Physician Considerations for an EMR Implementation
By Robyn Kessler, PA-C

Most physicians don't have the time to learn a new computer program, yet they rely on these programs to perform their daily tasks. What non-clinicians fail to understand is the enormous pressures placed upon these physicians their institutions as the number one source of income. So the question arises', how can we get and keep our physicians attention long enough to prove that Electronic Medical Records (EMR's) are a great tool for documentation, patient safety, research and subsequent patient care?

While building the system, it's important to remember how your system can benefit the physicians and make their job easier. The initial meeting with your physicians is a great time to discuss options for them to consider while formulating what they would like from the system. The creation of specific list choices, standardized text, how to quickly document patient information, and improve billing are examples of thing that most EMR's can do today. Keep in mind the physician's view point: the initial learning of the system is a time consuming task. With an analyst's help, they can make the system work to suit their needs and ultimate goals, including improving patient care.

When not seeing patients, physicians are:

• Reviewing lab work
• Educating students and residents
• Navigating insurance companies
• Returning telephone calls
• Learning about their billing practices
• Learning about advances in medicine

Ways to help the physician see the relevance of an EMR are:

• Expeditious ways to review labs, track trends
• Web links to medically relevant date (Medline, PDR, etc)
• Standardized text for insurance companies
• Quick documentation of patient calls (no documentation of these calls is a big part of litigation)

Growing a practice takes time, however there are things a physician can do to advance their career and work their way up to the coveted position of chief. To do this, a physician must not only be an exceptional doctor, but must also publish articles in prestigious magazines. Reporting can be a useful tool for a physician to know about early on in the design process. Knowing what type of fields are reportable, as well as, how they can be used in their daily tasks, will give the physician an idea of how to structure a particular text, form, or even a screen. This will make the system seem more intriguing and useful to achieve your physician's appreciation of the system. In the end, this acceptance from your physicians will add to the value of what you are trying to achieve.

Prospective, retrospective, and clinical trials take hours of man power to look back and gather information, only then to interpret the findings. With an EMR, fields are used for reporting purposes. Within a minute a report can be generated with vital information to support a study. Studies no longer entail filing through hundreds, even thousands of patient charts looking for specific information. Even with comparable retrospective studies, knowing what specifics can be investigated can save physicians and research coordinators a wealth of time. For example, suppose a physician wanted to know all patients that had a specific procedure and the outcomes related to the procedure. Specifically, patients that had gastric resection vs. an intestinal resection for cancer and what types of nutritional deficiencies each develops. Just a report on patients with gastric resections will save the researcher hours of time. This eliminates the lists of patients that the researcher will need to keep and, further more, save them the time of pulling the charts to gather the desired information. In addition to simply looking up of information, reminders can be set in the system to alert the physician that certain tests/studies need to be done for follow up on their study patients; that may have otherwise gotten lost for follow-up.

A specialist has somewhat different needs than a primary care physician. A very important part of their visit is the communication back to the referring physicians. Coordinating these letters to include portions of the visit with specific functions of an EMR can expedite this essential task. The letters will contain a wealth of information that a referring physician or even the primary care provider would appreciate. Many systems now automate these letters directly from the office visit. Look at structuring the office note to a format that will look nice and provide the important detail needed. Again, explaining the simple tasks that the system can do automatically will help ease the work load for the physicians.

Once a physician is aware of benefits of an EMR, usually they develop a vested interest in helping to build the system. Often the support staff is forgotten. They hold another important role that should not be overlooked. Physicians recognize the importance of their staff to their daily function. Administrative assistants, medical assistants, and billers help physicians on a daily basis. Standardizing pre-approval letters, patient letters, appointment reminder letters, scheduling and other monotonous tasks will help these assistants function more efficiently during their daily tasks. Teaching these members of the healthcare team will continue to prove to the staff the merits of an EMR.

Utilization management is yet another group that needs to be addressed. Scheduling trends are a great way to formulate the physician's scheduling needs to improve physician relative value units' (RVU's). These units are a measure of how well a physician is utilizing their office time and staff. It's a means for administrators to determine the financial value of their resources. Using electronic scheduling, physicians or administrators, can determine how best to fill appointments. For example, if specific procedures are taking a physician longer to complete while on their own, it may behoove the practice to add an assistant. This will decrease the amount of billable time the physician is using trying to accomplish a task. They now have more of the hour to generate more RVU's. Trending appointment time is another example of how an EMR may benefit scheduling needs. A pap smear will require a 20 minute appointment; however an upper respiratory infection may only need 15 minutes. Schedulers can determine which patients will require more or less time.

EMR's are a wealth of information waiting to be unveiled. It is important to educate the physician and all members of his/her staff about the benefits of an EMR. Once physicians realize the rewards, they will become an effective and key member of the implementation.

For more information on this topic contact us at 610-444-1233 or visit our website at www.getvitalized.com

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