Advanced EHR Utilization for Physicians

Last week's post described how my office has incorporated the use of an EHR into our daily work flow for providing patient care. With the new incentives proposed by the federal government driving the incorporation of an EHR into medical practices, it is important to remember that not all EHRs are created the same. I would encourage each practice manager, physician, nurse, etc., to be an active participant in the selection process and visit other practices that are already using an EHR to see how well it works for each office. That is just what I did several years ago.

The efficient workflow starts with check-in at the office. My receptionists are able to verify that each patient's insurance coverage is active. Identification of a past balance is also easily handled and helps to keep our patient accounts as low as possible. Appointment reminders are used by an automated service that pulls the demographic data from our EHR and calls each patient two days prior to their appointment. Patients can either confirm their appointment or select an option for a call back to reschedule or cancel.

Once the patient enters the clinical area, my nurses are able to quickly identify certain patients using either preset alerts or color codes. Diabetics are identified by color on the schedule and the nurses are able to review their flowsheets to see if a hemoglobin A1c is due. Patients that are on oral anticoagulation are also quickly identified and a fingerstick INR is obtained and placed into their current visit before the physician enters the room. It is important to remember that we do not let our EHR tell us what to do, rather we use it as a tool to provide better and more efficient patient care.

Physicians and nurse practitioners are able to stay on time and see patients in the order they were scheduled by configuring our tracking board to display an identifier by the "next" patient. Once the encounter starts, we are able to have a snapshot of our patients' medical histories by reviewing the health summary. Health maintenance is completed by using the preconfigured rules to prompt us to ask about mammograms, pap smears, colonoscopies, etc., and quickly order those tests when needed. Flowsheets allow us to review vital signs and see how well the patient has done with weight loss, blood pressure control, etc., and even quickly give the patient a printed graph showing the relationship of two measured clinical data points (ex- weight and LDL).

Medications are easily updated and refilled using the prescription writer tool. My nurses also verify the patient's pharmacy of preference before I come in and as medications need to be refilled, those medications are sent electronically to the correct pharmacy. Redundant refills are avoided because we are able to see when the last medication was refilled. Important medication interactions are also easily reviewed by using a color-coded legend that reminds the physician of pending problems.

We are also able to decrease our number of call backs from pharmacies, labs and outpatient hospital departments because each medication that is prescribed or test that is ordered is properly matched with the ICD-9 code during the ordering process. When a patient is given an order for a diagnostic test, the codes match up properly on each line and my electronic signature is placed on the bottom of the requisition.

When our office receives the results of previously ordered labs and diagnostic testing, the results are placed into the documentation management tool and my nurses are able to forward them to each patient's chart in the form of an intra-office e-mail that the physician can open, review, and then send an action back to the nurse. Labs are received and automatically imported via an interface into each patient's chart. Patients that choose to use our online portal can view their lab and x-ray results within hours of receipt by our office.

Making the leap to adopting an EHR is a daunting task for those practices that are still using paper. After choosing your EHR wisely and incorporating each feature into your daily workflow, you will then be able to add this powerful tool to your clinical arsenal and provide more efficient care to your patients.