EHR’s JUST DON’T WORK!

July 11, 2012
Let’s face it; most EHR’s are designed for primary care physicians. The idea is to continue to grow the patient data in the record each time you see a patient. Eventually you end up with a robust history and clinical data that can be used to improve the quality of care. However, specialists get a patient referral, they see the patient two or three times and they are sent back to their primary care.

That’s the response I get from Specialist trying to adopt to a new EHR. Let’s face it; most EHR’s are designed for primary care physicians. The idea is to continue to grow the patient data in the record each time you see a patient. Eventually you end up with a robust history and clinical data that can be used to improve the quality of care. However, specialists get a patient referral, they see the patient two or three times and they are sent back to their primary care. This means that every patient is a new patient (outside of the frequent fliers).

 You have to treat a specialty EHR implementation different than a primary care. Your first step is to try to import all the electronic data that you can. The CCD export/import format is there for a reason. Insist that primary care physicians supply referrals with a CCD record on an electronic media. This will help reduce the staff’s time trying to build a record. Use or create an electronic history. Use your patient portal to get patient histories BEFORE they show up for their appointments. This should be done with discrete data, not a PDF or scanned document that gets stored with all the other images that never gets looked at.

 Once you have data, now you need to get a specialist to actually use a keyboard and mouse and try to see the same amount of patients every day. Unless you plan on adding two hours to your workday, you need to weave speech recognition into your workflow. Some EHR’s play better with dragon than others. The key is to develop the templates in such a manner, that the specialist can bounce around med lists, problem lists and other key fields without touching the keyboard or mouse. I know of some organizations that actually hire a scribe to follow the specialist around and complete the EHR note. Dragon will do this; you just need to find a good Dragon Slayer (Speech Recognition Analyst; I use Brian Mizell from HealthMagic) to build the profile, prompts and weave it into the template. Once you are done it will feel like they are dictating just like “the good ol’ days” before that nasty EHR. 

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