Help! My EMR is Killing Me
It goes without saying that physician and practice manager burnout is increasing with no end in sight.
This justifiable exhaustion and pessimism about the future of their vocations can distract from capitalizing on opportunities to increase practice efficiency and increase revenue – not to mention increase job satisfaction for physicians, practice managers, and the rest of the staff.
Despite their glaring deficiencies around areas such as usability, EMRs are key to achieving this goal.
In this article, I will discuss some ways to use your EMR to boost productivity for staff and physicians.
Decrease Repetitive Actions
This probably seems like common sense; nevertheless, if you monitor or record your tasks – or your staff’s – for week, how likely are you to find a significant number of repetitive tasks being undertaken?
This could be with a provider’s charting behavior, communication to patients, or even internal workflow tasks.
Your EMR has features for providers to simplify charting along with features to ease the reporting burden placed on practices by health plans.
EMR Efficiency for Clinical Staff
Are the providers using their EMR’s templating features?
If not, a first step would be review a set of notes for common visits – e.g., Welcome to Medicare, Annual Wellness, Well-child, UTIs, etc. – to see what items can be templated.
For example, some structured tasks such as preventative screenings, documentary evidence of education provided for items such as weight counseling or tobacco cessation are good targets for templating.
Additionally, in some cases, most of the visit can be templated and then the provider or other clinical staff can simply change structured text result or date values.
Templates have also been successful with planned diabetic visits.
Dr. West, an Endocrinologist in private practice, has written a very good summary of how he has found tangible benefits from using templates for common visits.
If your EMR has dictation capabilities, this may be another area to examine for improving efficiency.
Some providers have found tremendous success – especially, if they have used dictation at previous practices or in a hospital setting – with using Dragon from Nuance or another dictation product that is available within the practice’s EMR.
If your practice’s budget supports it, hiring scribes can be a surefire way to increase efficiency and take away a huge burden from providers.
Think of having a scribe as the next step above dictation software.
With a scribe, the provider spends the entirety of the visit interacting with the patient, and instead of having a prescribed documentation period outside of patient care time, the scribe performs the charting in real-time while the provider is treating the patient.
A scribe that is paired with a specific provider quickly becomes adept with how that specific provider conducts patient visits; moreover, as proficiency with the EMR grows, the scribe can concentrate on translating a provider’s care into structured data that will make it is easier for billing and other back office staff to send quality data to payers.
Also, as a further benefit, since providers with scribes can see more patients, an article in Keiser Health News noted that the use of scribes can boost a primary care practice’s revenue by up to $105,000.00.
There are also many other EMR tips and tricks that can be implemented. Some of them include using order sets for common diagnoses to speed up the documentation of a treatment plan, taking advantage of any capabilities to store favorites such as favorite diagnoses, medications, lab, or radiology orders.
Back Office EMR Efficiency
Clinical users aren’t the only ones in a practice that can benefit from more efficient EMR use.
Administrative staff within practices are increasingly responsible with providing quality data to health plans, fulfilling reporting requirements for CMS incentives such as MACRA/MIPS or GPRO for ACOs and large practice groups, and ensuring that claims – oxygen for a medical practice – are filed and paid in a timely manner.
Every practice is probably accustomed to receiving gaps in care reports or record requests from health plans that they subsequently must work through to maximize their eligibility for performance-based incentives.
Along with both the desire to maximize the quality of care received by their enrolled members, health plans are rated by the NCQA on their aggregated HEDIS scores; the push for practices to close gaps in care is part of that effort to increase their NCQA ranking or their Star rating with Medicare.
In addition to their recent increased pivot to cost, CMS is also still focused on providers’ quality. On both the CMS and commercial health plan front, optimized EMR use by staff can lead to increased quality scores.
As mentioned in the previous section, providers have a few options to increase the effectiveness of their charting.
Regardless of the method chosen, more standardized and structured data makes it easier to report HEDIS data and get ahead of health plan generated gaps in care reports.
For example, designated personnel – e.g., an incentive coordinator if one exists – can use registry functionality that exists in almost every EMR – although it may be an add-on with an associated additional cost- to run reports to create a list of, for example, patients whose last blood pressure put them in a hypertensive category, patients with abnormal BMIs that lack the requisite weight management counseling, diabetics with uncontrolled A1Cs or no recent A1C screening, or Medicare patients that need a fall risk screening.
Ideally, staff would run regular reports and then reach out to patients with gaps that also don’t have appointments scheduled, and if the patient has an appointment scheduled, make a notation in their chart to resolve the care gaps at the next visit.
Along with registry functionality, there are other features that EMRs and EMR vendors have available that can assist practices.
Given that there is a continuing migration away from the traditional fee for service payment model to value or population-based payments, accurate risk stratification is increasingly important.
Ensuring that your practice is billing that maximum number of allowable claims – when applicable – and that the services rendered are billed properly is critical to accurately assessing risk for a practice’s patient population.
Outside of risk stratification, effective billing is also important for closing HEDIS care gaps for patients. CPT codes – even those billed without a cost – are the preferred means to close gaps in care by payers, and the more performed services that a practice codes, the fewer items they have to manually submit from EMR data to close HEDIS gaps.
Examples would be coding exclusionary diagnoses – e.g., complete hysterectomy without residual cervical tissue to exclude a patient from the cervical cancer screening measure – or coding the patient’s BMI to avoid having to manually enter height and weight values into a payer’s web portal.
Maximizing Your Portal
If you don’t have a patient portal, you are most likely missing out on some potential efficiencies.
Most EMR vendors have portals that can be implemented in a relatively straightforward manner at low or no additional cost.
With a concerted effort at driving patients towards your portal, you can move towards decreasing the volume of calls to your prescription renewal line, non-emergent questions can be pushed into portal messages and responded to in a more efficient manner (using batching techniques for instance), patients can view their own clinical summaries, and patients can often request appointments.
If these tasks are increasingly moved away from discrete events that interrupt the concentration of the staff – i.e., if they are no longer bombarded with phone calls when they are trying to complete other tasks – they will be able to take advantage of optimal work methods to complete tasks with fewer errors, at a higher level of quality, and in less time.
Additionally, patients – regardless of their age – are increasingly comfortable with mobile devices, so taking responsibility for some of their healthcare through a mobile patient application won’t be any different than a lot of what they do with the rest of their life.
Think of how much of our personal financial life is managed through a mobile application.
There is one final area where portals shine – visit prep.
Increasingly, patient portals let practices push down forms or assessments to patients.
Examples include screenings on alcohol usage, the PHQ-2/9, and screenings for future fall risk to name a few.
Often, these forms are then tied to structured data within the practice’s EMR so that when the results of the assessment are pushed into the EMR, the data is already structured.
This then loops back into efficient charting to both save clinician time but to also make it easier for other staff to glean quality data to report to health plans.
Using the tool to make life easier
It is undeniable that for many physicians, the transition to EMRs has resulted to more time spent charting and increased burnout.
It, however, doesn’t have to be that way.
Despite their known challenges and deficiencies, there are many tools that EMRs have that can – when used properly – increase the efficiency of the practice and generate additional revenue.