Your practice is being inundated with information about electronic health records (EHR) systems and the promise they bring to make your practice more efficient and profitable. But do you know if you are ready to adopt? Deciding to implement an EHR is not a simple affair. It requires careful consideration and extensive planning; however the first step in the process should be to determine whether your practice is ready to make the leap into a new world of practice automation.

The biggest mistake a practice can make is to jump into an EHR purchase because of the federal government’s EHR incentive program (for more information about this program, visit www.aad.org/hitkit). A practice should implement EHR only on the basis of a sound business plan that can help drive improved outcomes and goals.

The first objective of any practice thinking about implementing an EHR should be to analyze their practice operations. Shadow all of your staff to determine workflows. Chart these workflows into a process map to determine exactly where all of your deficiencies and inefficiencies lie.

Does it take your practice a significant amount of time to process refill orders? How long does it take your practice to find a paper chart and obtain the proper documentation to refile a claim? How often must your front desk staff pull paper charts? Identifying exactly the amount of time required for each of these tasks will help you determine and measure whether an EHR will bring your practice more efficiency and enhanced internal communication.

After you have identified all of your practice’s workflows, you should list out your goals and what you expect an EHR to accomplish in your practice. Determine exactly what you want to see improve within your practice with measureable benchmarks for each workflow. For example, if it takes an average of 10 minutes to fill a prescription refill, your goal could be to reduce this time to one minute with an EHR.

Remember to not only look for efficiency standards but also medical error rates, coding and documentation, billing accuracy, and patient care. Also, while you are outlining your goals for the practice make sure you are thinking about your overall vision for the next decade. It may not make sense to purchase an EHR system if you are planning on retiring or selling your practice within the next few years. However, if you are planning to adopt, and have a partner(s) designated to succeed you, it may be a good idea to get their buy-in from the start.

Once you have identified all of your goals, determine how far away your practice is from achieving them and whether it warrants the purchase of an EHR. You want to ensure your return on investment is high enough whereby your practice will see significant achievements through the implementation of an EHR.

If you determine that an EHR system will bring positive changes to your practice, your next step will be to convince staff of your endeavor and to establish a practice-wide consensus and approach on how to move forward.

Survey all staff to determine how knowledgeable they are with respect to technology and how likely they are to support the adoption of an EHR system. Use the Academy’s EHR FAQs Manual for more technical practice support guidance. You want to be certain that all of your staff are aware of this major undertaking and are willing to help take the leap with you.

After all of your staff are on board with the decision to adopt an EHR, your next step will be to assess vendors and determine which product is best suited for your practice. This will be the most important step in your process of adoption.

Article originally appeared in the July 2010 issue of Dermatology World.

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What are the CCHIT dermatology-specific criteria?

Thanks to the Academy’s advocacy efforts, CCHIT formed a dermatology workgroup in 2009 to recommend optional criteria and test scripts to address the unique needs of office-based dermatology physicians and practices. Ten Academy members served on the workgroup and have recommended criteria including the ability to upload and draw on anatomic diagrams and photos, capturing characteristics of a lesion, and creating tracking logs, among others.For more information, visit http://www.cchit.org/certify/2011/cchit-certified-2011-ambulatory-ehr. A list of certified vendors is also available on the CCHIT website.

What about free EHRs?

Practice Fusion has been advertised heavily to physician practices as it is a free ASP-based model EHR. It is supported with advertisements that run on the screen of the system. There are obvious advantages to such a product, namely cost. However, dermatology practices should note that it is not CCHIT-certified for dermatology and there is significant administrative time required because all patient data would need to be manually entered into the system. Hardware costs are also not figured into their implementation and there are limitations with respect to dermatology specific templates, data ownership and security.

Besides Practice Fusion, current “safe harbor” exceptions to the Physician Self-Referral Law and the Anti-Kickback Statute allow hospitals to donate any EHR software to physician practices as long as the physician paid for 15 percent of the estimated cost of the product. Again, this could be financially viable for your practice, but it is important to speak with a health care attorney because there are many rules and regulations concerning the donation, including the fact that hardware costs and staffing assistance cannot be donated to the physician.