You are also right on the last point; this nationwide rollout of EHR’s under fire from MU and penalties and the like has led to so many systems that are hard to get data into, harder yet to actually get data out of. Yet when it is done right, it feels like a miracle has happened.
A doctor I spoke to yesterday has finally discovered the ‘joys’ of being able to get his patient data where and when he needs it, easily and quickly. He used the EHR during the patient visit I observed yet it did not slow him down – at all. In fact, with the related imaging up on screen and far more readable then what he used to have on paper, he is actually more efficient and makes fewer mistakes.
@R Troy,
You know, for the most part, no matter how “bad” the EHR, if implemented correctly, things will be good.
The problem is, too many docs think implementation is just installing software.
There is a lot that goes into this, but really, if docs chose to go to an EHR vs being “forced” you’d see a lot more docs involved and driven to see the EHR succeed instead of griping the whole time and putting in minimal effort to learn the system.
The doctor two days ago said something interesting, that he and others (including the young woman who had done some ‘prescreening’), had absolutely hated the system at first. I’m not sure if some reconfiguration had been done, but I noted that he did very little navigation, that everything he needed was easy to get to. Also, the waiting time was noticably less then it had been on the prior visits, as no one had to wait for the paper files to be put on the right door.
I am curious what business school the administrators pushing EHRs went to
You save a few bucks on low paid transcriptionists. In return, average Doc spends an extra hour or more each day typing and entering discrete data.
Wouldn’t it make more business sense to have Docs see an extra hours worth of patients each day and keep low paid staff? Moving transcription and data entry from low paid individuals to highly paid individuals does not make business sense.
Of course, what should happen is that EHRs should provide higher quality care with less MD work. The current crop of EHRs fails that specification.