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 Meaningful Use

How to use pen and paper to achieve MU with an EHR

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   By Sheila Tonn-Knopf, September 2012

On a recent trip to Navy Pier in Chicago, I realized my practice, The Center for Orthopedics, is a lot like an amusement park. Everyone wants a great experience; no one wants to wait in line for the big rides.

Eighteen months ago, in the midst of planning our electronic health record (EHR) rollout, I recognized we could make significant changes in practice operations. Our providers are in the 90th percentile for patient volume, so we often had long lines and extended patient wait times. We processed eight to nine patients every 15 minutes.

Arguably, I needed to add front-office staff regardless of our EHR implementation, but I wanted to be strategic about new hires by placing them into roles to improve process, not just keep it going. Could I find a way to leverage work already being done by patients during the check-in process and avoid redundant data entry?

Taking our practice electronic meant that it would no longer be sufficient to have patients fill out demographic and medical history forms on paper and simply file them in a chart. Even scanning these forms into the EHR would not be enough. The valuable information provided by the patient, some of which includes meaningful-use (MU) data, would simply be a static image, rather than actionable and structured data incorporated into the rest of the encounter documentation.

It would have meant hiring three additional full-time employees just to keep up with the data input of patient forms, and would have required the build-out of additional cubicles to capture patient information. We didn’t plan, nor could we afford, to expand our clinic footprint as part of our EHR implementation.

Productivity was another challenge. I had heard from industry colleagues about EHRs creating a 20 percent permanent impact to physician productivity. I wasn’t content to accept that so I began to explore innovative ways to get technology to work for us, rather than vice versa. The winning solution would allow us to use the space we had available, maintain our clinic productivity and provide a positive patient experience.

We evaluated patient data entry solutions that included patient portals, kiosks, bubble sheets and digital pen technology. An online patient portal would not be used by all patients; we needed a solution that captured structured information on 100 percent of patients. Bubble sheets may have been easy for patients to fill out, but would only be helpful for checkbox-style questions – plus our EHR was not compatible with the bubble-sheet-scanner technology. Kiosks seemed like a good alternative to staff, but unless I wanted to build a custom solution, which was resource prohibitive, the available options only captured demographic details without addressing clinical-MU items.

Eventually, my search led me to Shareable Ink, an enterprise cloud-computing company that transforms handwritten documentation to structured data and allows automatic electronic capture of clinical and administrative information in the most natural manner for the provider and patient. Using a specialized ballpoint pen and our existing paper forms, patients could complete forms during the check-in process as they had always done, with no training or help required by our staff. Clinical and administrative information from any form used in the practice can be electronically processed and mapped to appropriate fields in the EHR.

At patient check-in we maintained our volume and productivity levels, while capturing the additional MU data. I added one full-time employee (instead of the six I would otherwise have needed) to help manage the check-in process with significant savings. The configuration of our clinic waiting areas remained the same, and we actually improved our patient experience.

For MU, we chose to capture directly from our patient forms: height, weight, past surgical history, allergies, smoking history, flu vaccines, pneumonia vaccine, race, ethnicity and language. These elements are mapped to corresponding fields in the EHR, thereby avoiding data entry by the staff. We can also collect pharmacy, primary care physician and medication lists. If the patient documents information incorrectly, the medical assistant who takes the patient into the room can easily edit it in the EHR.

Despite launching an EHR and new patient data-capture technology on the same day, our practice saw no permanent drop in productivity, and we’ve succeeded in providing a positive patient experience that eliminated the long lines. As I had hoped, with a little innovative, outside-the-box thinking, we succeeded in getting technology to work for us without changing our practice to suit the technology.

About the author

Sheila Tonn-Knopf, M.H.A., CMPE, is the executive director for The Center for Orthopedics. For more on Shareable Ink, click here.


Tags:  Meaningful Use