Principle 8 of a 12-part series on Optimizing Office EHRs
Whenever I call you "friend"
A patient-focused approach works.
The office EHR can be an asset or a liability; or perhaps, friend or foe. Our expectations and attitudes often shape our outcomes. Or as the industrialist Henry Ford opined, "If you think you can, or you think you can't, you're right." With Principle #8 we turn to specific patient-focused features and activities that your "friendly" EHR can provide to a physician in an office practice. And if you are not a physician, you are probably a patient. Consider sharing this article with your own doctor. Everyone benefits when their doctor and office EHRs are more patient-focused.
Friend or Foe
In old war movies, the anxious soldier responds to the sound of a breaking twig in the darkness, "Friend or foe?" My observation is that office EHR anxiety will not abate if there is a "foe" in the room. So in your journey for optimization, consider your EHR your "friend." Discover how it can help you be more patient-focused.
Principle #8: Patient-Focused
One can find lots of ways to make their EHR more patient-focused:
- Train your staff to get the best possible history under "reason for visit."
- This will allow the physician to focus quickly on the core issue(s) and help to direct the encounter. Plus good documentation by staff that is pulled into the encounter will save the physician time.
- Document something that the patient deems important into your note as a reminder for the next visit.
- It greatly adds to the patient experience when you ask him/her at the next visit about that event/milestone. For example, "Did your niece decide on a college yet?" or "How was your cruise to Alaska in June?"
- Keep longitudinal history up to date.
- Inaccurate chart elements can lead you down a wrong diagnostic/treatment path.
- Be clear on ownership of chart elements and their configuration.
- Sometimes an office EMR will be set up to only allow staff and not the physician to document vital signs. This is a sign of improper configuration for an office EHR. It is not that unusual for the physician or mid-level provider to recheck a vital sign such as an elevated blood pressure/pulse or orthostatic readings. The provider should be able to document these discretely and not just as free text, since they contribute to the patient's clinical trend.
- It is typically wise to have the providers "own" the physician Problem List for accuracy and maintenance. This has more importance as we share data through electronic continuity of care documents (CCDs) with health information exchanges (HIE) and with other EHRs.
- Make sure the Social History is up-to-date. Studies show that the patient's tobacco use (as well as high-risk behaviors) can be most successfully addressed and altered within the context of the patient-physician relationship. Getting a person off tobacco use probably has more benefit to your patient's health than most other things we do. Studies even show that cancer survivorship improves when patients quit smoking upon diagnosis (CDC).
- Define what elements of Family History are most important to your practice. A dermatologist may be most interested in a family history of dysplastic mole syndrome while a primary care doctor focuses on a broader spectrum of familial diseases such as premature coronary artery disease and a broader group of hereditary malignancies.
- Consider "Open Notes" through your patient portal (This voluntary effort now gives over 20 million patients access to their office notes. See https://opennotes.org).
- Most physicians today have a patient portal. Yet many do not allow patients to view their own office notes. "Open Notes" creates a new level of transparency and patient empowerment/trust. Patients can see reinforcement of their treatment plan and can help to correct any out-of-date elements in the chart, especially their medication list. OpenNotes states that "research indicates that 25% of patients who contact their doctor as a result of reading their note report a possible error."
- Having most of the chart available to patients through a portal will give them access/availability to medical records should they become ill during travels.
- Leverage all aspects of your EHR patient portal.
- Consider a few open scheduling (walk-in) appointments each day that patients can select via the portal for acute illnesses.
- Most physicians already share lab and diagnostic results through their portal. If not, consider doing.
- Secure email messaging can help reduce phone calls provide simple ways to facilitate refills and simple questions.
- Consider virtual visits.
- Today technology provides secure, efficient telemedicine video visits. While some insurers still lag in reimbursement codes, many are now permitting these today. Many scenarios lend themselves to telemedicine visits. As we see retailers enter the field, physicians need to decide whether they want to yield this space to pharmacy chains and retailers or offer this service within their practice. Having an EHR greatly expands your options in this area, including use of an externally staffed group of providers who can provide virtual visits to your patients with full access to their medical records.
- Health maintenance and disease-specific reminders.
- We have discussed in earlier articles how patient-specific reminders can ensure that immunizations, screenings and interval monitoring happen on time.
- Focus first on the patient when you enter the room.
- See Principle #7, item 6. [LINK]
Many physicians can add dozens of ways that their friendly EHR can help keep their practices be more patient-focused.
Action Plan for Principle #8: Patient-Focused
- Write out five things the EHR helps you do better for patient care. Share these with your staff/peers in your office.
- If you don't have five things by now, go back and do the action plan for the first seven principles. Leverage the list above.
- Verbalize to at least one patient each day how the EHR helps you provide better care.
- Focus always on your patient and his/her needs first during each encounter.
- Identify and put into practice one new EHR technique monthly that will improve your time, finances and/or peace of mind.
Catch the Introduction for this series:
More on the 12 Principles for Optimizing the Office EHR (Published weekly):
- Know what you want. See First, do no (EHR) harm
- Commit to moving forward. See Don’t look back
- See your EHR as a practice improvement activity. See Where do we begin?
- Use Your EMR as an EHR. See "Is Your EMR as an EHR? "
- Eliminate Waste. See "A penny saved, is better than a poke in the eye"
- Make the EHR Work for You. See "Know thyself".
- Reduce Cognitive Load. See “Saved time will keep us together".
- Patient-Focused. See "Whenever I call you friend” on this page.
- Read between the lines
- First measure the cost
- Eating the elephant one bite at a time
- Nothing’s “gonna” stop us now.
The 10 Myths of Office EHR
Myth #1: I don't own my EHR, so I cannot fix it.
Myth #2: We have the wrong EHR for my practice.
Myth #3: There is no way the EHR can save me time.
Myth #4: I just need to go back to paper charts.
Myth #5: EHR office notes are never going to be usable.
Myth #6: The EHR cannot make my patients safer.
Myth #7: I don't have the time to fix my EHR.
Myth #8: It's not up to me to fix my EHR.
Myth #9: To use my EHR, I have to see less patients.
Myth #10: You don't understand, my practice is different.