Seven Best Practices for Optimizing EHRs Clinically and Financially

Healthcare professionals today face numerous competing daily tasks beyond patient care appointments. With the constant strain, healthcare facilities struggle with knowing if they are using their electronic health records (EHRs) to the full potential. To alleviate the confusion and optimize your EHR for combined clinical decision making and operational effectiveness, use the following seven tips.

Clinical Optimization Tasks

End-user education, data collection and system usability are the main areas of focus when initially assessing your EHR from a clinical standpoint. Are you collecting the correct information in the appropriate form? Are workflows efficient? Do clinicians have the appropriate tools, and are they using the EHR effectively? These questions can help as you conduct a comprehensive assessment, reviewing your EHR system and processes from patient registration to final billing.

1. Conduct clinical end-user interviews– Begin by reviewing daily end-user operations. Ask employees what they think needs to be improved and what is working well. Then assess end users’ system utilization. Is user knowledge an issue? How often is end-user education provided, and does it align with system upgrades or application transitions? Do new hire EHR education modules include simple and clear documentation and real practice examples? One easy way to improve system knowledge is to partner new employees with an EHR superuser mentor to help them quickly become comfortable with system use. Having a good understanding of providers’ perception of how the system is functioning is a good starting point prior to looking at the specifics of system use, workflows, information storage and providers’ direct interactions with the system.

2. Assess data collection processes– How information is collected impacts everything from direct patient care decision making to triggering clinical care best practice alerts appropriately. Can you trend information for research? Are you able to run historical reports based on cohorts of patient or diseases? These are just a few questions to consider when determining how data is collected, how it is stored and what data is being pulled from previous patient visits. Ensuring that the correct data is collected in the correct form is important, but making sure the workflow facilitates the provider’s view of aggregating data is just as critical. This is directly related to observing providers interacting with the system.

3. Perform a usability study– Review how clinicians interact with the EHR including the hardware and clinical tools that correlate. Are providers documenting at the bedside, or are they using scribes? Do they effectively navigate the system? Do they document in real time or after patient contact? Evaluate how these observations line up with the initial end-user interview process. Are there gaps or discrepancies? Are there bottlenecks in the workflows or limitations due to equipment or space? These critical factors can significantly impact system usability. For clinical optimization post assessment, look for documentation points where data should be changed from either discrete to free form or free form to discrete. Work this into clinical workflows to alleviate end-user system frustration.

Financial Optimization Tasks

With clinical optimization assessment considerations in hand, concurrently look at revenue cycle management (RCM) concerns. Provider practices typically have limited staff fulfilling business office duties, with most juggling multiple hats. Bottom line: financial representatives must utilize more efficient workflows. Follow these financial optimization steps to save staff time and improve their ability to create clean claims and reduce denials.

4. Create a list of authorization numbers per major health plan–Request a list of procedures that require authorization numbers from your payer representatives. During the appointment booking process, flag those procedures to prompt staff to call the payer for an authorization number and create a report to list those without one during nightly processing. Within the final financial clearance process, establish a step to check for an authorization number. If the A/R follow-up sees a new denial for a procedure not listed, it can easily be added to the list. By reviewing for the presence of an authorization number, you can minimize preventable denials.

5. Ensure consistent copay collection– Health systems with multiple clinic locations often experience inconsistent copay collections over time. To regain lost traction, create quick reference sheets with standardized documentation of proper copay workflow, noting particular transaction codes for correct system postings. Make sure you participate in and assess monthly reports on the rate of copay collection per clinic location. Such reports hold each clinic accountable by direct comparison to peers and national benchmarks for copay collection, which is 98 percent of all scheduled appointments.
6. Evaluate common claim denials– Do a deep data dive on your top 10 denial codes and identify the payer for each. Identify the root causes of each denial and correct faulty processes or overlooked administrative or business office steps. If poor coding is a root cause, provide additional education for providers. If procedure authorization is not routinely obtained, business office staff may need additional training on payer requirements.
7. Reduce charge entry lag time– Using data from the EHR, create a weekly report with the following fields:

• Patient ID– system’s unique patient identifier
• Encounter number– system’s number for a specific care episode
• Encounter start date– the date of admission for an inpatient care episode or the date of the visit for an outpatient care episode
• Charge entry date– the actual date the charge was successfully posted (may not equal the charge entry date due to edits)
• Service or procedure date of service– the date the procedure or service was rendered to the patient
• Service department– the name of the ancillary department that performed the service/procedure

From this data set, calculate the lag time between the date of service for the procedure/service and the charge entry date. Sort by service department and calculate the range and average per department. Then, meet with the appropriate representative of the service department to discuss any entries that exceed five days. Ensuring departmental charges are posted within five days of the service greatly decreases the risk of lost charge revenue.

You can make the most of your EHR system with these seven tips for two-pronged optimization. Over time as technology evolves, it’s important to approach EHR optimization as a continuous process improvement effort. Keeping an open line of communication with key stakeholders and superusers across both clinical and financial areas, revisiting implemented changes to evaluate their effectiveness, and making data-driven adjustments throughout the process will help your organization get the most from your EHR investment.

Dan O’Connor, vice president of client relations, Stoltenberg Consulting, Inc.

Joncé Smith, vice president of revenue cycle management, Stoltenberg Consulting, Inc.

Both can be contacted at [email protected]