Case study #2

See previous post – here is part two.

Setting: Private ambulatory care practice with two physicians, an office manager, a billing person, and five ancillary staff

Dr. Z had been interested in EHRs for at least six months before becoming part of the “Dr. Know” Beta project but was unable to purchase one due to budgetary constraints. A stipend from the health plan to help defray the cost of hardware enabled Dr. Z to move forward. He compared numerous EHR systems and then carefully reviewed his office workflow and business practices. He anticipated a short-term reduction in productivity as a result of EHR implementation and had prepared his staff for the changes in workflow that would occur.

Dr. Z was, at the same time, the EHR champion and senior management supporter for the practice. He understood that the implementation process was complex and committed his time to the training. He encouraged his staff to do the same. In contrast to Dr. Z, the staff was ambivalent about implementing an EHR system in the office. The staff possessed some technical skills, however, prior to the implementation. The staff had to use computers to check patient eligibility online. But the EHR, by comparison, was far more complex and they were afraid of the disruption it might bring to the office.

With these concerns in mind, the implementation team took small, calculated steps in training staff. As the staff grew more comfortable navigating simple parts of the EHR they became motivated to further their learning. With Dr. Z’s enthusiasm motivating them the staff quickly adapted to the full EHR functionality.

Dr. Z began using the EHR soon as he was trained. Almost immediately, he began crafting his disease management templates. He selected his favorite prescriptions, diagnoses, and procedures and took other actions to customize the EHR to his practice.

Dr. Z’s routine use of the EHR helped him retain what he learned during training and helped him elucidate how the functions of the EHR corresponded to his current workflow. He was able to rethink and improve his clinical and business processes. Thus, not only was the EHR aligned with his business processes, it created an environment in which those processes could be observed and improved.

The speed the process of implementation, the team was able to extract patient demographic information from Dr. Z’s billing package and important them into the EHR. This saved a significant amount of the staff’s time and enabled them to use the EHR to see patients almost immediately. Therefore, the disruption of workflow in the early stages of implementation was negligible.

Followup
Six months after implementation, Dr. Z and the staff continue to successfully use the entire EHR system, including the clinical, scheduling, billing, and prescribing modules. Dr. Z has been able to identify patients who need preventive care, treatment, or follow-up and who might have been missed through the manual system. His patient flow increased by 20 percent and his income by 15 percent. (This difference between volume and income is explained by the number of capitated patients for whom Dr. Z did not receive any additional income.)

Discussion
Dr. Z’s success was the result of clearly defined goals and his ability to become both the EHR champion and project leader. He communicated well with his staff and allowed them enough time to train. The initial resistance was greatly diminished by his senior level support and enthusiasm for the project.

Dr. Z had anticipated a slow down in workflow but this was ameliorated by the ability to electronically transfer patient demographics from his billing system into the EHR system. His staff’s basic computer skills facilitated EHR training during implementation and enabled them to learn the system quickly.

Dr. Z was cognizant of the needs of the health plan in terms of delivery of quality care and preventive medicine. He gradually initiated a culture of change in the office so that the EHR was accepted.

The implementation was a complete success.

These case studies were adapted and reprinted with permission from the “Guide to the Electronic Medical Practice: Strategies to Succeed, Pitfalls to Avoid,” by Stephen Arnold, M.D., MS, MBA, CPE, Editor, published in 2007 by the Healthcare Information and Management Systems Society (HIMSS).

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