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The Little Guy

May 1, 2007
by Jack Smyth
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What electronic health records look like at a small practice

Like many emerging software products, electronic health records (EHRs) have suffered from an emphasis on technology. Product design has been dictated largely by what was possible rather than what was the best fit for the medical office, especially smaller practices. And product designers have been more likely to come from a technology background rather than a medical one.
Jack Smyth

But, as with all technologies that mature and become truly integrated into the environments that they serve, EHRs have evolved. More and more, EHR product design is being dictated by workflow — and no longer the other way around.

First a note on CCHIT

The Certification Commission for Healthcare Information Technology (CCHIT) is a helpful initiative that is creating objectives for the adoption of healthcare IT. However, it can also be a hindrance to the adoption of EHRs for smaller medical practices. Under current guidelines for CCHIT certification, providers must include features that make their solutions impractical and expensive for small- and medium-sized practices. In fact, some of these “bells and whistles” dictated by CCHIT, such as security rules that require frequent changes to passwords, actually impede workflow and simply drive up cost.

But CCHIT is a new initiative and as it evolves, many in the industry remain optimistic that as it refines its methodology, the workflow needs of small- and medium-sized practices will be given more weight.

Efficient workflow depends on ease-of-use

Now that EHRs are in more common use among smaller practices, some key lessons have been learned. Ease-of-use is now acknowledged as the most important feature of any EHR system and a key attribute to integrating EHRs into the workflow of a practice. The reason is simple. In order to be effective, an EHR must be used and embraced not only by physicians, but by their staff members as well. And in many small practices, one of the physicians or a staff member serves as the in-house IT person/helpdesk, therefore, a user-friendly system is critical.

Integration with medical office workflows is a key component of ease-of-use and crucial to a smaller practice. Everyday operations such as scheduling an appointment, writing or refilling a prescription, or creating a referral letter, must be intuitive and straightforward — achievable quickly with a minimum of clicks and data entry. And it goes beyond mere efficiency — if it does not fit into practice workflow, implementation will likely fail. The staff of a smaller practice is simply too busy to adjust workflow.

Benefits to a workflow-friendly EHR

There are vast benefits to implementing an EHR system that integrates smoothly into practice workflow, significantly impacting the physician, the practice staff and the patient. These benefits are felt perhaps most strongly in small practices where staff members often wear multiple hats. For instance, the filing person may also be taking patient calls and scheduling appointments, and in instances like these, an EHR is almost indispensable.

In a small practice, the value of time cannot be calculated. Instant access to a patient's EHR saves the clinician's staff time and enhances efficient workflow. For example, in a small office, there is not a designated staff member to pull and route charts. An EHR alleviates the need to sort through cumbersome paper charts as simple electronic searches can retrieve a patient's complete medical record from any office desktop. Before seeing a patient, staff members are able to review the patient's medical history, current medications, problem list and more. These time savings are invaluable and improve patient care.

Efficient workflow is the key

The market is flooded with EHR products, but what doctors in small- and medium-sized offices are truly looking for is not just software that provides a charting solution, but a cost-effective product that manages their day.

Doctors want a solution that automates their office while enabling consistent high quality care and increasing patient loads, but does not dramatically disrupt workflow. They are not interested in technology per-se, but a practical and affordable solution to everyday practice problems. Fortunately, more EHR products today are being designed with these goals in mind and the smaller practice, and more importantly, its patients, all stand to benefit.

Jack Smyth is CEO of Houston-based Spring Medical Systems Inc.