Written by Stevie Davidson Tuesday, 28 September 2010 00:00

With the push for EHR adoption it is clear that providers are in need of education and guidance now more than ever.  Meaningful Use is on a steady path and is increasingly becoming an initiative that appears to not have enough clarity to give providers a full picture of what it entails.

“Transformation” is the magical word that I still believe is the one critical area not receiving enough attention, or more importantly, the type of attention it deserves.  With the Regional Extension Centers (REC) grabbing at straws to try to build a model to try to meet the incredible amount of providers that will need to adopt EHR technology by 2015, the struggle is not only how, but who will do it and accomplish the task in a way that will not compromise the stability of a practice, or incur patient safety issues and non-compliancy risks.

We all know that resources with the necessary proven expertise and experience to transition practices to EHR are scarce at best.  Providers need to be very careful about who will be assisting them.  Community colleges and institutions are ramping up our workforce with individuals to do this through certification or post-graduate programs in HIT and EHR, specifically.  The biggest misconception I see with this plan is the belief that EHR adoption is an IT implementation, when it certainly is not.  EHR adoption is a clinical implementation and institutions need to understand that on-the-job training must be incorporated as part of their curriculum if they hope to achieve success.  How can you guide and transform a practice and not know how a medical practice truly works?  Transformation is unique to each practice and putting in a system means nothing without knowing how it impacts all the moving pieces that affect providers, their staff, patients, and revenue.

Transformation is the part of EHR adoption that carries all of the risk and liability factors that you cannot afford to overlook.  Understanding the flow of a patient, and how that will change in an electronic environment is critical.  Even if you are currently using an EHR system, workflow re-design and system optimization is not an option, it must be done to meet Meaningful Use and compliancy alone.

HIPAA compliance, security, workflow, patient safety, best practice clinical protocols, billing and HR processes all need to be evaluated and documented thoroughly.  Once performed, a solid gap analysis for planning will be imperative to the overall success of implementation.  If you are planning on obtaining NCQA recognition to move towards becoming a patient centered medical home (PCMH), transformation is the only method to achieve this.  You can be sure it is only a matter of time until PCMH, even though currently slotted for primary care, will be a model that will morph and be used by payers in the future for all specialties.   

Transformation also entails proper coding and documentation for providers as well as their billing resources.  ICD-10 is coming, RAC is already here for Medicare, and Medicaid will be in 2011.  Providers are struggling with documenting without the safety net of a super bill.  Non-compliance, drastic revenue loss, and frustration are building as the adoption rate is increasing. 

There are certain operational steps that are a staple when investing or making any major transition, and those steps are the ones that will impact the success and financial stability of a medical practice.  Transformation is one of them and it costs much more to fix and restructure on the back-end due to poor planning and workflow redesign than doing it up-front prior to going-live. Practices and healthcare entities must be proactive, not reactive, in order to survive.

Remember…an EHR is a tool, and I commonly use the analogy of it being a pumpkin.  In order to get a good pumpkin pie out of it, you need to use the highest quality of ingredients or it will always remain a pumpkin that will eventually rot and be thrown away.  Do not hurry up to fail or compromise the future of your business, staff performance, and the quality of care to your patients.  Hire experts, plan well, take your time, don’t cut corners, start now, and transform yourself to excellence.  There is light at the end of the healthcare reform tunnel, don’t let yours be on the front of an oncoming train.