BUSINESS PLANNING

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Streamline Practice Workflow

How to create efficiencies while remaining EHR compliant

LORIE LIPPIATT, O.D., SALEM, OHIO AND KIM CASTLEBERRY, O.D., PLANO, TEXAS

With the recent government EHR patient documentation requirements, many optometrists feel that patient care is suffering rather than improving. Some feel that they and their staffs are now spending so much time meeting data collection obligations that providing quality patient care is no longer possible.

Here, we explain how you can streamline practice workflow to provide high-level patient care while also adhering to EHR patient documentation requirements.

Evaluate current workflow patterns

To be sure, the daily business processes in optometric practice are overwhelming. The first step in managing effective change in workflow patterns is through the “discovery” phase of current workflow processes. By following the steps below, you will gain an appreciation for the workflow patterns in your office:

• Critically observe the care flow of the patient encounter. Take a fresh, critical look at your practice website, scheduling, check-in, prelim, exam, contact lens, optical, checkout, back office and recall systems to see whether they deliver high quality, cost-effective care without duplicating efforts and adding work to your workflow.

For example, how and when is insurance eligibility checked? How will you and your staff know what vision benefits patients are eligible to receive when they arrive at your office? Will the pre-examiner be aware of these benefits? You want to also scrutinize the diagnostic, treatment and consultative services provided to the patient.

• Ask staff to write in bullet point form the specific processes for each procedure they’re responsible for. For example, when are patient demographics entered in to your EHR? Are staff members gathering the appropriate demographics prior to the patient encounter to facilitate a more streamlined experience at check-in? Are the data points associated with Meaningful Use compliancy captured?

Once you have the information from the first two steps, you then can identify areas of unnecessary redundancy and correct them.

Example: “Collect demographic and insurance information during patient scheduling, and don’t ask for it again at patient check-in or checkout. Rather, ask whether their insurance has changed since you spoke with them, and update only if necessary.”

• Amass all documented processes into a chronological format. Over documentation is the biggest workflow killer for many O.D.s. This exercise will enable you to prevent needless keystrokes on documentation that is self evident or documented elsewhere.

Example: Restating expanded optic nerve cupping when it is self-explanatory in the photo and/or CD ratio field. Coded terminology in exam findings makes lengthy descriptions in physical exam findings and interpretation and reports unnecessary. Meaningful Use CCD communications, in fact, do not transmit detailed exam findings; rather they simply send the ICD or Snowmed CT codes describing the condition.

• Validate the documented workflow processes with key staff members. You want to do this to make sure the processes encompass all that is vital to patient and business office management.

Take full advantage of your EHR

Be sure to identify all your EHR’s features so you can determine “how” to use them to solve the workflow problems you believe the documentation aspect has caused. (Remember, your EHR isn’t just a computerized documentation system; it is also a workflow management system in that it provides instant accessibility of patient records and a fast path for patient and insurance payments, among other capabilities.)

For example, is it possible to have patients provide personal information prior to their visit via electronic submission? If so, is your staff promoting this EHR feature? Patient Portals are the new green in EHR efficiency. They can reduce the need for phones, fax machines, printers, e-mail and staff. In fact, Meaningful Use Stage 2’s biggest contribution to health care could well be the Patient Portal mandate. Appointments, registration, communications, prescription requests, records, billing, online optical services, referrals and eVisits will be services available online with 24/7 access through patient portals.

In addition, the portal’s ability to supply patient education provides valuable resources to the patient through your office. This is a great opportunity for improving practice workflow and efficiency.

Additional solutions

In addition to using your EHR to its fullest ability, your evaluation of current workflow patterns may reveal it would be beneficial to:

• Outsource insurance or billing. Most practices can increase collections and decrease costs by utilizing technology and outsourcing.

• Update to digital refraction. This allows for automated documentation of preliminary and refraction data with one touch. The capital investment for digital refraction equipment has a nice ROI.

A win-win situation

By scrutinizing current workflow patterns, using your EHR to its fullest capacity and considering additional solutions, those pesky EHR government mandates will be less of a hassle, and you’ll be able to decrease staff stress levels while facilitating a streamlined patient experience. Everyone wins! OM

	Dr. Lippiatt is CEO of Salem Eyecare Center, Inc., in Salem, Ohio. She is a technology consultant for Vision Web and a pioneer in EHR and healthcare information technology. E-mail her at LLLEYEDOC@aol.com.
	Dr. Castleberry is CEO of Plano Eye Associates, a group single-location private practice in Plano, Texas. He is a technology consultant for Vision Web and a pioneer in EHR. E-mail him at KimCastleberry@PlanoEye.com, or send comments to optometricmanagement@gmail.com. Both authors are technology consultants for VisionWeb but have no financial interest in the company.