Digitized Medicine

In a previous blog the methods used to perform a work flow analysis in a physician's office as a part of the EMR selection process were described.  The  next steps are to:

Document Future Desired Work Flows

An analysis of current work flow identifies bottlenecks in the physician's practice.  Changes in work flow may alleviate those bottlenecks.  Some of the identified changes may not be dependent on having an EMR and could be made immediately.  The other work flow changes that are dependent on using an EMR and will later become part of the EMR implementation.   

It is not readily apparent to many physicians how an EMR could improve work flow in their office.  There may also be unrealistic expectations about how an EMR could improve things.  Therefore, it is helpful to first gain knowledge about the "best uses" of ambulatory EMRs as experienced by other physicians before identifying desired future work flows.  To gain insights on the realistic and best uses of EMRs physicians may be wise to engage a knowledgeable IT consultant.  Alternatively, physicians may use other resources  to gain insights such as:

• DOQ-IT's Operational Redesign Workbook
• AHRQ Health IT Toolbox
• CCHIT
• Networking with colleagues
• Physician professional organizations

The knowledge gained on EMR "best uses" and the identified work flow  bottlenecks can now be analyzed together to determine at a high level what future work flows are desired for the practice. 

Prioritize this list of work flow desires

The physician practice may now discuss these desired work flow changes and prioritize them.  For the purposes of discussion let's suppose the practice has identified a top ten list of desired work flow changes that they want make when they implement an EMR.

Develop a prioritized list of EMR functionalities

The prioritized top ten list of desired work flow changes will naturally translate into a list of EMR functionalities that are top priority.  For instance, a practice that determines "refilling 80 prescriptions/day" is currently their top bottleneck, then the most important EMR functionality to compare among products is the usability of the EMR's e-prescribing feature.  A different practice may identify their top bottleneck to be getting patients through the check-in processes and determine that they want to reduce time patients spend filling out papers on clipboards by providing online registration forms and using a self-serve kiosk in the waiting room.  They also desire an EMR that can quickly register and check-in patients.  In that practice the most important EMR functionalities will be a robust patient portal, efficient integration with kiosks and the fewest number of necessary screens and "clicks" when registering or checking-in patients at the front desk.

Compare EMR products based on these priorities

EMRs have hundreds of functionalities.  It is not humanly possible to effectively compare hundreds of functionalities between different EMRs.  Comparing EMRs without focusing on specific needs easily leads to frustration and/or confusion.  Using the described list of prioritized EMR needs will improve the comparison process. 

Physicians might consider limiting their comparison to EMRs that have been certified by CCHIT (and soon to those certified for "Meaningful Use" as well).  One can be confident that a CCHIT-certified EMR has all of the functionalities that are described on the CCHIT website.  There are hundreds of such functionalities.   However, CCHIT does not necessarily quantify how well the EMR performs each function.  So, if a physician practice limits their comparison to CCHIT-certified EMRs, they can be assured the EMR can do those hundreds of things an EMR should be able to do and instead spend their time comparing how well the EMRs meet their own, identified "top ten" needs.  

Using an earlier example of an identified "top ten" EMR need, a comparison may find that EMR Product "A" allows prescription refills to be completed in 45 seconds using three screens and 17 clicks, while Product "B" refills prescriptions in 15 seconds (30 seconds faster) on one screen with 6 clicks.  Since the work flow analysis revealed that the practice has 80 refills/day, refilling prescriptions using Product "B"" would take 40 minutes less each day as compared to Product "B".  

In summary, it is helpful for a physician practice searching for an ambulatory EMR to perform a work flow analysis to identify the major bottlenecks in the office, gain insights on how EMRs can improve work flow, use this knowledge to develop a prioritized list of desired future work flows, identify the "top ten" things an EMR needs to do to meet those desires and then compare CCHIT-certified products based on this prioritized list of EMR needs.

EMR Selection Guide provides an outline of other topics on the selection process

EMR Implementation Guide provides an outline of topics on the implementation process

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