Doctor's Office Quality-Information Technology Program - What does it mean to your practice?

MGMA Connexion, Aug 2005 by Nelson, Rosemarie

Quality improvement organizations (QIOs) are charged with "promoting system changes, including adoption and effective use of information technology (IT) such as electronic prescribing and reminder systems, in conjunction with redesign of office processes, in the physician office setting." The initial thrust of QIOs' work, as defined by the Centers for Medicare & Medicaid Services (CMS), focuses on "more reliable delivery of preventive services and effective management of patients with chronic conditions, such as diabetes and heart disease."

Doctor's Office Quality-Information Technology (DOQ-IT) pilot projects and statewide programs create an opportunity for practices to receive assistance with the selection and implementation of an electronic health records (EHR) system. (For more information, see www.doqit.org.) The local DOQ-IT program will solicit commitments from interested practices and help assess, plan, select, implement and evaluate an EHR system.

Typically, a medical practice lacks personnel trained in the discipline of project management - which an all-encompassing EHR project requires. The first steps - operational and readiness assessments - set the stage for the subsequent redesign of workflow. The optimal use of an EHR system for clinical quality care standards and revenue maximization requires evaluating and redesigning work processes. An experienced QIO program administrator serves as a consultant and can advise the medical practice on developing the appropriate infrastructure and support for patient access and provider productivity during EHR implementation.

The QIO will assess current office processes such as task analysis, workflow patterns and patient flow patterns. It will help the practice establish goals and prioritize targeted improvement opportunities. This assessment (see sample readiness assessment form, page 46) produces an understanding of what EHR systems require. The QIO will provide EHR system and vendor-selection guidance based on the practice's needs and goals.

Just as critical to selection is staff preparation for the inevitable process changes. The QIO will develop a how-to plan for providers and staff. The workflow analysis recommends process changes. The QIO can educate the staff about the changes and how best to adapt to them during implementation.

EHR Systems will affect how the staff performs daily duties and how physicians practice. Essential components of successful implementation include communication and managing expectations. The QIO program can share lessons learned and provide insight on the training and implementation methods best suited to your environment.

Training is not a one-time event. Practices achieve the best results when training occurs close to the go-live date, when they can play with the system outside the formal training sessions. This increases staff comfort with the system. In meetings, share the best methods of using the system and lessons learned from it. "Super users" can provide supplemental training in a nonthreatening environment free of distractions during meetings.

Both incremental and "big-bang" implementation approaches can succeed. The QIO can help your practice determine the appropriate strategy - one of the most important decisions the practice will make regarding EHR systems. Detailed plans for either method increase the chances of success.

An incremental approach can prevent productivity losses. A QIO can supplement vendor support by assisting with workflow and process changes. The QIO can also help reduce the chance that your practice gets "stuck" in the middle of the implementation. It can bring new energy to the implementation process.

The big-bang approach to EHR implementation can be great for small practices where all providers are excited about EHR (the small-practice market is where QIOs have targeted their pilot work). Getting assistance from a QIO can reduce the risk of failure that can accompany big-bang implementations. QIO representatives can share experiences about productivity losses and setting appropriate expectations for the golive period.

There is no "right" approach to EHR implementation - only one fits your practice needs. Like an experienced consultant, the QIO can identify and document those needs so that your implementation strategy aligns with your objectives.

by Rosemarie Nelson, MS

Rosemarie Nelson, MS, MGMA Health Care Consulting Group senior consultant, rnelson@mgma.com