CASE 5: SELECTING AN EHR FOR DERMATOLOGY PRACTICE

Suppose youve just been hired as the practice administrator of an eight- physician dermatology practice. After several years of contemplation and serious deliberations, the physicians have made the strategic decision to invest in the selection and implementation of a facility-wide EHR system. They also want to replace their practice management system (which includes patient scheduling and billing). Its an older system that is rather clunky. Ideally, theyd like to find an integrated practice management system that has an EHR component.

Dan Brown, the current CEO of the physician organization, has very little knowledge of information systems technology. He has been reluctant to move toward an EHR system for many years, primarily because he heard stories from a few his colleagues in other specialty areas who have implemented EHRs in their practices and have found the systems to be highly cumbersome and disruptive to the patient care process. One of his best friends claims he spends an extra hour or two a night in the office because of the additional time demands of the EHR. He claims the system never seemed to work right.

CASE 5: SELECTING AN EHR FOR DERMATOLOGY PRACTICE 481

Brown is convinced that there are not any great dermatology-related EHR products on the market, but with value-based payment looming, and the opportunity to improve quality of patient care, hes open to taking another look. In addition, one of their newest partners, Pam Martin, just finished her residency program where EHRs were an integral part of her training. She is a big champion of the effort to select and implement an EHR. She has offered to help lead the effort. One of the other partners, John Harris, came back from a conference impressed with the vendor presentation from Allscripts and con vinced its the way the practice ought to go. The other physicians are nearing retirement and a little nervous about the possible disruption to the office.

Information Systems Challenge

Even though the patient records at the dermatology practice are paper-based, the practice has been using computerized practice management systems for patient scheduling and billing for years. Six months ago, they started to have a nurse enter physician-dictated notes into the paper record while in the examination room with the patient. The physician then reviews the notes at the end of the visit or day and signs off on them. This is in an effort to decrease the dictation and transcription that the practice had historically done and to get the nurses and physicians ready for the EHR. The expecta tion is that nurses will do the bulk of the data entry in the examination room while the physicians are seeing the patients. However, the physicians will have to review the documentation and sign off on all entries.

The practice currently has approximately four thousand patient visits per month, including 40 percent Medicare and 10 percent Medicaid.

Discussion Questions

You are tasked with leading the team charged with the selection of the new practice management system, including EHR, for the practice.

1. You begin by convening a practice managementEHR selection team. Who would serve on the team? Who would serve as executive sponsor? Explain your rationale.

2. How might you conduct an EHR-readiness assessment for this practice? What factors will be important to consider? Why?

3. Develop a draft system selection plan for this practice. What do you envision will be the practices greatest challenges in selecting a replacement practice management system and a new EHR? Explain your rationale.