Healthcare Technology Featured Article

November 18, 2016

Working Smarter, Not Harder: Helping Clinicians Optimize Use of EHRs

Electronic health records (EHRs) are here to stay in medical practice. And doctors spend a lot of time with them. A recent study found that doctors spend at least two hours during the office day working with EHRs, and between one and two additional hours after work with tasks associated with the technology. Some of that time involves using EHRs during clinical face time for diagnosis and treatment, such as sending electronic prescriptions and verifying lab results to inform treatment decisions. The remainder is spent on administrative tasks, including data entry and checking all the boxes required for pay-for-performance by various public and private insurers.

It can be overwhelming, but doesn’t have to be. The answer is working smarter, not harder, by optimizing the use of EHRs. A better work flow has practice benefits, such as improved quality, safety and efficiency. Using EHRs more efficiently will help doctors meet new requirements posed by the Medicare Access and CHIP Reauthorization Act (MACRA). These will have a direct impact on how physicians will be paid under Medicare or have downward payment adjustments. MACRA requirements replace those previously compelled under the meaningful use EHR incentive program. Finally, optimizing use of EHRs can lead to a better work-life balance, which is something everyone can get behind.

Opportunities. Working smarter but not harder with the EHR sounds easy, but it is not intuitive. Here are five opportunities that biopharmaceutical sales teams can use to help physicians get through their day by optimizing use of EHRs. They can help doctors:

1. Identify useful but overlooked EHR functionalities. Today’s EHRs come with a variety of functions that can help physicians save time and improve treatment. Many EHRs offer drop-down menus or the ability to create favorites lists, so prescribers do not have to manually enter dosing instructions in the free text field and remember prescription quantities for electronic prescriptions. Not only does this save time, it also reduces the opportunity to introduce errors that can affect patient safety and outcomes.

2. Integrate in-depth patient education materials. Most EHRs include some patient education materials, which lack the breadth and depth required by many providers. Pharmaceutical companies have invested considerable resources in developing such materials, which can be repurposed for use in office EHRs. After physician buy-in occurs, the account manager and sales representative can work with a larger practice’s information technology (IT) staff to incorporate those materials directly into the EHR. In smaller practices, the IT contact may be the office manager or practice administrator. Once this has been done, the physician can print the information on demand during a patient visit or a patient can access the materials through the office’s patient portal, which currently is the way most practices provide patients administrative and clinical information. Clinical information within an EHR can help physicians target posted patient-specific educational materials. This also will help physicians meet MACRA requirements.

3. Create customized care alerts. Any number of factors can cause issues, many of which can be easily corrected with slight modification to an EHR. An example is establishing predefined care alerts, which can be created by a physician on a one-time basis. This will help avoid alert fatigue as well as create a customized guide for patient care. Depending on the specialty or patient mix, alerts can follow established clinical guidelines, standards of care and payer requirements. This can be especially useful if the physician is a member of a patient-centered medical home or an accountable care organization, because alerts remind health care providers about standards of care. In addition, alerts can capitalize on structured data within the EHR, providing time-saving yet personalized decision making and treatment options at the point of care.

4. Capitalize on electronic prior authorization. An increasing number of medications require preapproval — or prior authorization (PA) — before they can be dispensed. This currently is a lengthy and frustrating process that is based on antiquated paper-phone-fax methods. That’s changing with the advent of electronic prior authorization (ePA), which is increasingly available for use in electronic prescribing in EHRs. Physicians need to be educated about the existence of ePA and its availability in their EHR. Persuading them to use ePA should not be difficult because it reduces their time spent on each patient request. CoverMyMeds estimates that turnaround time of a PA request has decreased from as long as three to five business days to within hours, in most cases, and mere moments when the insurer is equipped electronically to accept and process the transaction as well as return a real-time response. This adds up. A recent analysis suggests that doctors spend a whopping 868.4 million hours on manual PA each year, not counting the time devoted by such other staff members as nurses and practice managers. Surescripts has created a new ePA calculator that helps doctors estimate how much time and money their practice could save by using the company’s ePA solution. ePA also improves patient care by helping to cut through the hassle and paperwork and get the patients the therapies they need at the proper time.

5. Identify capabilities that would improve practice productivity and quality.  Documentation templates provide a good example and they have two advantages. First, they standardize visit documentation and create discrete data much better than free text notes. Second, a well-crafted and specific documentation template will speed documentation in the patient encounter. Many EHRs have a set of documentation templates that are a good start but which may not be customized for a specific set of patients. For example, a urology practice may have a template for overactive bladder (OAB) patients but does not distinguish between those presenting with a mild initial stage and those suffering from a more severe, complex case. More specific documentation, supported through better templates, benefits pharmaceutical companies because they provide better data the practice may use to identify patients and evaluate care. For example, how many patients with more severe OAB might have missed an appointment and are suffering with no care? What impact will this have on patient satisfaction measures for the practice? Pharmaceutical companies can help by assisting in the design of well-reasoned and scientifically backed documentation templates.

While EHRs are far from perfect, there are many ways they can help physicians work smarter, not harder. 

Edited by Alicia Young
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