Section 6.2 Optimize

Section 6 Optimize—Optimization Strategies for Physician Use of HHA, EHR, and HIE - 1

Optimization Strategies for Physician Use of HHA, EHR, and HIE

Use this tool to ensure that physicians can use the electronic health record (EHR) and health information exchange (HIE) services you adopt. Although you will have been communicating with them throughout your adoption process, by the final stages of implementation you will need to ensure that the physicians have access to your system, are trained to use the technology, and know what to expect moving forward.

Time needed: 40 – 80 hours
Suggested other tools: Section 1.7 EHR and HIE Belief Assessment, Section 2.6 Workflow and Process Redesign for EHR and HIE

How to Use

  1. Use the physician communications tool below to review your communications to date with physicians and determine what additional, general communications with physicians are necessary. Plan for specific communications surrounding providing the physicians access and training on use of the EHR and HIE.
  2. Prepare to monitor physician use of EHR and HIE, obtain feedback on their satisfaction, and provide periodic citations of benefits, expressions of appreciation, tips for enhanced use, reports on quality of care rendered through your agency, and other communications that ensure their continued use (and referral to your agency).
  3. Plan to address questions about interoperability with physicians’ EHRs and HIE services. Many physicians already use an EHR and HIE and may understandably want to connect directly with your agency.

Physician Communications

Use the following table to identify communications with physicians. Several examples are provided; modify the table according to the type of HIT you are acquiring and the expectations you have for the physicians to use these systems.

Message / When / Medium / Results
We are acquiring an EHR, participating in HIE, or adopting other HIT to improve the quality of care we provide our clients, to make your interactions with us as efficient as possible, and to ensure optimal reimbursement. Your participation would be greatly appreciated. / Early in Assess and no later than Select. Repeat several times with slight variation on the theme. / Newsletter, letter, or other formal communications you regularly have with physicians.
One-on-one with key thought leaders and physicians in your community who can spread the word. / Plan to address any resistance one-on-one. Also plan to address how your EHR and HIE will interoperate with their EHR and HIE.
Acknowledge participation of physicians in newsletters.
We are pleased to announce that we have selected ABC product to support our care services. Special appreciation is given to Drs. X, X, X for their guidance. We will be keeping you informed of your role in this as we move forward. The first step will be start regular communications about our progress via email. If you do not have access to email, please contact our office immediately. Be advised that at this time NO communications concerning patients are permitted using email. / As soon as a product is selected. / Newsletter, letter, or other formal communications you regularly have with physicians.
One-on-one with key thought leaders and those demonstrating resistance. / Use physician time judiciously. Ask for very specific feedback on certain aspects of what you are doing.
We are in the process of implementing our EHR and HIE. We invite you to participate in a brief demo to start the process of introducing it to you. This system will help you (modify per EHR and HIE capabilities) refer patients to us, gain access to patient information, complete the CMS-485, view and sign orders, and obtain automatic documentation in support of your reimbursement. / Start 1 – 2 months prior to go-live. / Send the announcement through a formal communication.
Conduct the demo ideally through a webinar, but also via a CD you send to the providers and worst case via a “brochure” you prepare with relevant screen shots and mail to the providers. / Take attendance. Follow up with any physicians who did not attend the last webinar.
We will be going live with our EHR and HIE on [Date]. Prior to then, each provider needs to obtain a userID and password and to log on once to the system to change your password. [Explain how they should contact you for this. Also identify anything else they need to do to use the system.] Training will be conducted [Dates] – explain how you plan to train providers. (Providers tend to prefer one-on-one training. If you have a large number of providers, it may be necessary to schedule small groups for demos over time.) / Within one to two weeks of go-live. / Send the announcement through a formal communication. / Plan to address providers still not online.
Take attendance and gauge understanding. Follow up with anyone who does not attend or who appears to have issues.
Acknowledge attendance in newsletters.
You are scheduled to attend the EHR and HIE training session on [Date]. Here is how you will do that [explain]. / Within two days of the training. / Send the announcement through a formal communication. Follow up with a personal telephone call if feasible, or at least for your heavy admitters.
Distribute “cheat sheets” to aid their use on the key things they need to do. / Reschedule as necessary.
We are now live. Please use the system to [describe what must be done for the first patient the physician must provide oversight for after go-live]. / First patient after go-live if you do not see the provider responding to the automated prompt for attention / Within a designated time of expected response, call the provider. Redistribute “cheat sheets,” including to office staff. / Be prepared to walk the provider through the process of performing whatever task is at hand.
We are making excellent progress on achieving the goals we had for our EHR or HIT. Please see attached the quality measures we’ve been tracking. If you have ideas for improvement in any area, please let us know. (Provide any measure or measures that make sense to share – primarily to ensure continued and optimal use.) / About 1 or 2 months after go-live. / Send the announcement through a formal communication and via automated messaging. / Monitor adoption by all providers. Contact any one-on-one if there are use issues.
We’ve now been using our EHR or HIT for [specify amount of time]. We would like your formal feedback as well as any suggestions for improvement. / About 2 to 3 months after go-live. / Send the user satisfaction survey (Section 5) through a formal communication or a link to an automated survey via automated messaging. / Monitor responses from all providers. Contact any one-on-one if there are use issues or no response (especially those who are heavy admitters).
Continue communications with tips, quality measures, targeted reimbursement statistics, and other communications physicians may find useful. / Periodically. / Send via automated messaging. / Monitor response by all providers. Contact one-on-one if there are use issues or no response (especially those who are heavy admitters).

Support for Key EHR Functions for Physician Oversight

Key functions relative to physicians that you might look for in any form of HIT you are considering include:

Referral management is a streamlined process for physicians to make referrals (using a portal, Direct email, or community service registry through a health information exchange organization [HIO]) can encourage more referrals to your facility. In addition, a Web site that describes your quality measures as a report card or in scenario form can be a powerful way to compete with others if this is applicable to your agency.

Care plan oversight and order management is a portal that enables physicians to access your EHR directly from any location, be guided to tasks they need to perform through a dashboard, and easily review documentation and care plans and modify and sign orders. This keeps physicians current with their responsibilities and relieves pressure on agency staff to constantly track and update physician tasks. It makes communications less onerous. Physicians are able to organize and prioritize their work.

Reimbursement records, can be automatically generated for physicians, concurrently with documentation of oversight. Physicians see the value of prompt responses to required actions, and you virtually eliminate the task of supporting this function.

Patient summaries for any transition of care—supplied in the Continuity of Care Document (CCD) or Consolidated-Clinical Document Architecture (C-CDA) (as described in Section 2)—can make coordination across the continuum of care easier for your agency and more complete and accurate for the provider. Whether the patient is being referred to you, being admitted to a hospital, referred to a specialist, or physically moved to another location to see a new provider, the CCD or C-CDA supports a consistent, standard set of information about the patient and provides an update since the patient’s last episode of care.

Copyright © 2013 Updated 11-20-13

Section 6 Optimize—Optimization Strategies for Physician Use of HHA, EHR, and HIE - 1