Plenty of health plans will provide incentive payments through various performance improvement and quality initiatives. You may already be doing the work. Learn how to mine that information from your EHR. Speaker: Nancy Meisinger Senior Consultant at HealthPower Advisors Doylestown, Pennsylvania

1. What Money Are You Leaving On
The Table Because You Don’t Know
What's In Your EHR
2013 PAFP REGIONAL LEARNING SERIES
NANCY MEISINGER BSN, MBA
PCMH CCE
NORTH WILLOW GROVE FAMILY MEDICINE
NMEISINGER@ NWGFM.COM
215-672-7070

2. Think Ahead
 If there is a possibility that you will need to report on
data, decide carefully where to put it in your EHR

Think about upcoming reporting requirements like Meaningful
Use, PQRS and other clinical quality measures
 Start small and use an iterative process
 Use a PDSA cycle to identify problems before you roll out to
the whole practice
 LISTEN to feedback and concerns
 Adjust, but be prepared to set a rule and follow up on it

3. Think Ahead
 If there is a possibility that you will need to report on
data, decide carefully where to put it in your EHR
 WHO is going to record the data?
 WHERE are they going to record it?
 HOW will you confirm that the process is being
followed?
 WHY is this workflow necessary?

4. Think Ahead
 What goes into the EHR must come out of the EHR-or
does it?

Unstructured data
Free text-allows for variation
 Potentially easier workflow at time of care
 Makes reporting very difficult
 Will not be able to capture all info on reports


Structured data
Consistent format
 Consistent location within the EHR
 Much easier to capture on reports


Workflows to support process
Different workflows based on how the information is obtained
 Interfaces, fax server, paper
 Scanning documents and also entering data as structured


5. Think Ahead
 Maximize the use of the EHR standard reports and
registries



Run existing reports to get a baseline on what it is capturing
and where it pulls data from within the system
Understand how the EHR “closes the loop”, for instance
Meaningful Use metrics, Clinical Decision Support alerts
Change workflows as needed

6. Identify the Issues
 Technical vs. Social/User Issues

Technical examples
Network/computer hardware/infrastructure
 EHR Software installation/configuration
 EHR design – is it the right software for your type of practice?


Social/User examples
Users don’t know how to use the software
 Users don’t want to use the software
 Users don’t use the software consistently
 Workflows are absent, poorly followed or inconsistent


7. Identify the Issues
 There is rarely just one issue
 The fix is a combination of changes

8. IT issues
 IT inefficiencies are VERY expensive to live with
 Slow software, dropped connections, lost data all make
documenting slow and painful
 Sometimes just replacing old/outdated hardware will save
many dollars in the long run
 Check to see that you have printers, scanners, cameras
everywhere it makes sense
 If you are having problems with connectivity, speed,
backup, etc. seek help – these are complicated
issues and can cause major problems if not
addressed

9. User issues
 Try to identify the root of non-compliance
 Are the workflows good?
 Are the workflows well documented?
 Do people understand why they must use the EHR?
 Are the providers “on-board” with the EHR?
 Who is non-compliant?
 Providers?
 Clinical Assistants?
 Front Office

10. User issues
 When workflows are problematic
 MUST be well documented
 Training should be accompanied by written instructions
 Standing orders and practice policies must be written and
available to the users
 When people are non-compliant
 More training
 More education
 Listen to them – are they unable to comply because of bad
workflows or uncertain instructions?

11. EHR Vendor
 Engage your EHR vendor
 Even if it is challenging, try to work with them
 Communicating a technical problem effectively is a
skill




Work on this skill!
The better you are at communicating with your EHR vendor,
the better results you can expect
Some techs are bad, don’t be afraid to ask for another person
Be friendly and polite – you will catch more flies

12. Approach to Change
 Change is hard – take a small-ball approach
 Don’t try to fix everything at once
 Identify the root cause of the problems
 Create a list of problems and prioritize them, even if they are
interconnected
 Look carefully at the problems individually
 Are they technical or social in nature? i.e. is there a problem
with the EHR itself, or a problem with how the EHR is being
used? Perhaps a little of both?

13. Questions???