It's no secret EMRs can be complex and confusing, and despite the buzz surrounding their implementation, health IT expert Shahid Shah believes some organizations are better off taking things slow.
"Although most people who are new to healthcare IT always point to EMRs as the most important application, there are many different healthcare IT applications that make up the 'industry' as a whole," said Shah. "When you’re dealing with healthcare IT, EMRs might be a good entry point for some folks, but it’s actually more likely that EMRs aren’t your first place to start your automation journey."
So to help with deciding where your first point of entry into healthcare IT should be, Shah gave us his top 10 technologies to embrace before jumping into an EMR:
1. ePrescribing. According to Shah, ePrescribing is a great way to begin automation since it’s a fast way to see how much slower the digital process is at capturing clinical data. “If ePrescribing alone makes you slower in your job, EMRs will likely affect you even more,” he said. “If you’re productive with ePrescribing, then EMRs, in general, will make you more productive too.”
2. Email. “Internal office messaging and email is a great place to start,” said Shah. “If you haven’t started your office automation journey here, you should.” But, beware of HIPAA, he added. Although it doesn’t prohibit the use of email for sending electronic PHI records, its Security Rule specifies standards for making transmission of PHI via email secure. Regulations include standards for access control, integrity and transmission security.
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3. Microsoft Office 365 and Google apps. When it comes to scheduling and document sharing, “Google and Microsoft have some very nice online tools for managing contacts, or patients, and scheduling appointments,” said Shah. In addition, both tools have “dirt simple” documentation management, he said, which allows everyone in the office to be on the same page. “Before you jump into full-fledged EMRs, see if these basic, free tools can do the job for you."
4. Clinical groupware. This new category of software is an evolving model for the development and deployment of HIT platforms and applications. Shah said the technology helps streamline work and prioritize according to patient. “This is a new category of software that allows you to collaborate with colleagues on your most time-consuming or most needy patients and leave the remainder of them as is,” he said. “By automating what’s taking the most of your time, you don’t worry about the majority of patients who aren’t.”
5. Patient registry and CCR bulletin board. “If you’re just looking for basic patient population management and not detailed office automation, then patient registries and CCR databases are a great start,” said Shah. Although they don’t necessarily help with workflow, they do manage patient summaries. In fact, patient registries have been proven to improve chronic disease care. An article published by the AAFP explains how, although an EMR manages chronic diseases in a proactive and organized fashion, a commercially available spreadsheet program offers the same benefits. “For example, using a spreadsheet program, [such as Microsoft Excel or a database program, like Microsoft Access] you can easily create a list (or registry) of your practice’s patients with a given chronic disease and then use that list to track key measures and remind you and your staff automatically when patients need certain labs and preventive services,” according to the article.
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6. Document imaging. “Scanning and storing your paper documents is something that affects everyone,” said Shah. “All scanners come with some basic imaging software that you can use for free.” And once you’re good at scanning and paper digitalization, he said, you can move to “medical grade” document management that can improve productivity even more.
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7. Clinical content repository (CMS). Open source systems, like Drupal and Joomla, do a great job of content management, said Shah. “And they can be adapted to do clinical content management.” Both Joomla and Drupal offer users flexibility to change and manage content on their own. And, not to mention, a clinical content repository allows for easy searching, cross-correlation, and simple updates. One success story includes Cedars-Sinai Medical Center, which implemented a clinical content repository to collaborate with other research facilities and create a database that included information from a significant number of trials, as well as numerical data from blood and tissue analyses.
8. Electronic lab reporting (ELR). “If labs are taking up most of your time, you can automate them pretty easily with web-based lab reporting systems,” said Shah. ELR has many benefits, including timeliness, reduction of manual data entry errors, and more complete reports. It’s been promoted as a public health priority for the past several years, and since it’s a meaningful use objective, its adoption is being accelerated.
9. Electronic transcribing. On the flip side, if clinical note taking is eating up most of your time, consider automating it by using electronic transcribing, suggested Shah. Additionally, electronic transcribing will help on your journey to adopting an EMR by maintaining an optimal, popular dictation interface, creating a document-sharing system among multiple locations, and reducing transcription expenditures by reducing the number of lines transcribed.
10. Speech recognition. Shah said speech recognition is another “point solution” to helping with capturing clinical notes. “You can get a system up and running for under $250,” he said. And today’s speech recognition software can be do more than pure dictation. Most systems can be used to manage email as well as speed up information turnaround and protect employees from repetitive stress injuries. Additionally, the software can be integrated with most EMRs.
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