conducted by the Institute for Health Policy (IHP) between late 2007 and early 2008 found that only 4% of physicians are using a fully functional EHR, with an additional 13% using only portions of a basic EHR. Although EHRs have been available for the past 10 years, and recent incentives have been provided to incorporate EHRs into practices nationwide through HITECH (Health Information Technology for Economic and Clinical Health Act), the adoption rate has stalled. Why is this? There appear to be two major obstacles: (1) the lack of electronic patient information embedded into the EHR when a practice goes live; and (2) the amount of time it takes to enter information compared with dictation or handwriting. Let’s examine these issues in greater detail and evaluate which steps can be taken to minimize or remedy them.
Data transfer from other sources
When evaluating data entry methods, we need to consider electronic data transfer from other sources. Let’s start with very basic information, such as a patient’s demographics and insurance information, which are the easiest data to enter. Because most practices already have a practice management system (PMS), physicians should require their EHR vendor to transfer all patient demographics and insurance information over to the EHR. Additionally, since the PMS application maintains visit dates and CPT and ICD-9 codes, physicians should require their EHR vendor to convert visit-level data into identifiable, discreet data showing patient visit dates tied to the appropriate diagnosis codes and any procedure codes not related to the office visit level. Using this methodology, a patient’s clinical record could be pre-populated with dates of service, problem lists, and medical history.
Another key set of patient data are laboratory values. Because laboratory organizations in most regions are required to maintain patient clinical laboratory results for 2 years, physicians should require their EHR vendor to download specific patient clinical laboratory results from local and nationwide labs. If these data are downloaded following LOINC matching criteria, 27% of the necessary clinical data could be available electronically on the first date of going live, saving
the average practice more than 156 hours of data entry time per physician.
This same methodology would work for “active and prior medication history.” Using the SureScripts
network, EHR vendors can obtain a patient’s medication history, assuming the medication was paid for by the patient’s local health plan. Given the number of prescriptions maintained in the SureScripts network, it is likely that more than 70% of prior medications could be electronically entered into a practice’s EHR database before going live, which could save the average practice more than 141 hours of data entry
time.The Patient Health Record
When a patient checks in at the front desk, the registration clerk usually asks the patient to fill out numerous forms that cover family, social, and medical history. Instead of asking every patient to fill out the forms when they are in the waiting room, practices could ask patients to fill out the same information via the practice’s Website or a kiosk located within the practice. Enabling a patient to electronically enter this information eliminates the costs normally associated with entering these data in practice. By using an electronic program like Instant Medical History
, which interfaces with more than 40 EHR products, the practice can direct the patient to a site where discreet data can be captured and seamlessly imported into the practice’s EHR without anyone in the practice touching a keyboard. Each practice could customize their patient clinical questionnaires based on clinical protocols and physician-specific guidelines. Once the patient has filled out the practice’s questionnaires, a nurse or medical assistant can capture information on the chief complaint, allergies, medical conditions, vital signs, active medications, recent medical and social changes in the patient’s life, and other key information.
A survey conducted by the AC Group in May 2008 that included 137 practices found an 83% higher EHR implementation success rate when the practice assigned a nurse or medical assistant to entering Review of Systems (ROS) and History of Present Illness (HPI) data for patients into the EHR. These findings indicate that once the clinical data entry template has been approved by the physician, entry of ROS and HPI data could be assigned to a nurse or medical assistant, who would be trained to follow the physician’s clinical protocols and guidelines. This single change
in data entry methodology could save physicians more than 100 hours of data entry time per year.