Harnessing the Untapped Potential of EHR Systems

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1 CASE STUDY Harnessing the Untapped Potential of EHR Systems TalkChart Transforms the Documentation Efficiency of the Child & Adolescent Psychiatry Department of a Large Academic Institution Electronic health record (EHR) systems have the potential to transform the entire business of healthcare, from doctors to patients to administrators. But EHRs are not living up to their promise. Studies conducted by professional associations are recording dramatic reductions in physician satisfaction. Healthcare facilities are experiencing significant productivity drops which result not only in provider dissatisfaction and frustration, but also direct and measurable revenue loss. BACKGROUND In mid-2011, a large academic institution fully implemented physician electronic documentation within the EHR. The move was intended to improve efficiencies and dramatically reduce administrative costs. But almost immediately, Howard R. Weeks, MD, Assistant Professor of Child & Adolescent Psychiatry, encountered those productivity problems that are being overwhelmingly reported when doctors are compelled to switch to using an EHR for their documentation specifically, the increase in the time required to document patient encounters and the unnecessary complexity introduced into a doctor s workflow. The promise of the EHR is to allow data to be entered in a discrete manner so it can be analyzed and provide guidance that can improve patient care. EHRs are built to guarantee that all the correct information is included in a patient record in order to ensure compliance with billing and government regulations. In order to accommodate this advance in patient documentation technology and as an alternative to the traditional free narrative, EHRs are designed with standardized templates which are intended to increase efficiency. 1

2 CHALLENGE Once the EHR was implemented into his workflow, Dr. Weeks encountered an array of frustrations during the process of integrating it into his daily routine. But the number one challenge? How to decrease the amount of time he and his colleagues were suddenly spending doing documentation. I have colleagues who were spending quite literally over an hour typing their admission notes, Dr. Weeks says. I have colleagues who were spending quite literally over an hour typing their admission notes. The reason? The EHR did not offer physicians the flexibility to design their own workflow, which would facilitate integrating the EHR seamlessly into their routine. Instead, they were suddenly faced with a platform forcing them to use it in a prescribed way that best suited the platform, rather than their own style and that meant a striking drop in physician productivity. The first issue was the time it took to enter a note into the EHR, Dr. Weeks says. There was also a sense of redundancy, as physicians were forced to re-enter previous information for every encounter. And finally, Dr. Weeks notes, The finished product exported from the EHR didn t appear professional, and required extensive manual reformatting before consultation notes and letters could be sent to referring providers. As is common for most doctors when implementing new EHR work requirements, Dr. Weeks experimented with a number of workarounds in his attempts to combine productivity with cost effectiveness. The existing documentation functionality in the EHR, Dr. Weeks says, was very cumbersome. It was hard to look at, hard to enter data and it took too long. It was so frustrating that I had to stop using the EHR templates. He continues, My colleagues were also experiencing the same impediments. The physician group tried several workarounds to get notes done. Traditional Dictation. While incorporating traditional dictation was effective in addressing many frustrations, the doctors encountered several unforeseen problems. Frequently key pieces of information (e.g., details of the history, exam findings, lab results, etc.) would get dropped in the initial dictation pass. When the note came back from transcription, the physician had to manually type the addendums with the EHR s very basic word processor, which impacted productivity even further. Of course, even with this method none of the data was entering the EHR in a discrete manner, which was impacting the system s overall efficiency. 2

3 Cloning. Some doctors tried cloning a previous note-- copying the information and then manually going through and editing the changes to reflect the most recent exam. Unfortunately, this was extremely cumbersome due to limitations within the EHR s word processing program and even broke the links to discrete data in the system. Dr. Weeks says, We also saw a clear pattern of mistakes where details were not changed from note to note, leaving us open to serious concerns on an audit. We also saw a clear pattern of mistakes where details were not changed from note to note, leaving us open to serious concerns on an audit. Word Docs. Cutting and pasting patient information and notes from Word documents into the EHR not only caused inefficiencies and raised similar audit questions, it also skirted HIPAA compliance regulations. Patient information existed outside the EHR on laptops, instead of as secure data in the EHR system. SOLUTION As EHR systems are becoming more widely implemented, it s becoming increasingly clear that they have serious usability issues across vendors that need to be addressed. These growing dissatisfaction levels, with even just basic EHR functionalities, highlight the need to improve existing technologies rather than just focusing on adding new features and capabilities. Doctors need ways to reinstate or even boost productivity levels, improve turnaround time, and significantly reduce errors--to harness the original promise of the EHR system. Dr. Weeks had been aware of and had worked with EvolveMed, the company behind TalkChart, as well as its president, Glen Larsen. As TalkChart was being developed, Larsen spoke with Dr. Weeks about some of the application s features. He demonstrated how the TalkChart platform was designed to smoothly integrate with an EHR and directly address the widespread issues physicians were encountering with the rigid, inflexible EHR systems. I immediately recognized how it could be applied to our workflow, Dr. Weeks says. After I saw TalkChart and got to understand what the capabilities were, I was able to demonstrate how much more efficient it was compared to my current workflow, not only in time, but also by increasing the cost effectiveness of the process. Best of all, this wasn t a new EHR, but rather an overlay that made my existing EHR more efficient. TalkChart addressed the specific problems Dr. Weeks and his colleagues had been encountering on a daily basis. 3

4 TalkChart is one platform that allows all the different users to use it in the way that best suits them... Workflow and Flexibility. TalkChart, Dr. Weeks says, is one platform that allows all the different users to use it in the way that best suits them, as opposed to having one platform that is making all the users use it in a prescribed way that best suits the platform. TalkChart allows a physician to take advantage of the most efficient way to complete a task at any given time. Physicians aren t tied to a rigid system with a limited number of workflow options. Instead, a physician utilizes whatever combination of methods is more efficient for a particular encounter, be it direct typing, voice recognition, on-demand dictation, or individually personalized common phrases and shortcuts. Most importantly, among the most useful features of TalkChart is the ability it gives doctors to add past history to their documentation workflow. With TalkChart, any information that has been previously entered by any provider is available as a data element that can be pulled into a new note quickly and easily. Thus, cross coverage becomes amazingly simple and the redundant components of the note can be verified and quickly entered. While this makes the day-to-day note faster, a huge efficiency gain is realized when a patient returns. Instead of having to re-dictate large parts of historical data, it is available at the click of a button and can then be expanded upon based upon the new clinical presentation, thus decreasing costs of dictation, time spent re-entering previous data, and time the physician has to spend documenting. Workflows are then streamlined considerably. In the end, TalkChart was designed around the basic truth that every doctor has their own workflow. Dr. Weeks says, My partners will have a different workflow than I do. We re not trying to make every physician do something exactly the same way because humans are humans and that just doesn t work. We re not having to adapt to its predesigned workflow, so that makes each physician the most efficient they can be, from typing to voice recognition, from on-demand dictation to leveraging commonly used phrases and past history. Customizable User Interface. The TalkChart interface is designed to be easy to look at and easy to use. It s intuitive out of the box, but each TalkChart implementation is customized and personalized to each individual practitioner. But it doesn t stop at implementation physicians are given the power to easily add the common phrases they use every day on the fly and save those changes immediately, without having to submit a support request. This makes the interface customizable on an as-needed basis. 4

5 Metrics. The TalkChart dashboard is an innovation in productivity metrics. It is a reporting system that allows not only administrators but also physicians to analyze patient documentation efficiencies. The easy-to-use metrics allow macro comparisons among physicians, but also offer the ability to drill down into the data and compare the efficiency between a combination of physicians and workflows. This allows physicians to analyze their workflow patterns against colleagues by measuring the time it s taking them to do each note type, how much they are dictating versus not, the cost efficiency of documentation, and how many patients they are seeing. The power of this feature is that it presents the data in a graphical way that everyone can look at and benchmark themselves, says Dr. Weeks. It is not so much telling people they need to do things differently or better, but it does allow my partners to analyze their own practice style by comparing to our entire group. The graphics make starkly clear the differences in practice workflows. At Dr. Weeks office this has led several of the group to change their workflow to gain the efficiencies they see their partners enjoying, all without it being mandated to change their practice. Auditing and Compliance. With the ability to pull in history as a data element, versus copy and pasting or cloning previous notes, physicians gain an extra level of compliance. Since patient history is added deliberately to a new note, rather than history being duplicated from an old note, audit and regulatory compliance is maintained. The power of this feature is that it presents the data in a graphical way that everyone can look at and benchmark themselves. 5

6 RESULT TalkChart has transformed how Dr. Weeks and his colleagues work with their EHR. Number one, the doctors are getting their notes done faster, says Dr. Weeks. They are showing up in the EHR faster, allowing our insurance reviewer to authorize the stay faster, which then allows us to keep someone in the hospital when they need to be kept, and for doctors to actually get paid for their time. The on-the-fly adaptability of the TalkChart interface has transformed the doctors EHR workflow. Doctors dictate pieces of a note, use common phrases for other parts, and pull in previous history where necessary. It dramatically decreases redundancy and turnaround times. Doctors can see, in real-time, where their note is in the process, from creation to delivery, so they never lose track of their patient records. The signing feature allows physicians to finalize their notes fast, quickly scanning through a document to detect errors, questions or missing elements. Doctors not only avoid signing documents that are unpolished, but can finalize their notes in a fraction of the time. I m able to finalize them and sign them and move on, and I m not having to spend hours every night. Plus, the addition of the mobile application allows doctors to improve efficiency because notes are done in real time. I m able to finalize them and sign them and move on, and I m not having to spend hours every night, says Dr. Weeks. Compliance has also dramatically improved. Dr. Weeks group had a problem with getting discharge summaries done in a timely manner. One of the main issues was the length of time it was taking to do the discharge note. Plus, physicians were putting off dictating the formal summary. This led to the problem of charts not being completed for up to 30 days after a patient had been discharged. His group designed a new note which combined the day of discharge note and the discharge summary. This means doctors are completing both note components at the time that the patient is being discharged. Documentation is being completed and sent out the very same day the patient goes out. This has transformed patient care and billing, since now the outpatient provider has the vital information they need right away and the billing office is able to close the chart and bill the insurance. Dr. Weeks notes that one of his doctors went from having charts that were over 30 days out of compliance to being 100% in under two days. Other colleagues, no longer hampered by the cumbersome EHR workflow, are staying on top of their clinical practice. 6

7 Doctors, says Dr. Weeks, often exhibit a lot of resistance to change, and so I have some docs in our group who didn t want to give it a try. And then they ended up using the TalkChart solution and their response was I wish I d been doing this sooner. and Why didn t you make me do it sooner? On average, Dr. Weeks has found that TalkChart saves anywhere from 23% to 65% in dictation costs, depending on the type of note compared to straight, pure dictation, due to a built-in customized and adaptable front-end, history being pulled forward, and the elimination of dictation redundancies. Their response was I wish I d been doing this sooner. and Why didn t you make me do it sooner? While costs are important to administration, the time efficiency is often the most important issue to a physician. In Dr. Weeks group, clinicians decreased the average time to complete a daily progress note from greater than 23 minutes to around 5 minutes. I get my note done much faster so I can actually spend more time with patients, I may even see more patients, Dr. Weeks says. TalkChart makes my life easier. It lets me do my job and minimizes the time I spend charting. A physician can take one look at TalkChart and clearly see the advantages and how it will improve their particular workflow. How can TalkChart help you transform your EHR system productivity? Learn more now. Contact: EvolveMed Andrea Jaques, Business Development Manager Phone: x

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