Advantages of an Allergyspecific EHR How careful evaluation of solutions can help prevent buyer s remorse When it comes to electronic health record (EHR) systems, specialists prefer those that avoid a cookie-cutter approach. This is especially true for allergists and immunologists because proper management of their patients chronic and often life-threatening conditions requires a solution that fits their workflow. Today, more and more physicians are utilizing at least a basic EHR after making the switch from paper to electronic health records. Nearly 40% of office-based physicians have a basic solution an increase from 33.9% in 2011, according to a 2012 survey by the National Center for Health Statistics (NCHS). 1 The NCHS defines a basic EHR system as one that includes: Patient histories Patient demographics Problem lists Clinical notes Medication information Allergy notations This covers the necessities, but a bare bones EHR falls far short of meeting the highly complex needs of allergy and immunology practices. EHRs that are most beneficial for allergists and immunologists offer advanced technology, a userfriendly interface and innovative functionality. EHR Checklist for Allergists and Immunologists: Comprehensive immunotherapy tools (shot labs) Template-based skin tests Reaction checking and treatment Vial production and management Recipe generation from skin test results Shot schedule templates Auto check-in kiosks Clinical decision support Flow charts Health maintenance Chronic care management E-prescribing Automated lab processes Superbill generation More Than a Name Unfortunately, many practices choose an EHR based on a vendor s well-known name or company size, rather than taking a deeper look at the specific functionality of their products. This is reflected in several user satisfaction surveys revealing that physicians want EHR vendors to do a better job of tailoring solutions to their specialty.
In fact, overall user satisfaction has decreased significantly in recent years. In 2012, 39% of clinicians said they would not recommend their EHR to a colleague, compared with 24% in 2010. 2 Physician practices like Dr. Safadi & Associates, Inc., located in Sylvania, Ohio and founded by Dr. Ghassad Safadi, that focus on allergy and immunology for both adults and children, have needs that go well beyond that of a basic EHR. When they embarked upon their initial EHR journey, they sought to find a system that could handle the complex and specific data related to allergy and immunology with the ultimate goal of going completely paperless. The practice used one system for more than five years, but they were not satisfied with its performance and began to seek out other options. This type of buyer s remorse is a story commonly heard regarding healthcare software especially for practices with very specialized clinical needs. Often, the lure of an inexpensive EHR or one with a sleek interface can influence initial purchase decisions, but after using these types of systems, practices often find that they simply need more customization and better functionality. In fact, a survey by AmericanEHR, an online community of clinicians, found that between 2010 and 2012, slightly more than 10% of physicians intended to switch EHRs. 3 Among those who wanted to change, 46.65% cited a lack of specific features needed for their practice. Because the workflow of allergists is so unique from that of other specialists, they benefit most from comprehensive EHRs with such features as automated prescription writing, drug interaction, formulary checks and fully integrated drug databases. When all systems work together seamlessly, they can Between 2010 and 2012, slightly more than 10% of physicians intended to switch EHRs. Among those who wanted to change, 46.65% cited a lack of specific features needed for their practice. AmericanEHR survey help physicians see more patients, reduce errors and provide better quality of care. In addition, there are several benefits to having an EHR with an integrated shot lab. Those with reaction checking and treatment help providers better manage and track patient reactions and their associated treatments. Systems with this functionality allow physicians to document local, systemic, none or unchecked reactions with customizable templates; set alerts and reminders specifically for critical reactions; and link care plans with treatments. Tailored EHRs with template-based skin tests allow allergists to quickly document skin test results, create custom panels, and define antigens, allergens, histamines and diluents for therapy. With built-in shot schedule templates, allergists and immunologists can define individualized or templated shot schedules, track, build-up and maintain shots, modify patient shot schedules as needed, and follow up with patients who missed shots either via email or snail mail. EHRs make these complex, time-consuming tasks much easier to manage than the paperbased processes often used by allergy practices that have not yet transitioned to an EHR. 2
True Integration vs. Add-Ons Several EHRs on the market today promote their integrated solutions, but what they re really referring to is the ability of their system to use add-ons that enable their software to work with other systems and devices rather than actual true, built-in integration of solutions. In the area of EHRs for allergy, systems that have true device integration can be hard to come by. For example, Allergy and Asthma Center of Texas needed a comprehensive allergy EHR solution that was user-friendly and helpful in streamlining their workflow. In their initial selection of an EHR, they thought they had found that, but they actually ended up with a solution requiring them to use two separate applications to perform their consultations. After a short while, they switched EHRs because that solution was not integrated with their immunotherapy software and lacked the customization options they desired. By moving to an EHR with a builtin spirometry interface, Dr. John Meiser and his team were able to eliminate redundant scanning and dual-entry a huge benefit to the practice. Redding Allergy and Asthma of Atlanta, Georgia, cited the fact that their EHR was designed specifically for allergists is definitely the key to their success with the system. According to Dr. Alan Redding, Features like the customizability of the skin testing module that lets you easily add or subtract antigens from skin testing and allergy shot mixing show that this software was truly designed with the specialty in mind. Built-in vial production is another benefit of having an EHR tailored for allergy and immunology. Solutions with vial production built into the EHR enable physicians to: track vials with bar-coded labels for improved patient safety; quickly create vials with different dilutions for desired concentrations; create lot numbers for tracking of diluents and antigens; and manage inventory and track lot numbers. All of this data is part of the EHR and therefore is part of the patient record. Additionally, with this type of tracking ability, practices can have better control over the vials they produce and store. This same type of efficiency and functionality is what persuaded Accredited Allergy Center of Springfield to change EHRs. Practice Administrator Megan Butterworth says they have seen the greatest value in the immunotherapy module. One of the services we offer is take-out shots; for example, if a patient s pediatric office is closer to their home than our office is, we can document shots in our system, but allow them to be administered at that location, Ms. Butterworth notes. Previously, especially when we were working with paper charts, if the nurse at the other office wasn t tracking the shots correctly, there was a lack of proper documentation that caused a lot of issues. Considerations for EHR Selection In addition to making sure the product has the features and functionality required for allergists, there are other things that should be carefully considered when selecting an EHR. It is recommended that practices carefully analyze their workflow and speak with similar practices to see what type of solution they have implemented and learn about its pros and cons to discover what works and what doesn t. 4 It is also crucial to consider the size of the practice and the characteristics of the patient population. 5 Physicians who have 3
multiple offices undoubtedly have different needs from those with a single location. Dr. Michael A. LeNoir, who has offices in Oakland and East Oakland, Calif., had a myriad of problems with his initial EHR software, including poor handling of prescriptions, laborious visit documentation and long wait times for patients. After switching EHRs, his office staff has regained control via easy monitoring of physicians, staff and patients with activity reports and other tools. The reports that are instantaneously available to me are very helpful for reallocating resources to meet the various aspects of my practice, Dr. LeNoir says. Another important factor that should not be overlooked when comparing EHR vendors for the allergy specialty is support. Allergy and immunology workflows are complex and unique to those of other specialties. It s important that customer service and technical support representatives understand your specific challenges and can help answer any questions or address any issues that may arise. Questions that you should ask: Are the support representatives knowledgeable about allergy and immunology procedures and terminology? Do they understand the complex workflows of an allergy practice and the associated challenges? Conclusion In the end, when evaluating an EHR, it all comes down to practical daily use and functionality. Does the solution you re looking into support the complex workflow of allergists and immunologists in a seamless, integrated way that delivers tangible, measurable results? That s what is meaningful to physicians like Dr. Safadi, who says the specialty-specific features he finds most useful in his EHR are efficient allergy shot administration and automatic billing for shots. Both of these together provide improved workflow and reduce chances for mistakes, he explains. I also appreciate the allergy serum ordering; with this module I can enter data, avoiding errors by using the templates. The label printing is flawless, helping me organize all vials, and finally, the skin test documentation is very thorough, with the skin test templates including all possible combinations in a completely legible document. When both the front and back offices work harmoniously, practices can significantly improve their quality of service. By choosing an EHR designed specifically for allergists and immunologists, practitioners don t have to settle for fewer tools and resources than they need to have the best practice possible. As a result, they can benefit from higher patient satisfaction, an improved bottom line, and most importantly, provide better quality of care. References 1. Modern Healthcare - https://home.modernhealthcare.com/clickshare/authenticateusersubscription.do?csproduct=modernhealthcare&csauthreq= 1:473505953793254:AID IDAID=20121206/NEWS/312069953 ID=:84B8F4D2248C7DCD3316A9ABBEEBC2&AID=20121206/NEWS/312069953&title=Docoffice%20use%20of%20basic%20EHRs%20hits%20nearly%2040%25%2C%20survey%20finds&ID=&CSTargetURL=http%3A%2F%2Fwww.modernhealthcare. com%2fapps%2fpbcs.dll%2flogin%3fassignsessionid%3d473505953793254%26aid%3d20121206%2fnews%2f312069953 2. Becker s Hospital Review - http://www.beckershospitalreview.com/healthcare-information-technology/survey-ehr-user-satisfaction-has-fallen-by-12- from-2010.html 3. AmericanEHR - http://www.americanehr.com/blog/2013/03/why-do-physicians-want-to-change-their-ehr-feedback-from-dissatisfied-users/ 4. Medicalrecords.com - http://www.medicalrecords.com/single-vs-multi-specialty-emr-or-ehr 5. Medicalrecords.com - http://www.medicalrecords.com/physicians/how-to-choose-your-emr 4
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