Why You Need a Clinical End of Day Procedure?

At the end of the working day, every healthcare organization performs a reconciliation of fee tickets and receipts to assure that all charges and payments were properly posted and applied.  This effort assures the integrity and accuracy of the financial records.  A similar process is needed to maintain and assure the integrity of your EHR based patient information.

Do You Know The Paper Chart to EHR Transition Risks?

I co-authored a case study on Medical Professional Liability (MPL) Risk with Susan Lieberman, Vice President of Risk Management for Conventus Inter-Insurance Exchange.  This case study highlights the importance of making good transition decisions as well as the substantial number of MPL Risks and, more importantly, risk reduction strategies you need to use to avoid serious problems in the future.

Can Your Practice Afford Vendor Best Practices?

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.

Why Should Your EHR Be “In Service” by December 31, 2011?

As we move further along on 2011, you should seriously consider your plans for the year and the most advantageous (and soon to be extinct) tax benefits of an EHR investment in 2011 or 2012.

What are the Critical EHR Technology Infrastructure Issues?

The loss of access to you PMS may be disruptive, but your will still be able to practice medicine.  However, the loss of your EHR will stymie you clinical operation and pose serious challenges to continue serving patients.  In order to prevent the loss of your EHR requires appropriate hardware design and management commitment to invest monies to mitigate the chance of an EHR failure.

What are the Issues with Clinical Content?

Clinical content refers to the various checklists, documents, and forms that address an area of medicine when using an EHR.  For example, a pediatric practice would be interested in documentation tools for a newborn visit. Not all EHRs have clinical content for all areas of medicine.  For example, some EHRs have clinical content for internal medicine, but lack the details needed for dermatology or cardiology.

A disturbing number of practices have failed to analyze the clinical content of their EHR and are distributing exam documents and other information that do not adequately or accurately document patient care.  In the more serious situations, EHR clinical documents misrepresent the care provided and the patient’s condition.  For example, one practice was distributing exam notes that had inappropriate gender information for all patients.  In another situation, a specialist included extensive ROS information on the patient’s cardiovascular system which was not performed and not the specialist’s area of expertise.  Such problems could precipitate a wide array of care, insurance, and medical professional liability issues.

How Do You Provide Technical Support for an EHR?

Any EHR effort requires a plan to support the EHR technology.   Some practices have created an information technology (IT) position or even a department.  Unfortunately, many practices overspend on IT support that is more than they need technically, but less than they need operationally. 

What Are the Old EHR to New EHR Conversion Issues?

Data conversion from an old EHR to a new EHR is challenging and problematic.  In most cases, old contracts (and unfortunately many new contracts) do not obligate the current EHR vendor to provide the patient’s data or support the conversion.  Indeed, many practices are left to deal with the data that the current vendor “can” provide and the loading of data that the new vendor is ”willing”  to support. 

The gap between the old EHR information and the new system could pose a variety of operational issues and call into question continuity of patient care and even your stewardship of the patient medical record.  Indeed, contextual issues due to missing information and placement in the new EHR may complicate clinical decision making.