EHR Lifecycle and Transitions to New Vendors in the Current Industry

Earn outHealthcare has made almost monumental movements in the technology used in various areas of the current field.  In recent years Electronic Health Records (EHR/EMR) have successfully helped physician owners make the shift from paper medical records for patients to an online database that is easily accessed at the click of a mouse.  There are many choices on the market for an EHR provider, and The Ambulatory M&A Advisor has discussed with professionals on the subject regarding the process of obtaining a new provider, the lifecycle of an EHR, and how physicians can avoid mistakes when looking to change programs.

Qualities to Look For

When looking for a new EHR provider, there are some specific qualities that business owners want to look for before making the final decision to go with a certain provider.

Alan Ayers, Vice President of Strategic Initiatives for Practice Velocity says that the quality and availability of training and support will have a direct impact on how well the EHR functions in a business owner’s center as well as the depth to which their providers and staff will utilize all of the EHR’s features.  Ayers says that frequently, when users complain that a system doesn’t do certain things or doesn’t do certain things well, it’s simply because they are unaware of how the system functions.

Renee Vandall, Director of Marketing for Net Health, says that proper documentation is an important aspect to look for in urgent care EHRs.

Vandall says that providers should look for an program that allows them to chart fast and code appropriately.

Vandall says an EHR should also be able to recognize missing information from a patient’s chart, so that when charts are audited in the back end of being paid, all of the correct documentation is captured so that providers receive appropriate reimbursement.

“Your information should all be in one seamless place; no need to go back and forth to capture any information,” Vandall says. “An EHR with good documentation is proactive and can catch what’s not captured appropriately up front so that it doesn’t affect things on the back end.”

While speed and ease of use are the two non-negotiable urgent care EHR attributes, there are other features that providers should still pay attention to.  Some of these areas that should be included range from online bill pay options to patient portals and integrated credit card functions.  All of these areas are very useful when considering the current healthcare market’s needs.

“Vendor focus on a specialty like urgent care enables a system to incorporate best practices in clinical care and workflow, saving provider time by streamlining documentation of the most common conditions. EHRs designed for inpatient care or to serve many specialties are “too heavy” for urgent care. These systems create ongoing costs through provider and staff inefficiency,” Ayers says.

“Given the dual business focus of urgent care on getting patients in and out quickly (with wait times being the #1 patient complaint) and supporting providers in seeing more patients per hour (with provider labor being the #1 cost in urgent care)…a system focused on urgent care should really focus on speed.”

Looking deeper into the issue, Ayers adds that a system should have proven integration capabilities with health information exchanges and enterprise systems, as well as have current Meaningful Use certification, and meet regulatory and security standards.

Last but not least, Ayers makes note that a vendor should be reputable.

“Ask for the names of leading urgent care operators using the system, ask for and check references, and look for ratings and comments collected by credible third parties like KLAS Research,” Ayers says.

Beginning the Process of Change

Not only is the “what” aspect of selecting a new EHR provider crucial, but the “when” area of concern is huge for physician owners as well.  Therefore, choosing when to make the change in a business life cycle can be crucial.

Wayne Sebastiano, MD and owner of Glendale Family Medicine and Walk-in Care says that his business made their changes during the summer months because that time-frame tends to have a slower patient flow for urgent care.

Sebastiano adds that ultimately, when making any changes, be it from provider to provider, or just going from paper to electronic, providers should expect that the process will slow their business down.  These changes can cause dramatic changes in revenue, as well as lower the amount of patients seen during the time of transition.

“Fortunately, the learning curve was very quick, and my biggest fears of having three to four months where volume suffered with the transition didn’t happen,” Sebastiano says of his initial change to electronic. “By the end of the first week, everyone was fully up to speed with the software.”

Urgent care owners and operators that choose an EMR not designed for the urgent care space may find it even more difficult to fully transition in a timely manner.

Knowing how long the process takes to complete is also important.  Sebastiano says it took about 6-10 weeks from the time he chose his EHR until his practice actually went live with it.

For first timers during this process,  Sebastiano says providers will need to figure out what to do with their paper charts, consider how they are going to set up their office, make sure that the proper equipment is installed in the necessary areas, and then finally, bring their employees up-to-date on the changes of software.

“I also had to go through the contracting process with the EHR company, which took a few weeks.”

Ayers agrees with Sebastiano and says that from start to finish, the process to switching HER providers or going electronic takes approximately 6 to 8 weeks to implement the software.  Much of that time is required for electronic payment/clearinghouse agreements and provider/staff training on the system.

Set-up and implementation generally includes building master files, entering provider information, insurance, establishing protocols and input of all other data needed to use the system, Ayers says.

Get the Staff in the Loop

Even though 6-10 weeks seems like a long time, Sebastiano says the EHR systems themselves are actually very quick to implement and learn.

“I sent two receptionists and my biller to an out-of-state training course for a week, and then when they came back, they trained everyone else,” Sebastiano says. “We picked a day to go live, and everyone practiced on a demo version beforehand so that they knew how to use the software when the time came.”

On the subject of getting the staff in the loop on the changes to the environment, Ayers says one best practice is to have a single staff member dedicated to managing the EHR project. This “responsible” individual provides a central point of accountability and is a vital resource to the practice.

Ayers says that as a whole, the health information security/privacy officer, and or compliance team should be engaged from the start to assure the system meets organizational requirements.

Ensuring a smooth transition in a practice is important, and that is why Ayers says that physician owners need to review and document current processes, policies and procedures, and patient flow to determine what changes will occur with implementation of the new system.

“It is always best to change processes before implementing an EHR. Challenges related to physical plant, staffing model, scope of services, or financial policies may be exacerbated by implementing the new system.  Before implementing an urgent care EMR, a center should implement best-in-class urgent care workflows across the organization,” Ayers says.

Ayers adds that owners need to establish a robust implementation plan with clear responsibilities and timelines and establish a routine of continuous communication between the urgent care center and the EHR vendor.

However, despite the best efforts of either the vendor or physician owner, mistakes may be made.

“Make sure that the reasons for switching from one system to another are actually system-related; a new system will not solve staffing, facility or workflow problems.

Some users expect that just because they have mastered one system, they can easily become proficient on another system. Switching systems requires that users invest the necessary time to thoroughly learn the new system,” Ayers says.

“Buyers should ask about additional costs for configuration, implementation, and training.  Some EHR suppliers provide classroom training at no cost, but there are travel costs and the challenges of keeping the center open while providers and staff are in remote training.  A “train the trainer” model using administrators, clinical, billing and front office staff to train others on the job after attending in-depth training is a viable option for an existing operation.

Some users also think they have to completely transition all medical records from their existing EHR to the new system, but they can actually migrate charts on an “as needed” basis, working old accounts receivable from the old system.”

If you would like to learn more about the concepts covered in this article, want to sell your business or discuss how Ambulatory Alliances, LLC might be able to help you out, contact Blayne Rush, (469)-385-7792, or Blayne@ambulatoryalliances.com.

If you have suggestions for future topics, email Blayne@ambulatoryalliances.com.

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