Our evaluation question for April is intended to explore the strategies you've used for pre-populating patient charts with information beyond basic demographic data, i.e., clinical information such as problems, diagnoses, procedures, medications, etc., and how that information, if any, was entered into the electronic chart. We know that some organizations simply start from scratch when patients come in the first time after the EHR is implemented, but this can add considerable time to the already extended visit and further decrease productivity. Other strategies include hiring temporary help or having interns enter key data elements, or doing a lot of scanning. And there are probably many permutations of these basic strategies. We'd like to hear from you on the following issues:
- What strategies did you employ for pre-populating electronic patient charts? How was it implemented?
- How was consensus reached on what would be in the chart at the time of initial use and what information would be built up over time? Who was involved in the decision-making?
- What are the benefits and drawbacks of your approach?
- If already "live" on EHR, what challenges did you face during the transition when some information is stored electronically and some information is still in the paper chart? (As Dean Germano once suggested, this is a huge topic in and of itself.)
Thanks in advance for sharing your strategies with the CNEA community!
2 comments:
This was a challenging issue for us during the planning stages right through to implementation and beyond. In preparation for EMR our EMR Committee gave notice to our clinical teams that they should be cleaning up their medication lists, chronic problem lists as a first step warning the teams that when the time comes to imputing the data this would make things a little easier. We also tried to make our transcription service follow a certain template format a year in advance so that we could import those dictated noted from the following 12 months right into the EMR. Well, it was a huge challenge to get the transcription service (and a dozen or more of their contractors) to do this so in the end we could not import old dictated notes (we could and did scan them). We also talked about using nurses to pre-infuse the EMR with medications, other specific data elements and shared with the medical staff that ultimately it was their responsibility to ensure that the entries were accurate. We also used some of our other clinical clerical support from our QI department to help input certain data elements such as the last dates of services for PAPS, Mammograms, etc. We found that process took considerable time, particularly with our most seasoned doctors who had among the largest patient panels. We had heard of private firms using RNs who do a lot of the pre-loading of the data at a price (too pricely for most CHCs). As we started our EMR implementation each practitioner and their nursing team started to enter data. To do so slowed the teams down so schedules were reduced and the clincians typically worked serveral hours over their normal daily hours to do this. We paid them for these hours and while expensive, the alternative was to cut access further during the day and/or to make them very unhappy. It was a tough 6- 8 months realizing that your most complex patients are typically the first ones you will see and that made it even more difficult. I will defer to Beth and Charles from my team for more specifics. We did use the weekly (sometimes daily) EMR committee to determine priorities as to what was to go in the chart and training and support issues. I think a weekly meeting of this Team that included several clinicians was critical to help us work through our challenges. The issues of what is scanned vs what needs to be inputed came up regularly and we made adjustments to those decisions as we went along. Folks moving down this road could learn a lot from the mistakes of those who went before. In all fairness, the software and hardware today is signficiantly better than what we looked at nearly 3 years ago. There are also more of us who can share some pratical experiences. Nevertheless, unless I missed something, moving from a paper based system that we had been using for nearly 20 years to EMR for our 40,000 active patients does not happen with just some computer programming or a few extra hands. In the end it is the clinicians who ensure that the EMR stands on its own.
We trained providers to "abstract" for about a month prior to Go-Live. For the patients they were seeing or more complicated patients that they knew would take time they entered diagnoses, medication info, etc into the electronic record during their admin time.
TCC-Epic
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