In September 2011, the Centers for Medicare & Medicaid Services finalized the one-year delay on implementation of the International Classification of Diseases, 10th Edition (ICD-10) diagnosis and procedure codes, clinical modification and procedure coding system.
The new deadline, Oct. 1, 2014, marks a drastic transition for many facilities. ICD-9, the current system in use, was implemented in 1979 and includes only 17,000 diagnostic codes. ICD-10 will include 65,000 codes and have the capacity for more than 155,000 codes. It will require all billing systems and electronic health records (EHR) software at every U.S. facility to be updated.
As part of the mandatory change, many facilities are undertaking the process of moving from paper charts to EHRs. Though beneficial in many ways, such as ease of locating patient information among specialists, ability to search and recall information at a moment's notice and faster dictation, some facilities are apprehensive about the move. ADVANCE spoke with industry experts to give you tips on how to ease into EHRs.
Planning for Implementation
When planning to implement an EHR program in your practice, it's important to realize one thing first: You will need to decrease patient volume in the early stages to maintain productivity. "Depending on the system and the size of your practice, implementation of an EHR could take months of planning, weeks of training and a year or more until staff are completely comfortable," said Andres Jimenez, MD, CEO of ImplementHIT, a company specializing in implementation of EHR for healthcare facilities. "The goal, however, is to regain full productivity about a month after implementation."
Once you've prepared for a change in practice, where should your facility start? "Begin with a reputable and certified EHR vendor who understands the needs and priorities of your facility," said Alan Kravitz, CEO of MedSys Group Consulting. Once a vendor has been identified, they will work your facility through the implementation process, but for most, the first step is the process of moving information from paper to electronic charts.
"This step requires someone who is familiar with the practice and clinicians' handwriting," Jimenez said. "That individual will identify what information is pertinent to patient charts before they go live for use by pre-populating some information, such as date of birth, current medications and other basic information." It can be beneficial to scan some patient notes of higher importance, Jimenez added.
When the planning phase is complete, it is time to begin using your new technology. "A facility must make sure it is devoting enough staff time to building the EHR system," said Rishi Agrawal, MD, MPH, pediatric hospitalist at La Rabida Children's Hospital in Chicago. "EHR systems do not come ready to use; they are a toolkit that must be customized to each facility." Juergen Fritsch, PhD, chief scientist for M*Modal, a company specializing in transcription and speech recognition software, said, "It's important to get a basic infrastructure in place, such as for scheduling patients."
Richard Rosenhagen, MBA, RHIA, assistant vice president, Electronic Medical Record, Health Information Management and Clinical Documentation Improvement at South Nassau Communities Hospital, Oceanside, N.Y., suggested identifying members of facility staff to serve on implementation teams. "Work groups should be composed of key administrative and medical staff for reviewing workflow issues, supporting clinical decisions, making orders, reviewing interdisciplinary documentation and testing coordination," Rosenhagen said. To organize staff work groups, Agrawal suggests using diagrams to understand and adapt responsibilities in the electronic system.
Easing Staff Resignation
Though EHR implementation is ultimately a benefit to your practice, you will likely encounter resistance from both administrative staff and clinicians. "Transition to an EHR comes with fears about job security," Rosenhagen said. "Staff members who have only known the paper record world may find it difficult to learn new ways of managing records. However, the earlier in the process you provide staff with needed education on what the EHR is and what the impact of having it will be like to the organization, staff and ultimately, the patient, the better."
Kravitz said it is important to talk about the benefits of an EHR to staff to ease concern and remind your facility that the change is not only positive for your facility, but the community at large, and address any worry about use in advance. "As with any change or new technology, there can be a large learning curve," he said. "While there may be some major differences between electronic and paper records, the information gathered in both is the same. It's just a matter of training the staff to input the information into a computer terminal rather than through the end of a pencil or pen."
Addressing Patient Concerns
As with any new technology, some patients will feel threatened by the thought of their health identities moving to an electronic format. But, Jimenez said that moving to an EHR is actually safer than storing paper records.
"With paper records, it could be easy for someone unqualified to grab your records," he said. "But with electronic records, there are very strict measures to secure patient data using standards provided by The Health Insurance Portability and Accountability Act (HIPAA)."
Most patients are concerned that someone will steal their data from the healthcare system, but Jimenez said EHRs are just as safe, or safer, than other electronic measures dealing with private information, such as online banking. "EHRs track everyone who accesses anything," he said. "If you access it, it's logged in the system for others to review. There is a lot of evidence left behind on all security levels, and safeguards to make sure information that may be relevant to one specialist, such as your psych history and relationship status, is not accessed by another specialist who doesn't need that information."
Rosenhagen added that a managing change control function of the EHR disallows any person with access to the system to modify a patient's records without tracking. "Each and every time the record is adjusted, changed, revised, added or deleted, it is recorded, from the moment your EHR goes live," he said. Fritsch said that in some EHR systems, patients are even able to fact check their own records. "Organizations can deploy patient portals as part of their EHR deployment," he said. "These portals typically allow patients to login and review some of their health information in electronic form."
After the EHR has been designed and put into use by your facility, it's important to maintain current training and support for system updates. "Most clinicians say they learn the most about the EHR after it has gone live and they begin using the system," Jimenez said. "Facilities should continue to use the system daily and continue training until complete ease of use is achieved."
As with most technology, updates are frequent and needed. But despite the concern and some technical frustration, your practice, and more importantly, your patients, will benefit from the transition to EHR.
Kelly Wolfgang is on staff at ADVANCE. Contact: firstname.lastname@example.org