If your front office does not operate efficiently, it has a negative ripple effect throughout your entire practice. The Meaningful Use program, mandatory E-Prescribing, and health system reform initiatives at the state level are taking their toll on many practices. The transition towards Electronic Health Records and adaptation to new workflow processes is creating significant challenges for clinicians; however, it is important to recognize that office staff and practice managers are equally challenged by these changes.
What can you do to optimize the front office? Here are some tips to assist you:
Training Across Multiple Roles
Cross-training staff is an important part of running most small medical practices efficiently. With a limited number of staff members, if one of them is ill, everyone else has to pitch in to keep the office running. When implementing an EHR system it is important to make sure that all practice staff receive training on how to use all of the administrative functions of the system even if they do not use them regularly. Additionally, administrative staff should be familiar with the clinical functions of the system even if they do not need to be proficient using it. Similarly, clinical staff should be familiar with administrative features. This allows individual members of the practice team to better understand the workflows within the practice and the downstream consequences.
While working with a practice a couple of years ago I came across a situation where the medical assistant was keying the most recent lab results for patients into the encounter note immediately before the doctor saw the patient. Although the practice had an operational lab interface, she explained that Dr. X insisted that the information be included in the pre-visit “triage” note she created before each encounter. In this instance the practice insisted that patients obtain lab work the week before any routine visit. Besides the increased risk of error, manual entry of the information was taking about 15 minutes for each patient, resulting in longer wait times. When I asked Dr. X why he required this step, he stated that he liked receiving a reminder to discuss results with the patient. When I explained the laborious process the staff were undertaking to enter this information, he was shocked. After a review, the practice decided to have the medical assistant type in “see lab results” rather than transcribe all of the information. Ensure that everyone in your practice has an understanding of the workflows within the practice and how all roles interact with any electronic system. This can help your practice avoid similar inefficiencies.
The standardization of process and forms/templates used to collect information is critical in order to optimize efficiency and improve patient safety. Make sure your practice uses standardized templates to enter administrative data. This can be just as important as clinical optimization of your EHR system. In fact, many of the tips outlined in Why Templates Are Essential to Using an EHR and Data Entry Strategies Using Templates also apply to administrative processes. It is also important to consider standardizing administrative processes in the practice. I cannot recall how many practices I have visited in which the administrative staff have a different set of information and triage process for each doctor in the practice. While I understand the desire of many clinicians to have a customized process to best meet their specific needs, every customization can cause operational challenges for the rest of the practice team and may even lead to medical errors. For instance, having a customized set of questions for each physician that staff are meant to ask when a patient calls the office can lead to confusion among staff and may result in miscommunication. It also limits the ability of staff to cross-cover for one another on busy days or if someone is sick. Wherever possible, try to come to an agreement on a single process for all clinicians.
Additionally, standardization is an important factor to consider when implementing an EHR system. Given the fact that people will learn to use the system at different rates, it can be easy to change processes to accommodate these variations. While this is expected, it is important to ensure that these differences do not become ingrained in the practice’s operations. Unfortunately I visited several practices in which one clinician is still using paper charts more than two years after the initial implementation and still requires staff to record messages using paper forms instead of the new electronic messaging system.
Reporting options available in your EHR system can help your practice do more than just qualify for Meaningful Use; they can also be used to optimize your business. Consider running reports on patients who need to come in for various types of preventive services and either send them a letter or have a staff member call them to set up an appointment.
In addition to being a great way to engage your patients, Patient Portals can also help improve your practice efficiency. I have provided an outline of the most common features and how they can help your practice.
- Online scheduling: While many practices are intimidated by the use of online scheduling applications, they can be a great way to cut down on phone call volume and no-shows. One of the common concerns I have heard from practices is a fear that clinicians will lose control of their schedule. However, by designating a limited number of appointments for online scheduling, this risk can be managed very effectively.
- Access to Lab Data: Providing lab data via a patient portal can reduce postage costs if you mail the results to your patients, or staff time if you call about the results. Some practices may be concerned regarding an increase in the number of phone calls or emails they would receive, but in most cases, they found that exposing this information actually reduced the volume of questions.
- Refill Requests: Allowing patients to request refills through a patient portal can help your practice stay on top of the process by automatically triggering a request to the correct individual. (Doctors, don’t worry: most systems allow you to determine who this individual should be.) Automated systems can also queue the requests so they can be acted upon in bulk. Most of these systems also link the request with the appropriate medication in the patient’s medication list.
Setting up interfaces with the laboratory(s) that your practice typically uses can be one of the best ways to improve office efficiency. Interfaces can substantially reduce the number of paper records your practice has to deal with on a daily basis. Remember too that you will need a lab interface in order to meet Meaningful Use, unless you want your staff to manually enter all of the lab data into your EHR. To find out more on lab interfaces I recommend reading the AmericanEHR Partners blog post Four Things to Remember when Acquiring a Lab Interface.
The use of a fax server can reduce the time staff have to spend scanning documents that were received via fax. Most fax servers simply create a .pdf version of the incoming document and store the document on a server. Staff can then attach the appropriate document to the relevant patient’s file in the EHR. Many EHR systems allow you to manually tag/associate a lab result with the appropriate lab order. While this process generally takes more time for admin staff to perform, it has several advantages.
- Information is more readily accessible. For instance, one practice I visited had a complicated filing system in which they had created a file (in the server) for each patient and sub-folders for labs, radiology, and consulting notes in which they stored patient documents. However, in order to access this information, the doctor had to locate the patient’s file on the network, find the relevant test, and then open it up using Adobe Reader.
- Linking orders with results allows one to track whether results were actually received. In some cases, the EHR can generate reports to determine if there are any outstanding tests.
- Patient reporting results for quality metrics are improved. Unfortunately, EHR systems are currently not sophisticated enough to recognize that a mammography report should count towards the relevant quality metrics. By associating results with the correct order, the system is “aware” that such a file exists.