As practices continue to utilize and expand the capabilities of their Electronic Medical Records (EMRs) for Stage 2 and 3 of Meaningful Use, there are many low cost technology tools that can enhance your practice operations, saving both time and money. Many of these resources are designed to not only improve patient outcomes, but to reduce two major costs: Labor and paper.
The Hidden Costs of Labor and Paper
In addition to the material costs of paper, toner, printer maintenance, etc., workflow based on paper documentation is an expensive one. Labor is the greatest cost associated with running a medical practice. To maximize the return on investment for labor, workflow should be designed to improve efficiency and to focus on higher level functions. This workflow is disrupted, often several times a day, when paper documents or patient files are not available at the point of care. According to Ricoh’s A Realistic Transition Toward the “Paperless” Medical Practice:
· It costs $20 in labor to find a document; $120 if misfiled.
· The average document is copied 9-11 times at a cost of about $18.
· 86% of mistakes in family care offices involved document-related activities, such as misfiling patient information, prescribing the wrong medication, and ordering incorrect or duplicate tests.
Many of the tools and resources in this article are designed to replace paper-based processes with electronic ones. The advantages of these identified paper-to-digital resources include how to:
- Reduce the time and cost to file and store paper documents
- Better utilize existing technology your practice likely already owns such as universal fax/copy/printers
- Integrate within your existing processes, particularly patient-centered medical home (PCMH) models
- Demonstrate how once digitized, documents can flow between various technology tools, such as your EMR
- Ensure electronic documents sit within your server’s protected environment for HIPAA compliance and security
- Train staff easily, especially for younger staff and providers who are tech savvy.
11 Tools and Resources You Should be Using Now
- Electronic Prescribing (ePrescribing)
The percentage of physicians e-prescribing using an EHR increased from 7 percent in 2008 to 70 percent in 2014, but it bears mentioning because there are still a large number of providers who continue to utilize paper prescriptions. ePrescribing has many benefits to the provider and the patient, including:
- Improving patient safety by eliminating illegible prescriptions, reducing verbal miscommunications, provides warning and alert systems when prescribing such as allergies, and provides the patient’s complete medication history to eliminate redundancy.
- Saving valuable staff time by reducing phone calls to pharmacies.
- Improving patient compliance by making the pharmacy experience easy and convenient, and also gives feedback to the physician to address noncompliance with the patient.
- Reducing cost to the patient by identifying generic alternatives to formulary drugs at the point of care.
- Electronic Fax (eFax)
Many practices still use a paper fax machine and the labor costs involved can be heavy. Contemplate that staff have to print the fax, scan it, and then index it properly into the patient’s EMR, or route it to the appropriate provider or staff when using a manual process. By utilizing an eFax service, faxes are received into your server electronically and can be quickly indexed to the proper location, either in the EMR or emailed/routed to the proper staff/provider, cutting out the redundant need to print documents that will need to be scanned into the patient chart later.
- Practice Website
A website that is customized to your practice is an invaluable tool to disseminate information to new and prospective patients and provides the foundation for many of the resources listed below. By providing information that is easy to access online, you can attract new patients, extend your practice beyond your ‘four walls’, and reduce phone calls to your practice for basic information. A few things to keep in mind:
· Your domain name should be as simple as possible and easy to remember, preferably your practice name.
· Utilize a template that is customizable for your practice so it does not look ‘cookie-cutter’ and can show off what is unique to your practice and is easy for patients to navigate.
- Whatever web developer you us, make sure that they provide you with a decent ‘content management system’ making it easy for you to update website content. Many practices make the mistake of buying a cheap website design that is difficult or expensive to alter, requiring a complete overhaul of the website even for small changes of information.
· Be sure to have an attractive and engaging home page and an informative “About Us” section that includes contact information and directions to your practice.
· If you have a patient portal with your EMR and / or e-messaging, display them prominently and make them easy to access
· Online patients forms and links to your Social Media platforms should also be prominently displayed
- Patient Portals and Secure Electronic Messaging (E-Messaging)
As patient use has lagged behind meaningful use adoption expectations, patient portals and e-messaging have gotten a bad rap — so much so that the Center for Medicare & Medicaid Services (CMS) had to dramatically downgrade the requirements for their use. However, these tools, which are now usually included with your EMR, can be very valuable. By encouraging the use of e-messaging and the patient portal, you can save valuable staff time by reducing call volume, staff time spent looking up information, handling prescription refill requests, and sending requested forms. Some patient portals also allow for online scheduling, which in turn reduces calls and wait times for patients with more urgent requests.
To encourage the use of your patient portal and e-messaging, these services should be highlighted and easily accessible on your practice website, and posted in your waiting and exam rooms. Make sure staff and providers are promoting these services to patients as a means to quickly receive information. While CMS has temporarily reduced this portion of the Meaningful Use requirements, the reasons to fully utilize a portal have little to do with meaningful use metrics and everything to do with office productivity and patient request processing efficiency.
- Online Patient Forms
By providing patients with online forms on your website, you can save time and paper by collecting medical and insurance information prior to the visit. You can also provide patients with information about what they need to bring to their appointment, inform patients of your practice’s policies, better prepare your providers with medical information, and advise your care coordination team of any potential ancillary services and referrals.
There are two ways to accomplish this:
- Create PDF files that are easy to download and print from your site, so that patients can fill these out ahead of time and bring them with them to the appointment,
- Utilize a HIPAA-compliant online electronic form platform (such as Jotform.com) which allow you to create custom online templates for your forms that can be embedded on your practice website at minimal cost and best of all, it’s easy to use! Just make sure that if you utilize an online form that you DO NOT have the details passed from the Form system to your email, as that would allow information to leave a secure environment and pass through a non-secure environment (your email service). Notification that a form has been received in your account is all that should be emailed to you.
- Electronic Surveys
Have you ever wondered what your patients want? Why not ask them? Many practices make business decisions without getting feedback from their customers, the patients. Thinking of expanding your hours, adding certain ancillary services, or want feedback on the state of your practice or performance of your providers and staff? How about getting feedback from your staff and providers on job satisfaction? Online survey collection tools such as Survey Monkey provide a free platform for creating and analyzing survey data that can be collected anonymously, and one again, it’s free and easy to use!
Note: having a feedback form available (such as on a tablet or ipad) to complete at the check in desk is the best way to ask your patients for feedback. Emailing them after the visit can often result in a low response rate.
- Social Media
Every practice should have a social media presence across at least one social media platform (facebook, Twitter, Pinterest, Instagram, etc.). These platforms are best used to encourage relationships, whereby patients feel connected to your practice on a regular basis. Social media can be used simply to share operational information such as holiday hours, introduce new providers and staff, as well as important medical information like updates regarding flu season, or information from medical societies. Expand your content to include tips, useful articles, expert opinions and even a little fun, and it can also your best tool for promoting your practice and strong sense of community with your patients.
- AutoVoice Recall
Another way to save time, paper and money is to ditch the reminder postcards and utilize auto voice recall systems. These systems generate an automatic call to patients who have upcoming scheduled appointments and reminder calls for those with chronic conditions who need to schedule follow up appointments. As this process is automated through your EMR, it prevents patients from slipping through the cracks, ensuring more optimal care and maximizing revenue by increasing follow up visits. The staff time required to phone patients individually or, the even more expensive route of sending reminders by mail, can be reduced substantially.
- Electronic Dictation and Notes
The chief complaint of many providers who struggle with their EMRs is the time it takes to enter information into the record. Many providers find the physical process of typing while seeing the patient intrusive, requiring them to multitask as they try to provide the best care and bedside manner possible. Others struggle with their typing speed and are unable to keep pace with their visits as the EMR slows them down.
To help with that, there are a couple of options providers can explore. The first is voice recognition software, such as Dragon, where the provider wears a headset and verbally enters notes into the EMR and dictates the notes for the visit. Many providers really like this technology and the cost to benefit ratio typically more than pays for itself.
Second is the use of scribes. Medical scribes are trained in transcribing medical documentation. Scribes assist physicians by sitting in on patient visits and entering notes into the EMR. This requires a thorough analysis of your workflow to ensure the cost-benefit is worth the investment of staff time, training, and workflow redesign, but the increased physician productivity (and happiness!) is usually worth the investment.
- Telemedicine and Virtual Visits
A rapidly growing area is the use of telemedicine and virtual visits to eliminate barriers to access of care, particularly for patients who are home-bound or in rural communities. The technology and security of networks has dramatically improved, as has the diagnostic equipment used to provide virtual visits (for example, listening to heart and lung sounds using an electronic/digital stethoscope). It’s important to check with your Payers to determine if they are covering these services (many will only do so through third party companies), but there are now several companies helping physicians to offer these services to patients that are looking to pay directly for the convenience of a virtual visit. According to the American Telemedicine Association, some examples of telemedicine include:
- Primary care and specialist referral services may involve a primary care or allied health professional providing a consultation with a patient, or a specialist assisting the primary care physician in rendering a diagnosis. This may involve the use of live interactive video or still diagnostic images, vital signs and/or video clips along with patient data for later review.
- Remote patient monitoring, including home telehealth, uses devices to remotely collect and send data to a home health agency or a remote diagnostic testing facility (RDTF) for interpretation. Such applications might include a specific vital sign, such as blood glucose or heart ECG or a variety of indicators for homebound patients. Such services can be used to supplement the use of visiting nurses.
- Consumer medical and health information includes the use of the internet and wireless devices for consumers to obtain specialized health information and access online discussion groups that provide peer-to-peer support.
- Medical education provides continuing medical education credits for health professionals and special medical education seminars for targeted groups in remote locations.
Technology is Only a Tool
Technology provides useful tools to deploy in your practice, but can never be the solution to providing the best care. By streamlining processes within the practice, you and your staff can eliminate mundane tasks and focus on higher-level processes such as care coordination, chronic care management, and other processes required to transform you into a higher functioning patient-centric practice. In addition, utilizing technology may help to differentiate your practice by providing patients with information at their fingertips in an easily accessible format. Patients experience technologically-enabled tools at every other service point in their lives – they expect it from you too. And these tools can help your practice save time and money by automating costly processes that used to require staff time. Who wouldn’t want to improve service and decrease costs at the same time?
Sidebar: Assessing your Practice’s Use of Tech Tools (In a box)
Of the following 11 technology tools, how many is your practice currently using? Give yourself one point for each box you check off, then proceed to the bottom to see how you scored.
- Patient Portal
- Online Patient Forms
- Practice Website
- Social Media
- Autovoice Recall
- Electronic Dictation and Notes
- Telemedicine and Virtual Visits
How did you do?
Score of 9-11 points: You’re a tech tool pro! You recognize the value and benefits of using these tools and are improving processes and delivering better care as a result. Keep up the great work!
Score of 6-8 points: You realize there are real advantages to tech tools but some of them may seem too complicated or unfamiliar so you’ve resisted adopting some of them in your practice. Pat yourself on the back for getting this far and commit to adding one more tech tool from the list in the next 6 months.
Score of 5 or lower: Whether you know it or not, your practice is falling behind the rest. By missing out on the advantages available to you through tech tools, you’re giving your competitors a leg up. When you’re ready to catch up and take the first steps towards saving time and money, drop us a note at firstname.lastname@example.org and one of our experts can help you on your way.