When a new system is implemented, in can be challenging to get everything setup just the way that you need it for your practice. Many EHR systems have a great deal of flexibility to customize clinical content within the product to meet your exact needs and workflow. However, it is often difficult to develop a customized system until you have a better understanding of how the system works and how to create customized content.
There is a balance in customizing a system that meets a practice’s workflow versus changing a practice workflow to meet a more standard set of clinical content. Over and over, we have heard from practices that they don’t want to reinvent the wheel. They would prefer to use clinical content that either comes with the system or something that has already been done by another practice. When they gain access to this content, they often realize that they aren’t exactly like the others.
We find that once a practice has access to other content, they generally want to “redesign the wheel”. The other practice may have preferred to do a physical exam in a certain way or their custom list or educational handouts vary. There are many reasons that the clinical content may need to be updated.
I am a very big fan of customizing the system to make it work for your practice, while maintaining a minimum set of standards. Often times, providers and staff are told that they have to use the system out of the box because it has all of the measures needed for various programs such as Meaningful Use, MACRA, PCMH, etc. I believe that this leads to one of the main reason providers are so dissatisfied with their systems. Most systems can actually do so much more than what the vendors typically implement.
What is the best approach to developing customized Clinical Content?
- Define realistic minimal standards of data capture
- Have providers develop a “Wish List”
- Work with developers to understand full capabilities of your EHR system
- Allow flexibility with provider workflow and customizations
Clinical content often becomes the largest portion of System Optimization projects. We work with providers and ask them to develop a wish list. We specifically tell them to ask for the stars. If we are unable to do it then no harm done by asking. If we can do it, then they may have something that makes their day much better by having a system that keeps standard requirements but gives them flexibility to complete the necessary documentation.
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Here are some topics to consider
- Provider customized physical exam and review of systems templates
- Interactive Quality Metrics that alert providers when something is due
- Customized Orders form
- Billing review page
The other issue that I often find, is that developers often don’t push the systems to work more. Very innovative people designed these robust systems that allow for flexibility and customizations but mediocre implementations do not take full advantage of all of these features. Instead, we just make the providers and staff alter their workflows to meet the system requirements.
Now that we are moving toward a Quality Payment System, it is even more important to allow providers to take full advantage of the technology available to them. We cannot continue to force providers to be tied to systems that are not flexible and do now allow for them to provide the best care for their patients. We must capture and meet certain data requirements while allowing for flexibility and customizations.
If you haven’t reviewed your system since implementation, it is a good time to do so. We will be changing our payment system very soon. There will be a focus put on the quality of care and this will drive your reimbursements. Adding additional work onto providers is not the best way to improve quality. However, you have very powerful technology at your hands, you just have to make it work for you instead of you working for it!