Guest blogger, Tabetha Thompson, details the plan her practice has put into place to circumvent Internet outages and computer issues when adopting an EHR. Tabetha is Team Leader for Nephrology Associates of Michigan, P.C., Ypsilanti, MI. If you have questions for her, please leave them in the comments.
Transformation from the paper chart to the electronic health record has been one of the scariest things to implement for many health care providers and office staff. Today most of us are learning how to embrace it and make it work in our own offices with little or no objection from all involved. Baby steps are key to effective adoption, as is setting up the office with a trustworthy staff that will always look for the “way to make things work” instead of letting you know how this can’t possibly come together.
The object of the game is smooth transitions. For this to happen, you must have a plan in place for all the scenarios you can imagine. You have to think through each step for every process in the office and ask yourself, “Is there a way we can save time without exerting more cost and still meet all expectations?”
Preparing for glitches
One of the plans we came up with at Nephrology Associates of Michigan, P.C., was to take a look at down time (i.e., internet issues, computer problems) during the clinic visits of CKD patients at the main office as well as at all of the satellite offices and decide what to do if anything went wrong with connectivity. We needed a way to allow the physicians as well as the office staff to feel comfortable when glitches occurred. So, we developed the NAM Disaster Plan. In the event that Internet connectivity should be disrupted or computer problems occur and we are unable to access the electronic health record, we have paper copies of necessary orders, etc. on hand. This allows the physicians and the staff to feel confident that they can still see the patient without interruption.
The transcriptionist’s office can immediately fax notes for patients that have been seen by any of our physicians. The hospital can provide a copy of records for labs, tests and notes from patient stays. With information to review, the physician can then use the “generic” superbill/encounter form we created to inform staff of the following:
- When the patient will be due to return
- If labs are needed and when they should be done
- If there are any radiology requests or referrals to be initiated to other offices
- If the patient needs education on CKD
- Nutritionist appointments that need to be schedule
- If epo/aranesp/iron needs to be started
- If a surgery consult needs to be done
Safeguarding with patient paperwork
We also keep a running list of patients for the physicians that have medications/prescriptions that need to be entered into Dr. First. We have a return visit questionnaire and new patient packet needed for any notes, vitals and information for use while dictating. We also have a social history form to be filled out by the patient. For the office staff, these tools can be used in place of the order forms and superbill until service is restored. At that point, we go back to each patient’s EHR and enter the information.
This “disaster” plan was only needed a few times until a new dialysis clinic was built. The first week the new clinic was open, the Internet connection was hit-and-miss. At one point it was offline for 4 days. With our plan in place, patients were seen; the staff and the physicians were able to complete the appointments without hesitation and be fully confident of the outcome. Considering the “what ifs” and putting a plan in place ensured a smooth functioning practice even when faced with glitches.