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Practice Management

Easing the paper- to-EHR transition

Consolidating administrative functions while ensuring clinical data is shared amongst the group. By Kevin Mullen


n early 2008, the Massachusetts eHealth Collabora tive began supporting the Beth Israel Deaconess Medical Center (BIDMC) and Beth Israel Deaconess Physician Organization (BIDPO) with their electronic health record (EHR) initiative. This was a jointly managed program to provide EHRs to approximately 300 affi liated physicians located in more than 170 physical offi ces, geographically dispersed across eastern Massachusetts. Primary objectives for BIDMC-BIDPO were to enhance

quality, foster clinical integration across the network of providers and construct a foundation for health information exchange and continuity of care. Additionally, there were specifi c goals for all eligible providers to achieve meaningful- use objectives and clinical quality measures (CQM), im- prove diagnostic coding and documentation processes and advance other pay-for-performance incentives focused on advanced diabetes care, cardiac disease, asthma, depression bronchitis, appropriate radiology test ordering and use of e-prescribing. BIDMC-BIDPO provided a centrally hosted, service-as- a-software (SaaS) EHR - eClinicalWorks (eCW) application delivered to practices via the public Internet. However, as the majority of the practices are separate legal and busi- ness entities, they were set up on distinct and independent EHR databases to allow each group to develop practice and specialty-specifi c processes and isolated customization. In an effort to balance the objectives for clinical integration,

fort to balan the objectives for clinical integratnce e the

retain practice and specialty autonomy and ease the deploy- ment process, it was essential that BIDMC-BIDPO adopt a uniform approach to the EHR confi guration and develop a standardized content management plan, collectively referred to as the “model offi ce.”

Establishing a clinical standards work group A clinical standards work group (CSWG) was formed to set priorities for the design and build of the application, identify the minimum data and documentation standards and make policy recommendations for the EHR. The CSWG is comprised of key clinicians, administrative staff and subject matter experts who represent the needs of the constituent practices and specialties and provide insight into the clinical data and reporting requirements for the various internal and external initiatives. The CSWG is a primary advocate to garner broad support toward objectives and outcomes and the forum to communicate clinical data requirements and policies. Most hospital systems already have this type of functional group in place, as do many independent practice association (IPA) and physician hospital organizations (PHO). In some cases, it makes sense to recast and reorient an exist- ing team to focus on ambulatory systems. In other cases, you will want to solicit additional membership to better refl ect the needs of the larger specialty community.

System design and build process Ideally, all members of the CSWG will have had advanced training on the EHR application in time for them to make decisions on the design and build. However, we quickly learned that just assembling and getting time commitments from these “high-infl uence” individuals was a challenge in itself. At this point, we were more interested in their ability to make recommendations and decisions on standards and content, and less on developing them into application super- users. So, overview application training that covered all the functional areas of the application was provided to the group. As an overall process, we found it more effective to create a virtual environment to review and communicate the data sets amongst the working group. Using spreadsheets, Word docu-


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