Optimizing the EMR for Your Orthopedic Practice: A Framework for Clinical Transformation.

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1 Optimizing the EMR for Your Orthopedic Practice: A Framework for Clinical Transformation. Joseph J. Greene MS ATC Shari Khaja MS ATC Orthopedic practices of all types are being confronted today with how they will implement and optimize a new electronic medical record system. How a practice deals with the implementation is critical from both a patient care and financial standpoint due to the substantial cost and human resources needed for deployment. Since most practices are deciding to replace rather than upgrade their electronic health record due to Meaningful Use and other national mandates, the need for an appropriate approach has never been more essential. As orthopedics is a very high margin and high volume healthcare specialty, it has the potential to be affected to a greater extent simply due to the requirements of the EMR for each patient visit. The electronic health record market is forecasted to grow at a steady pace and reach 8.4 billion dollars annually by It is simply a matter of when and not if your practice or system will move to an All-In-One EMR or a Best of Breed EMR that is built specifically for orthopedics. No matter what type of EMR is selected, there will be many efficiencies and inefficiencies that are both real and perceived. Regardless of the software system that is chosen or has already been implemented, there are many important decisions to be made and considerations to be aware of. A new EMR will be welcomed by some, but is more often a source of anxiety for your physicians and staff. With this in mind, it is helpful to consider how you can minimize the anxiety and develop a productive attitude of those on the front line. This article will hopefully alleviate some of the uncertainties and help you form an approach that optimizes your EMR uniquely for your situation. We feel it is extremely important to look at the timeframe surrounding EMR implementation as an opportune time for you to evaluate your current processes and transform your clinic in all ways that are indicated. In many cases, this means changing a culture or changing processes that have been present for a long time. A new EMR can t fix current issues and will likely expose them and make them more apparent. With this said, we hope our background and insight, particularly with the Epic Systems EMR, can help you transform your practice and enhance the implementation and utilization of your selected EMR. We have broken our recommendations down into a number of themes that we have found to be helpful in our front line experience prior to, during, and after implementation. Identify

2 Identify the right people, the key personnel, and the frontline workers who will have the greatest exposure and who will be impacted most heavily by the implementation. These are the individuals who are often not in attendance at preliminary meetings, yet they are the individuals who can provide the most accurate and descriptive analyses of how the EMR could work most efficiently. It is obviously important to have physician participation during this preparation phase, as it is imperative that there be someone acting as a champion for the implementation, and who can serve as the liaison to the rest of the physician staff. By having physicians present, they will be invested and have a forum for expressing their concerns, requests, and ideas. It is absolutely key to have physician endorsement. This being said, the bulk of clinical workflow is performed by ancillary staff that assist or extend the physician in many capacities. These must be the individuals providing feedback and ideas for optimal EMR utilization. By identifying these individuals early in the planning stages, you will have a much more accurate depiction of current workflow and how to best implement the EMR. Standardize It is important to recognize the value of creating standardized templates and processes when going through implementation of an EMR. Workflows have and will continue to be based on the specific circumstances of each patient. Therefore, each patient encounter will look slightly different from the next, but getting as close to standardizing all processes is ideal. The ability to capture all of these unique characteristics in a patient visit will be a challenging task. However, with the EMR, physicians will have the ability to more seamlessly work through patient charts and information IF they have templated summaries or workflows that are easily accessible. These templates can include diagnoses, treatment protocols, follow-up information, post-operative information, exercise guidelines, etc. Despite the fact that each visit will carry its own distinct differences, the ability to create and disseminate appropriate information to each patient will be at the click of a mouse for clinicians. Again, it is important to readily understand the flow of each clinic and the idiosyncrasies of each particular physician, as this will be helpful for creating appropriate templates and smartsets based on need, frequency of use, and mandated requirements unique to your institution. Anticipate It probably sounds difficult to anticipate anything when you are starting a new program that is foreign to most everyone in your practice. What we mean by anticipate is more related to understanding that this transition will not be without problems. Anticipate that you will struggle at first trying to prioritize. Anticipate that you will find difficulty in maintaining the exactness of the previous workflow, and you will, no doubt, need to understand that the new electronic flow may substantially change the manner in which you care for patients. Anticipate that you will need to initially evaluate your institution s workflow on paper. You will then need to review how those processes will be affected by the new EMR and how that can change the

3 overall flow. You will need to anticipate that more patient-centered approaches need to be considered. Anticipate that your staff will need to change the way in which a visit process occurs based upon the requirements and appropriateness of when and where certain information is gathered during the visit. Anticipate that the physical space you work in may need to be changed to allow for smooth registration, check-in, scheduling, and patient care within the clinic room. Anticipate that certain processes typically done on paper will now be changed substantially due to your EMR. Now that most everything will be electronic, you will need to anticipate a new workflow will be needed for many areas of a patient encounter. Anticipate the challenge, but know that once you have considered the changes at hand, it will make the new processes much easier to understand and implement. Vocalize You and your staff need to have a voice, and a strong one at that. There are two very important things to remember here: 1) you are not expected to implement this on your own, and 2) you need to steer the direction in which the EMR is implemented. First, it is critical to understand that you and your institution are not required to implement the basic templates you are initially provided. There is tremendous opportunity for customization that is often not realized or taken advantage of. Your staff should be expected to provide necessary information prior to implementation about clinic processes and should lead the building of custom smartsets and templates. Second, you are certainly not responsible for solving software problems and re-engineering the software to make it more efficient. However, you must take considerable ownership and work with the system builders closely. If you leave every problem with the EMR system builders and engineers, the downstream effect on your processes will be of limited consideration. The system builders role is to fix the software problem; this doesn t always take into consideration how that fix affects the next step or the next step. So, it is your job to be a strong voice in the development of solutions for workflow problems because you can more readily evaluate how a particular solution will fare based upon the workflow of your practice. Visualize Conceptually, this means that you need to visualize what the EMR will do for your practice and how it can make it more efficient. Practically, this means that you and your staff need to visualize beyond just the implementation phase. If your institution only prepares for the implementation and has no strategy or intent to move forward and continually evaluate how to become more efficient, then you have lost the value of the EMR. After implementation, the largest opportunity for positive change, growth, and optimization is at hand. Once your initial system processes and flows have been determined post EMR implementation, it is the job of you, your staff, and your institution to visualize what can be done to continually improve. Implementation is just a beginning.

4 Define Knowing the roles of all health care providers and the type of access each should have is key in creating a seamless transition during the implementation phase of your new EMR. Each entity must determine the type of access to provide to its physicians and ancillary providers. Having these roles clearly delineated will eliminate trouble at the time of implementation. If all have a very clear understanding of their ability and their access levels throughout the EMR, you will experience a much smoother transition. Finally, it is essential that each staff member who participates in a patient encounter have a thorough understanding of the type of access that they have been granted in relation to completing orders, processes, referrals, medications, etc. When everyone fully understands their abilities within the EMR, knows their role, and is thoroughly trained, the efficiency of all processes within your practice can only be enhanced. Conclusions The implementation of a new EMR can seem like a daunting challenge to an orthopedic practice of any type. It is a large undertaking, but it can also lead to many improved efficiencies if handled well. There are many reasons to help mitigate the financial and patient care delivery risks as early as possible in your planning and implementation process. We have touched on many of them that are predictable. Some of them won t be and will be exclusive to your system. Expect them and work to address them as soon as they are recognized. The last thing that any administrator or physician desires is to have your physician staff be at work keying in notes, dictating notes, and entering orders late into the evening. You will have very unhappy physicians who dislike their EMR in every way and they will be correct in holding that opinion. It is absolutely critical to ask for additional help and resources that you may need in the form of staff and consider strongly how they can function as autonomously as possible in support of the physician. All possible tasks that they can perform which allow the physician to spend their time on value added patient care services should be considered and implemented when possible. When utilized well, a new EMR should not cause an orthopedic practice to experience a decrease in volume, access, and patient satisfaction. You should expect some small impact initially, but if the right decisions have been made pre-implementation, combined with appropriate training, the learning and optimization curve should be very short. When your newly implemented and optimized EMR functions well, it can be a game changer for your patients and your staff. With an opportunistic approach and the right philosophy, this result is very realistic and achievable. Contact Information: Joe Greene MS ATC Program Manager, Outreach and Development University of Wisconsin Hospital and Clinics Department of Orthopedics and Rehabilitation

5 CEO, OrthoVise LLC Shari Khaja MS ATC Program Manager, Physician Extender Services University of Wisconsin Hospital and Clinics Department of Orthopedics and Rehabilitation Consultant, OrthoVise LLC

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