The electronic health records system at 28-provider United Regional Physician Group was not working well with high levels of dissatisfaction among clinicians and staff members.

The organization retained ECG Management Consultants to evaluate its revenue cycle. The firm learned there was high turnover in the information technology department, unhappiness with the EHR implemented four years earlier, but also that the system was not to any degree being used to its full capacity, said Taraq Mazher, director at United Regional, during a session at this week’s MGMA Conference in Las Vegas.

The sentiment at the practice was to replace the EHR, said Michelle Holmes, a principal at ECG. “When we lifted the hood and looked underneath, it was clear that implementation was barebones and training was optional. Key processes such as new user training were not even in place.” Further, no workflow request or other change request processes were in place, the system was three versions behind in being updated, many functions had not been implemented and there was inadequate IT staff supporting the system.

ECG explained its findings and walked United Regional leaders through the lengthy and expensive EHR option that they were considering to replace the system, and suggested that updating and optimizing the current EHR to make it more usable was a preferable option.

Clinicians and staff members would not be happy with the candidate new EHR anyway, ECG consultants argued, and it did not make sense to spend money on a new system when Stage 3 of the meaningful use program had not yet even been defined.

The consultants asked a series of questions to hammer home the point that implementing a new EHR the same way the old was done would not bring improvement. Have you totally leveraged existing systems? Are users adequately trained? Are your needs different now than when the EHR was purchased? Is physician dissatisfaction the primary reason to consider replacement?

If the answers to all questions other than the last were “no,” then this was not the time to switch, the consultants said. So the task now started to complete implementation and improve the EHR, starting with evaluations of data optimization and governance, strategic initiatives, operating metrics, project status and infrastructure. A survey also was conducted to establish a baseline of current capabilities and understand what issues to target.

ECG conducted role-based use proficiency assessments by following nearly 100 users, and found low levels of proficiency and that service requests “went in a black hole,” said Holmes. When requests went through, IT was making changes on the fly without assessing how the changes would affect other functions within the EHR.

Clinicians and staff started buying into the fact that United Regional leaders now were investing in improving the EHR and started volunteering to be superusers. And a vocal opponent of the system became the physician champion and named the project “Burn the Boats,” meaning “let bygones be bygones.”

Optimization started in August 2013 and staff retraining was one of the largest initiatives. Staff members were offered various training sessions weekly. Workgroups studied changes to make sure they were appropriate and that everyone was made aware of them.

New policies and procedures were created for enhancement requests, communications, change control, downtime and the service desk, with logging and tracking of all requests, said Mazher.

Scheduling was optimized, registration fields were updated, credit card processing functionality was implemented as were real-time edits, tasking and work log functions were implemented, real-time insurance verification and eligibility checks were brought live, and additional reports were configured, among other tasks.

Workflows were improved for medication ordering, charge capture, tasking, telephone call routing, meaningful use workflows, orders and results, documentation and coding, and correction of documentation errors.

New workflows were created to standardize patient collections and bad debt processing, and check-in and check-out. A centralized process was implemented to handle medical records requests. Optimized processes were introduced for charge capture, cash-pay patients and hospital charge capture. And a best practices co-pay capture methodology was implemented.

The results: United Regional, which had not yet attested for Stage 1 of meaningful use, recently became a meaningful use organization and also now submits measures to the Physician Quality Reporting System, Mazher said. An ongoing infrastructure for maintenance and upgrades is in place, same-day radiology orders and results are a reality, and the organization is live on a health information exchange and a patient portal.

If other organizations decide to replace their EHR rather than optimize, “make sure the next implementation is your last,” Holmes of ECG counsels. “I know this sounds obvious and basic, but what we really see is the old mistakes carrying forward to the new project.”

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