Many of us who work in the informatics space full time are attached to academic medical centers, large hospitals, large physician groups, or vendors. We’ve been working with electronic health records, billing systems, and interfaces a long time.
In my case, I was fortunate to work with a large health system that saw the value of electronic health records and data exchange long before Meaningful Use or any kind of payer incentive programs. We decided to move forward with technology because it was the right thing for us, allowing better data capture and the ability to track towards better outcomes.
Although I worked for a large health system, many of our employed physicians ran offices that looked a lot more like private practices than anything else. When I went into consulting, that was naturally one of my sweet spots, working with small to mid-sized practices that might not know much about informatics or the forces changing healthcare.
I still do work for large health systems as well, but my partner and I are fielding more requests from independent practices than we can handle. Quite a few of the requests involve things that most of us take for granted, such as lab interfaces. My most recent client has three physicians and six support staff. They outsource their billing functions and revenue cycle and use a major vendor’s EHR and practice management software on a hosted platform. Their installation is pretty vanilla, with very few customizations. They haven’t participated in the Meaningful Use program in the past, but with the increasing penalties for failure to do so, they have decided to start increasing their use of the system. They’re still not sold on MU, but want to be closer to ready in case they decide to take the plunge.
I’m not sure why they didn’t implement a lab interface when they went live. They are an internal medicine group and order a large volume of labs. I’m guessing that at the time they installed their system, they had been managing well with their paper orders workflow and basically just automated it. They do order their labs in the EHR, but print a paper requisition and either send it with the patient to the lab, or send it in the pouch with blood drawn in the office. The laboratory vendor delivers results through a Web portal, which they had been using pre-EHR and were comfortable with it. They print the labs, scan them into the EHR, and then the physicians manage them either through a telephone messaging template or by sending a letter to the patient.
It’s fairly efficient, although you can’t graph or track or trend the results. You also can’t mine them for outreach purposes, which is the key driver of their interest in having a lab interface.
Working with someone who knows why they want a particular feature and what they hope to achieve by implementing it is always a pleasure. There are plenty of groups who embark upon technology projects due to penalties or fear of penalties, and that makes it more difficult because the team may not have a sense of buy-in or understand why the extra work needed is valuable or important. This group wants to be able to easily identify patients whose lab values show that the patients need extra attention or need to be brought back into care. Most of us take this functionality for granted, so it’s been refreshing to work with someone who is seeing it through new eyes.
Although at times there has been a sense of wonder, there has also been significant frustration. The EHR vendor hasn’t been terribly helpful. The EHR vendor supports multiple lab vendors, but didn’t make it clear that some of the lab vendors have multiple business units with different lab compendia, so my client downloaded the wrong one. The client doesn’t have any dedicated IT resources and the vendor didn’t require the client to attend any training prior to attempting to install a lab interface, so they immediately wound up off track.
They hadn’t talked to their lab vendor about installing an interface prior to starting work with the EHR vendor, either. They got in touch with their lab account rep to figure out which business unit they were using, and the lab sent the required test plan as they normally would during an interface project. When the practice saw it, the project ground to a screeching halt because they didn’t feel they had the resources to take on a testing effort while doing their regular work.
The project stalled for several months until one of the partners decided to push it again, and obtained some referrals for consultants. There are at least a dozen consulting companies that work closely with the EHR vendor, so I’m surprised that no one on the vendor side had suggested that the practice go that route to get the project moving. They ended up contacting me because I was local, which ended up not really mattering since I’m not doing anything for them in person. All they really needed was someone to run interference with the vendors and help execute the test plan. Since they were already ordering and managing tests in the EHR, there was maybe 30 minutes of training to do for the staff.
I put together a bid and they were surprised at how small the effort really was. I quoted them 15 hours to complete the project from their side and it ended up only taking 12 hours over less than two weeks to get them live. However, when you don’t know what you’re getting into or how to accomplish what needs to be done, that 12 hours is a mountain. It stood in their way for months because they didn’t know how to get over it. Guides were available, but they didn’t know how to find them and their vendors didn’t suggest ways to get help.
I’m glad I was able to help them, but it’s sad that it took so long to get a simple interface live. There are hundreds of practices facing similar issues every day, and unfortunately they’re choosing to sell out to big hospitals or health systems because they don’t know where else to turn and are weary of trying to figure it out.
It’s like the Benjamin Franklin quote about the kingdom being lost for want of a nail. Having come from private practice roots, I don’t like to see physicians give up and sell because they feel there isn’t another option. They are struggling with things that many of us find routine, and that’s sad since the knowledge is out there it’s just not in the right place at the right time. Some feel it’s better that we move into larger organizations and the Accountable Care movement certainly supports that. But we’re losing a little bit of our identity as physicians along the way.
What do you think is the answer for small practices to keep up with technology? Email me.
Email Dr. Jayne.