Top 10 'urban myths' of EHRs

For the most part, electronic health records are terrific. But they're far from perfect. And providers implementing EHRs shouldn't expect them to be problem-vanquishing panaceas, said Ann Meehan and Julia Kendrick of Nashville's Ardent Health Services.

Speaking at the  82nd  annual AHIMA conference and exhibition in Orlando on Monday, the two registered health information administrators (RHIAs), spotlighted what they considered the 10 most glaring myths about EHRs.

  1. Broken HIM processes are resolved in an EHR automatically. The goal, obviously, is to gain improved processes and functionality, said Kendrick. But implementing an EHR will often shine a surprising spotlight on operational areas that need work. The key is to flow chart all your current processes beforehand and plan ahead as much as you can.
  2. Chart reconciliation is a thing of the past. "Some paper has to be scanned," said Kendrick. "We still have to do chart reconciliations."
  3. "Missing charts… what are those?" Kendrick said that missing charts are a fact of life, "whether it's a piece of paper, or an HL7 interface." Mistakes are made. Monitoring and correcting errors must be a priority, and coding and operations teams should work closely together to identify missing charts.
  4. "Loose reports? Never again!" Loose reports "do not go away," upon implementation, said Kendrick. "We still get them, we just process them differently." Now they're in a pile waiting to be scanned. She said timely processing and scanning is imperative, and suggests "batch-process loose reports in order to decrease the processing time."
  5. "High DNFB? Solved!" It's important to monitor uncoded reports on a daily basis for DNFB ("discharged, not final billed"), and staffers should be prepared to record uncoded accounts, or accounts waiting for a response to a query or additional documentation, said Kendrick, adding that "coding and operations must work together, not be us versus them. Coders can't code if operations can't find the charts. Ands sometimes operations needs coders to ID things that might be missing."
  6. EHRs only gain you efficiency. Untrue. You get some inefficiencies too. "Electronic is only as smart as the build," said Kendrick. And manual workarounds will always be necessary. Moreover, headaches will be plentiful as different departments push back to varying degrees. For some, paper records will always be the preferred choice.
  7. EHRs will immediately help provider delinquency rate go down. "Yes… eventually," said Kendrick. "Just not right away." And in the mean time, "your providers are probably going to be one of your bigger obstacles. They want to sign paper, not a screen. They'll say, 'it doesn't work, I can't log in, it's too slow.' They're going to drive your staff crazy and complain to everyone who will listen." It's important to begin provider education very early in the process, and work really hard to eliminate as many paper deficiencies and lower delinquency rate as much as possible before you go live.

  8. Record storage is now a thing of the past. "People tend to forget the years and years worth of paper records in off-site storage," said Meehan, who stressed the added importance of keeping six months of charts to pull back out and correct records post-implementation.
  9. EHRs will translate into immediate staff reductions. Said Meehan: "Your CFO will say, 'How many FTEs can be reduced? And when? Yesterday, perhaps?'" That's not considering the "temporary staffing adjustments" that may be in order "to keep processes moving until more efficient and effective" and be redeployed to other HIM needs such as helping address regulatory and oversight issues. She suggests working with your vendor to help define staffing recommendations.
  10. "And they all lived happily every after…." AHIMA may be just a couple miles from the Magic Kingdom this year, but EHR adoption is not a fairy tale. "It's not without trials and tribulations," said Meehan. "But at the end of the day, the good overtakes the not so good. Change is not always easy. But be patient. Listen to what people are saying. Be upbeat and positive. There will be days when things don't go well. It's a transition. Educate, educate, educate – and in the case of some physicians, educate again."