Were there ever more daunting words than ‘EHR optimization?’ Truth is, there’s more logic than technical tweaking in the task.
Online Resources for EHR Optimization
Resources abound for community health centers and primary care associations who are tasked with bringing a fleet of EHRs up to speed, including the amiable healthit.gov site, which suggests first asking questions such as:
- “Am I accomplishing what I thought I would be doing when I decided to go to medical school?”
- “Are we providing the best possible care to our patients, or are we simply trying to make it through the week?”
- “If I had more time, what would I do differently?”
- “What would it be like to leave the office yet stay connected to my practice?”
For those who feel stuck due to fear of something greater, the Guide to Reducing Unintended Consequences of Electronic Health Records is an online resource designed to help you anticipate, avoid, and address problems that can occur when implementing and using an electronic health record (EHR).
The Guide, prepared by the RAND Corporation for the Agency for Healthcare Research and Quality, presents a compilation of best practices and practical, troubleshooting knowledge and resources.
Case Study: MACIPA’s EHR Implementation
Drilling down further, we can look at the experience of a pioneering physician group in Massachusetts—Mount Auburn Cambridge Independent Practice Association (MACIPA)–that discovered key lessons in an EHR implementation about its role in support of physician members.
KEY LESSON:Techy though it is, EHR is a clinical initiative. Be sure to involve physicians in clinical data standardization, first and foremost. A highly optimized EHR system uses analytics to assess ongoing remediation efforts to improve clinical outcomes.
But logic drives the process just as much as numbers. When MACIPA discovered, for example, that physicians weren’t making full use of the ‘favorites’ file, they added that to training sessions to ‘optimize’ its use.
MACIPA at a Glance:
* Founded in 1985 to organize physicians and negotiate managed care contract
* 50 employees; 520 physicians who admit patients to Mount Auburn Hospital and/or Cambridge Health Alliance
* Pioneer Accountable Care Organization
* First physician group to sign the BCBSMA Alternative Quality Contract (AQC)
In many ways, MACIPA is ahead of the curve, especially when it comes to understanding what EHR optimization means, and how to achieve it in four key areas:
- operational processes
- clinical workflows
- standardization of clinical data inputs
EHR timeline, condensed
In 2006, MACIPA chose eClinicalWorks (eCW) software. The organization decided to build its own datacenter with a network of servers running eCW, complete with a disaster recovery plan, according to Barbara Spivak, M.D., president of MACIPA, who spoke about the project at Healthmart ’09.
The project began in earnest in 2007 with four physician groups using the EHR, said Paul Sawyer, director of IT at MACIPA, who spoke at Healthmart in 2011. The staff worked with practices for 1-3 weeks following a go-live date, then transitioned them to a HelpDesk and Account Manager. MACIPA provided retraining if needed in month two, with additional training and support for “Super Users.”
Steadily growing its presence among physician practices, in April of 2010 MACIPA kicked off a Meaningful Use (MU) initiative. For a year, the group conducted scheduled and “just-in-time” training sessions to address gaps related to meeting MU requirements.
By May 2011, when it upgraded to the MU-certified eCW version 9, the MACIPA infrastructure had grown to include 45 instances of eClinicalWorks as well as connections to Converge, LabTrak, Meditech, Quest, GE-IDX, AthenaHealth, and MedFx platforms, a community HIE and a patient portal.
Support toward Continuous Improvement
MACIPA organization’s role extends to the resolution of software bugs, meeting new functionality requests, managing a collaborative working relationship with eCW, and deciding when and if to upgrade software based on operational needs and physician practices’ ability to absorb change, according to Spivak.
She was most astonished by the abstraction process, or “How to take 30 years of medical record and distill it to a few pages.” This rethinking and reorganizing can drive people to frustration, so it’s important to help physicians develop a new way of thinking about charting.
Optimization tip #1: Prepare charts prior to go-live, so on that day, the EHR is filled with data
Come back to the Azara Community next week to hear more about MACIPA’s EHR optimization. Have a tip to share? Contact us or comment below!