It is no secret that usability is a primary culprit behind EMR failures. It has been added as a criterion of Stage 2 meaningful use EHR certification and is a common complaint from frustrated physicians whose systems don’t support practice workflow — negatively impacting productivity, profitability, quality of care and staff morale.
Usability is why 31 percent of EMR users responding to The 2013 Black Book poll are considering replacing their EMR and why 17 percent plan to do so this year, leading the analyst firm to dub 2013 “The Year of EMR Replacement.”
There is a sense of urgency behind physicians’ move to replace inefficient EMRs. Many are desperate to recover from the productivity declines that continue to impact patient volume and practice revenues. Others are concerned about 2014 meaningful use attestation.
It’s a valid concern. Physicians attesting for meaningful use after Jan. 1, 2014 must do so utilizing 2014 certified EHR technology. However, as of July 1 there were just over 50 ambulatory systems with 2014 certification, versus 3,700 with 2011 certification. With so few certified solutions available, waiting much longer for an existing EMR to get 2014-certified could jeopardize attestation.
Finding a usable EMR
To ensure high EMR usability, physicians must first fully assess their needs and practice workflow. As basic as that sounds, it’s something that 79 percent of Black Book poll respondents said they didn’t do the first time around.
The next step is to identify EMRs that meet, or can be configured to meet, current processes by enabling folders, forms and workflows to be electronically reproduced. Physicians can assess this by asking:
- Which modules of the EMR can be configured or customized?
- Who can configure these?
- How long does configuration take?
- What does the system and configuration cost?
- Will this EMR force a change in the way I practice medicine?
- Will this EMR let me spend more time on patients and less time on software?
- How much learning time should I add to my plan?
- How can I reuse the data I already have?
Look for EMRs that are modular, configurable for each person in the practice, intuitive, and can be adjusted as needs evolve. It is analogous to building a LEGO city using multiple individual LEGO sets. Each set has its own instructions and is built with specialized bricks, but still allows for extensive modifications. This approach provides flexibility to mix and match components from other modules to create the perfect LEGO City.
Balance is crucial. Too much configurability consumes too many resources; too little forces practices to adjust to the EMR. However, when balance is achieved, a “build-it-yourself” approach can be the superior option.
This was the case for Elk River Health Services (ERHS), a federally certified Rural Health Clinic (RHC) and National Health Service Corps site. Founded in 1979 by Robert Hill, MD, it now encompasses four family practice clinics in rural Missouri.
RHC capabilities required
Though meaningful use accelerated ERHS’s move to an EMR, it had been exploring its options since acquiring its fourth clinic in 2007. That expansion was the tipping point. With patient encounters taking place across clinics, manually tracking and maintaining medical records was no longer sufficient.
Early results were disheartening. The prevailing advice was to focus on the top five vendors, but none could accommodate RHC billing requirements. Further, as the sole source of medical care for several counties, it was imperative that ERHS avoid post-implementation productivity declines.
The decision was made to implement a highly customizable system. To find it, ERHS conducted a “vendor shootout,” asking finalists to run seven scenarios to demonstrate their ability to support various financial classifications and billing mechanisms. Only BuildYourEMR succeeded. Cloud-based and 2014-certified, the system provided a framework upon which ERHS could configure templates and processes.
Though template design took longer than an out-of-the-box EMR implementation, clinician adoption was rapid and relatively pain-free. As a result, within three months productivity had increased, in particular related to e-prescribing and fast access to lab results.
A customized approach
A “build it yourself” EMR model isn’t for every practice. It requires in-depth analysis to define data collection points, plan items, clinical decision support rules, encounter/progress form layout and workflows — all of which must take place before the system is deployed.
However, for practices that are willing to take on the extra effort, a properly designed customized system delivers high usability and measurable value. The key is to identify an EMR that is easily configured to adapt to the practice’s workflows, including existing forms and preferred terminology, and is built to support current and future stages of meaningful use.
Mike Jenkins is the CEO of BuildYourEMR.