Example of Complexity for Medical Office EHR Execution

3Ps One of the first steps when considering purchase and implementation of an EHR is to develop an “As-Is” workflow diagram. The As-Is represents the starting point. It shows what you do in the medical office, who is doing it, and how data/information flows within and outside the office. It also describes the people who need access to that information.

This is an example of what an “As-Is” workflow might look like for a small practice that has not yet adopted an EHR or e-Prescribing system.The beige boxes represent manual processes that could be replaced by capabilities within an EHR. I will walk through each box with some explanation.

The office visit….

• Reminders, Appointments: A current or prospective patient calls for an appointment. Information regarding demographics and insurance is collected and verified. A date/time is set for the appointment with the patient’s initial complaint noted (e.g. reason for the visit). Patients are contacted to remind and/or confirm upcoming appointments.
• Chart Preparation & Schedule: At the end of the day, the Patient’s chart is prepared and a schedule is printed for the following day. Creation of the chart may include addition of appropriate paperwork and/or the patient’s primary complaint and reason for the visit.
• Assess, Treat, Prescribe, Educate: Functions of the MD, PA, or ARNP during the patient’s visit to the practice.
• Billing: Many practices have computerized billing systems. When a patient has completed their visit, the MD provides a Dx, Rx, and/or followup orders for the patient which must be keyed into the billing system. Often, here is where staff encounter problems that affect reimbursements as insurers, codes and/or payors change. If the practice also accepts credit card payments for services (either before or after the visit), additional manual entry may be required into the billing system to reflect the payment.

The follow up…

Telephone calls, inquiries, questions, documentation and notes: Here is where many practices spend significant time with patients and/or referrals or consultations that were ordered.

The results…

Voice, Paper, Fax, “Rich Media”: Currently, many practices receive information/results by voice, paper, fax, radiographic films and/or other media.

Here is where the water gets murky and where the technical complexities of data exchange lie. Data exchange between providers, facilities, and other healthcare organizations is necessary to prove “meaningful use.”

To summarize, based on the information above and the Health Outcome Policy Priorities identified in the “meaningful use” matrix, implementation of an EHR for a medical practice must start with a representation of what “you” are doing today. This should include people, process, and platform components within the “As-Is” picture.