In addition to the pressure on practices to implement EHRs, EHR vendors have seen a surge in activity that is stretching, if not breaking, their ability to implement and/or support their products. In order to deal with the accelerated adoption of EHRs, a number of vendors have developed “best practice” guides.
This cook book approach to EHR implementation helps the vendors standardize use and, in some cases, use less experienced people to put in an EHR. Such “best practices” may implement your EHR in a way that may not be most effective for your organization.
Unfortunately, it is extremely difficult, if not impossible, to determine the provenance of the “best practices” that you are being asked to use. Seldom do you find conditional best practices or even a decision tree that helps you figure out the best practice for the situation. Are best practices the same for primary care and specialty practices? Are there no differences in best practices between physicians that work with mid-level providers and those that don’t? Are best practices identical regardless of the area of medicine or the type of services that you provide? Are the same best practices applicable to all sizes of practices and organizational structures?
The best practices document may be imposing a process that is not effective for your practice. In the worst cases, “best practices” may undermine EHR use. For example, many “best practices” defer a wide range of decisions until after you have used the EHR for a period of time. However, deferring decisions could lead to constant changes to classification, presentation, and even use. Subsequent changes could result in additional costs to rework the use of the EHR, “fix” information from the old best practices, and retrain staff. Such changes can complicate access to patient information since the order and/or location of patient information location could vary from the old best practices to the new and improved best practice.
For example, using a preloaded set of document types (advertised as best practices) included very general classifications such as notes, tests, insurance. If the practice used these classifications for the initial EHR implementation, they would have been unable to more granularly classify document types. For example, an OB/GYN practice may want to separate Pap smear results from general lab tests, while an orthopedic practice may want a separate document type for physical therapy reports. Unfortunately, the best practice document types affected document views, security and even workflow.
Such compromises can lead to a wide range of operational, patient service, workflow and even medical professional liability issues. The key challenge is to assure that your properly analyze, design and plan your EHR installation with a critical eye towards recommended best practices or any other cookie cutter approach. In order to avoid running into strategic or tactical “best practices” issues for your organization, consider the following:
Design Your Own Best Practice Strategy – You can certainly use the best practices recommendations of the vendor as a starting point. However, you should carefully evaluate the proposed best practices and not assume that the proposed best practice is right for you or even your area of medicine. You should evaluate the affect on workflow, patient service, and charting issues. Additionally, you should not defer too many issues until after the EHR is in use. For example, deferring staff EHR responsibilities could result in inappropriate transitions from the paper chart and a lack of confidence in the EHR. You analysis should include detailed discussions on practice services and operations as well as how the EHR will be used to address the operational challenge rather than compromise on practice issues to accommodate the vendor’s best practices. Be especially careful to analyze EHR use that could be difficult to change or would require a lot of rework. For example, changes to clinical information could require additional work on reports and exam documents. Similarly, enhancing document types to better organize patient information could result in the op reports located under different document types: initial vendor best practices and updated practice focused practices.
Test and Verify Your Decisions – Before using the EHR or training all of the staff on a process that is destined to change, you should verify how you set up the system and how you plan to use the EHR. Thereby, you avoid changes and retraining before your start production use of the EHR. Implementation of an EHR is difficult enough without having to deal with the wide array of problems that are caused by a failure to adequately design and develop the detailed procedures for success in the clinical environment.
Unfortunately, pushing back on best practices may put you in a challenging situation with the vendor. Vendors have been known to warn you that they can’t help you if you don’t use their best practices. In other situations, vendors have warned practices that failure to use the cookie cutter approach could lead to more costs to figure out the specific procedure for the practice. However, it is your practice that will have to cope with how the EHR system is established and used. Failing to critically analyze EHR use and the vendor’s “best practices” at the beginning of your effort could leave you with continuing challenges and costs to use the EHR rather than additional implementation costs to do it right the first time.
© Sterling Solutions, Ltd., 2011
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