Capitalizing on Electronic Health Records (EHR) to Take Your Practice Where You Really Want It to Be

by Bill Granda

Since 1991, as consultant, business coach, and advisor with Paradigm Associates, Bill Granda has been helping businesses and individuals improve their ability to overcome obstacles and get results. He engages with key players and teams, particularly those in or approaching important transitions, to develop and execute practical business and transition strategies. Clients have found him especially helpful when they recognize they have to do something different, but don't know exactly what that is, or they know what is needed but aren't sure how to best get it done. Many of his clients are closely-held and family businesses, non-profits, and professional firm owners who put a premium on professional competence and really helping their clients.

It seems many physicians have experienced the frustrations and stress of running or working in a practice that requires doing more of everything except for spending time with patients while making a reasonable amount of money. It is just for those reasons that the transition from a paper-based practice to an electronic environment presents such a tremendous opportunity for medical practices. It can not only transform how patient data is captured and stored but how an entire practice operates and what it can accomplish as a result.

When the "Stimulus" rebate-intensified push toward EHR intersects with a practice environment of frustration and stress, it's no wonder that many physicians, especially in smaller practices, prematurely conclude that between the perceived cost and the learning curve of EHR, it is just not worth it. Mentally what might otherwise be viewed as just the obstacles to implementation gets blown up to become reasons not to act. Only when the benefits of taking action along with the consequences of inaction become great enough will the difficulties switch back to being perceived as obstacles to be overcome. Said another way, if EHR is only seen as a way to do on computer what has been done on paper, the transition will be dreaded as a great headache and unnecessary cost.

If EHR is to become a boon to medical organizations and practices, a shift in thinking and perspective can help it happen. It begins with looking for a quantum improvement rather than just incremental improvements. EHR offers the potential to make huge improvements in how practices run and the results they get, but thought has to be given to identify those desired improvements.

Such a thinking and planning process would do well to include these four phases:

  1. Come up out of the trenches. As in warfare, if the Generals are all down in the trenches, who is running the war? So the first step requires looking at the situation and evaluating how far the practice is from where its physicians really want it to be.
  2. Expand concepts of what's possible for the practice. This is close to impossible to do when you are always operating down in the trenches. By stepping away from the day-to-day, it becomes easier to take a fresh look at what the practice could be accomplishing. A structured approach and a coach/facilitator or trusted advisor can help here to expand thinking and make sure all bases are covered. Consider a comprehensive outline of potential areas for improvement patterned on all aspects of a typical patient visit. This can aid in generating new thinking of possibilities by creating a "virtual walk" through the practice. When coupled with new concepts of what's possible, hope for better things to come is both an important input and outcome of this thinking process.
  3. Define desired outcomes. Defining desired outcomes in advance greatly increases the probability of good things happening by intent rather than by default. Typically a double benefit exists. Both "big picture" thinking as well as specific, detailed outcomes improve. So it's wise to include both in the thinking. One framework for thinking at this stage involves looking at the practice through five lenses or perspectives. We recommend a financial perspective, a patient perspective, a management perspective (how easy is it to get things done quickly and correctly?), a learning and growth perspective (how will the practice keep improving and growing?), and a personal perspective (e.g. less stress, less late hours). Defining those outcomes desired for all aspects of the practice makes it easier to define how EHR will contribute.
  4. Create a plan to attain desired outcomes. This plan needs to include both general directions/solutions to attain outcomes and specific action steps. Many practices will fall short here because they insist on failing to plan in enough detail to make it really happen. For example, if a desired outcome of EHR is to eliminate transcription costs, a new process for capturing demographic and clinical information needs to be determined and implemented, including any necessary training. Likewise, freeing up a room used for storing paper records won't become a benefit unless it's used for a revenue-producing activity or expenses are reduced. Incidentally, freeing up time won't become a benefit unless it's used to see new patients, reduce salary expenses, or gain a personal benefit such as allowing you to leave the office earlier each day. In other words, defining desired outcomes also identifies the areas of action needed to attain the outcome.

The thinking and planning process just described becomes even more powerful when it includes all providers and staff. Doing so accomplishes three things. It expands everyone's perspectives and generates more ideas for consideration; it builds on the experience/knowledge of those involved; and it creates "ownership" in the goals and the plan, i.e. those involved have a greater stake in the implementation because their ideas were included in the planning. While at first glance that may seem cumbersome, just consider the alternatives. Practices that have adopted EHR report that physicians and staff who were not involved in the initial planning and discussion were much more reluctant and slower to adopt than those who were heavily involved.

We recognize that what professionals ultimately want their practice to be is up to them. Sometimes a neutral party such as a coach/facilitator can help them through the thinking process to expand their concepts of what's possible for their practice and crystallize their thoughts into a clear picture and an executable plan

In the final analysis, unless the destination is seen as a better place than where they are now, neither the physicians nor anyone else they need to make the journey with them will be willing to do what it will take to get there. EHR and an electronic environment alone won't get the practice there. But they can provide an important impetus and be a major part of the process of moving from "life as you know it" to "life as you want it to be."