Electronic Health Records: Our Story

Kathy W. Oubre, MS

The Good

The time has come to implement electronic health records. We all remember that one sentence and the anxiety it caused our staff and providers. However, we took it one step further. We decided to become a national testing site for a new oncology specific EHR. Our executive leadership team made this decision for two reasons: savings and input. We were excited about the idea of having ground-level development input on an EHR that would be new to the oncology space. Despite the anxiety and a few tears, we made the conscious decision to “buy in” to the concept and worked as a group to prepare for and implement the EHR.1. More accurate coding. In the past, we sometimes under-coded visits for fear of being audited. Our EHR takes into account the diagnosis, treatment plans, and length of the clinical note; and it generates a suggested code for the visit. The suggested code is often higher than what the providers would have coded pre-EHR. And now if we get audited, we have all of the documentation in the EHR to justify the codes.

2. Computerized physician order entry. CPOE allows physicians to place prescriptions and lab and imaging orders electronically. This not only saves time, but reduces errors from illegible handwriting. We also have all e-prescribing sent to our in-house pharmacy. Although we are not able to fill everything that is prescribed, we have seen a significant increase in in-house fills by having orders sent to our pharmacy first.

The Bad

3. Our staff like the EHR, especially the millennials. The EHR allows them to work more efficiently by utilizing e-messaging, entering orders electronically, and tracking workflow through e-reminders.1. Cost of set-up and maintenance. The costs associated with EHRs are not to be taken lightly. In addition to bearing the cost of EHR software, the oncology practice is expected to pay for setup, maintenance, training, IT support, and system updates. Often there are more costs for additional hardware that we would not otherwise need, such as scanners, laptops, and tablets.

2. They don’t talk with each other. There is a severe lack of interoperability between EHRs in healthcare. This often results in office notes, reports, and lab results needing to be printed out from one EHR in order to be scanned into another.

3. Our physicians don’t love the EHR, but they don’t hate it either. They do still dislike the decrease of face-to-face interaction with a patient during a clinic visit and the rise of pointing and clicking. However, because we have multiple locations, our providers do value having direct access to a patient’s chart simply by logging in through a computer terminal.

Write to Oncology Business Management Editor Tony Hagen at ahagen@onclive.com if you would like to contribute a Value in Practice article.