Although stimulus money incentives have been provided for hospitals and health systems to adopt electronic medical records, medical practices, for the most part, have had to make this significant investment on their own.
 
Buying the right EMR system remains a major monetary investment as well as a daunting task for overstretched medical practice staff and physicians.  These practices need to find the right technology to mesh with their processes in order to experience a strong return on their investment, which most understand to be time and money saved.
 
However, many practices fail to take the time to refine and improve their day to day processes before jumping into a new EMR system.  The theory of ‘garbage in, garbage out’ applies here.  If business processes are causing a practice to lose money or to duplicate tasks, an EMR system won’t magically fix that problem.  A savvy medical practice needs to take a step back, look at the entire practice with a critical eye, make adjustments and then begin EMR adoption.
 
In my work with medical practices, I have found the old saying that, “a picture is worth a thousand words” certainly true when applied to communicating and understanding complex business processes so that they can be refined, which is why I take a visual communications approach to my consultant work.
 
Not only is it easier to communicate processes using a picture, but it's also much easier for people to remember things that have been communicated to them visually. Psychologist Jerome Bruner of New York University has studied the art of communication, and his research has shown:

• People remember 10% of what they hear;
• 20% of what they read; and
• 80% of what they see and do.

 
Here are five ways that a visual communications approach has helped my clients refine their processes, increase revenues, reduce redundancies and then successfully embrace EMRs:
 
Document Job Functions.  This sounds obvious, but you’d be surprised how many physician practices do not properly document day-to-day functional processes -- largely because they don’t have the time to do this critical management task or they think it requires special technical skills.  If they do document processes, they are usually in Word and are placed in thick binders that mostly collect dust or at best, get updated once a year or viewed when a new employee is hired.  Get everyone on the same page by using a flowchart to document job functions.  Flowcharts clearly show the steps needed for jobs to be done.  Documenting processes with flowcharts have an added human resources bonus function as well.  When you have processes documented with easily updatable flowcharts, there is no sense of panic when ‘Brian’ leaves.  We know what Brian does and where his part in the process falls.  The next Brian can see what he is supposed to do, jump in, and start doing it. It’s all right in front of him as a convenient HR tool.  Creating visual communication pieces, like flowcharts, has to be easy enough for anyone in the practice to do.  I typically use and recommend SmartDraw software for visual communication tools like flowcharts, mindmaps and even floorplans because it’s easy, inexpensive, fast and doesn’t require heavy technical skills.  It also works well with the whole Microsoft suite, in addition to Adobe and other output options. Other software options include SmartArt which is more basic and a bit less versatile, or ConceptDraw, among others.
 
Eliminate Process Bottlenecks. Visually documenting businesses processes, for example, a patient throughput process, can yield startling results.  As an example, I usually work at a medical practice for 3 days to see exactly how the practice works. I become one of the staff members, moving papers, making copies. I want to see how much burden people in the practice put on their own work processes that can be eliminated. To help the practice, I use a visual communications tool called a mindmap to create a rough chart of the current situation in its reality.  This allows everyone to see where the bottlenecks are, where there are redundancies and how, by using practical solutions, we can eliminate wasted effort.  I was able to show the client ways in which their processes were needlessly costing them money and suggested ways to save resources.  I then created a flowchart for them that showed how the elimination of certain tasks would save $89,000 a year just in paper costs.  This was very striking for them.
 
Create and Own New Processes. When a practice understands where its bottlenecks are and eliminates them, it is free to create new and improved processes. By visually creating the new process in a flowchart, that process is more readily understood by everyone involved. Staff members can see where their part of the process fits into the big picture and are more likely to take ownership of their part of the puzzle. My suggestion: once a new process is created with a flowchart and everyone knows and understands it, enlarge the charts, laminate them, and post them in the employee lounge, among other areas.
 
Visually Prove Compliance.  When you visualize processes, it not only helps your staff understand what to do and when -- you’re providing a helpful tool for surprise inspectors who come to call. They don’t have to wade through the infamous (and rarely opened) fat process binders. They can see the visual process in your flowcharts or your organizational charts. They can see that definitive processes are in place and are in fact current. The Joint Commission and DNV (which accredits the new NIAHO credential) are proponents of the visual approach to documenting processes and for good reason. They know that employees are far more likely to view a chart to easily understand a process rather than read a weighty tomb of instructions. It’s human nature.  
 
I See, Therefore I Remember (And I Am Not Afraid).  New, streamlined processes as part of an EMR system will help everyone understand and take ownership of the new technology.  Visually communicate the processes leading up to and including input and extraction of data from the new EMR system.  Make a visual EMR manual that people can refer to everyday.  There is something about communicating visually that sparks an “aha!” moment when learning something new, rather than an “ugh... this is so much to read and learn.” Most people are visual learners; a US government study suggested that up to 83% of human learning occurs visually. The study also indicated that information which is communicated visually is retained up to 6 times greater than information which is communicated by spoken word alone.  Embrace EMRs with open arms and improved processes by employing a visual approach.

Ron Spiegel is CEO of RSES Consulting, LLC, (www.rses.com) a Tucson, Arizona-based consultancy that helps small to mid-sized medical practices make intelligent EMR and technology decisions.