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5 Tips for Improving Provider Productivity with an EMR

Posted on May 13, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The most recent EMR adoption numbers I’ve seen are putting EMR adoption at about 60% of doctors. When I think about the other 40% of doctors that have yet to adopt an EMR, my guess is that the biggest reason they haven’t adopted an EMR is based on their fear that an EMR will negatively impact their practice and their productivity. They fear that a change to EMR is going to be negative rather than a positive that it could be.

A whitepaper called Getting Lean with Your Practice: Five Tips for Improving Provider Productivity with an EHR does a good job looking at the issues of productivity in a practice and how to improve that productivity. One thing it points out is that if you can’t measure it, then you don’t really know how you’re doing. Turns out, an EMR is a great way to measure productivity.

Think about all the data an EMR can produce that would have never been possible in an EMR. Patient wait times and documentation times are the most obvious when we’re talking about productivity. In the paper world, you really didn’t have a good idea if a doctor had 20 charts outstanding or none other than looking at the stack of charts on the desk and checking them. In the EMR world, you can easily report on who’s staying up with their charting and who is not.

In the productivity whitepaper mentioned above, after studying 25 providers at 12 diverse practices they found that same-day encounter close rates (ie. finishing the charting the day of the visit) was the single most revealing metric about the success of patient workflow processes. They suggest that this doesn’t mean you document every patient as you seem them. Instead, they suggest documenting as much as you can with the patient when you’re with them and then you wrap up any complex patients as the end of the day. This is usually the right balance for most doctors I’ve worked with as well.

Here are the full 5 tips from the whitepaper:

  1. Start on time.
  2. Work with cross-trained staff that can handle intake and documentation.
  3. Document encounters as much as possible during and immediately after visits, but don’t document more than necessary or spend too much clinical time on complex documentation.
  4. Close all patient encounters by the end of the day – This should involve just wrapping up documentation for complex encounters.
  5. Route documents appropriately and delegate responsibility for document handling effectively.

One of the other great takeaways from the whitepaper is the idea that doctors can and should be delegating more of the documentation to their staff. A Dr. Lizabeth Riley pointed out that “the data the system provided immediately opened my eyes to the fact that I was only giving my staff 1% of charting duties! Once I saw that, I knew thing had to change. My staff now does 40%-60% of my charting for me.”

There was a lot more interesting data in the whitepaper including the 5 different physician work styles from Truly Lean to Falling Behind and Frustrated. This last group is behind the EMR backlash. Hopefully some of the tips above can help a doctor become more productive with their EMR.

One Way Of Measuring Meaningful Use Productivity Loss

Posted on August 26, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I think I better just invite BobbyG to join me as a blogger since he’s often contributing essentially great blog posts in the comment. I just have to highlight them. So, here’s one comment that BobbyG offered that talks about the potential productivity loss that a clinic could see if they focus too much on meaningful use and not enough on the business case for implementing an EHR. I think we all know where I stand on this issue. If you don’t, then you should be reading EMR and HIPAA more often;-)

One of my concerns regarding a “stimulus focus” (i.e., an incentive money fixation) in lieu of a broader “business case focus” goes like this, if you will permit what may be a simplistic example:

ASSUME

[1] an average 2 minutes additional MU documentation burden per chart (that’s only 6 seconds on average to navigate to/”touch”/verify/enter each of the requisite 20 measures as needed for each patient during the attestation period);

[2] 100 patients seen per week, 50 weeks per year, or 5,000 charts touched annually;

[3] That’s 10,000 minutes, or ~167 hours;

[4] Multiply by a blended, fully G&A cost-multiplied FTE rate of $40/hour;

[5] 167 hrs/yr x $40/hr x five years = $33,400 MU labor,

exclusive of the FTE burden associated with the additional CQM reporting (“Clinical Quality Measures”). Now, recall that the max provider Medicare MU incentive reimbursement over the 5 years is $44,000 (and that money will be taxable income).

Worth it? Draw your own conclusions. Play with the input assumptions.

Now, obviously, the task (from my REC Adoption Support perspective) is to so effectively re-design workflow as to totally mitigate/eliminate any additional MU documentation burden while streamlining workflow ops more broadly, so that the MU incentive money is neither effectively erased nor appreciably diminished by all of this, and the provider is better off both financially and in terms of care quality and patient satisfaction.

We shall see, I guess.

While my illustrative scenario proffered above is rather simple and to a degree hypothetical, it is nonetheless based to a degree on my own playing around, stopwatch at the ready, in a “sandbox” e-MDs login provided us by the vendor, noting the navigation paths to the various MU “money field” target destinations.

A few seconds here or there, annualized, adds up quickly.