Ambulatory Care and the Challenges of Interoperability

Ambulatory Care and the Challenges of Interoperability

In order to create a true “health IT ecosystem” as envisioned by the ONC, care providers must be better able to exchange or use health information in a timely matter in order to move from a billing-centered to a clinician-based perspective. In the ambulatory care setting, providers have been slow to adopt electronic health records (EHRs) and move toward interoperability, mainly due to workflow integration issues.

As part of its 10-year plan, the ONC seeks to identify and establish standards that will allow health systems and ambulatory care facilities to query, record and transmit patient data in a more efficient manner so that interoperability becomes more of a standard practice, rather than a burdensome obligation.

In this article, we’ll discuss some of the more common workflow concerns among the ambulatory care practice, as well as how these care groups can begin to implement EHRs without suffering from the administrative problems of the past.

Workflow concerns

According to a research report funded by the National Institute of Standards and Technology,* poor design and use errors can cause challenges and dissatisfaction of EHRs. Some of these challenges include:

  • Difficulty using the system to query and log information
  • Multiple logins and systems
  • Problematic system design
  • Fragmented care
  • More time to process orders and coordinate care

Visualizing the Workflow

The key to implementing a successful EHR involves understanding the day-to-day workflow and tasks conducted by the practice, and then integrating those work tasks into the EHR interface. Your IT staff and/or an outsourced IT support team like CoreTech Revolution can help you document the workflow of your practice, making it easier when implementing or upgrading your EHR solution. Based on observations from the study, workflow models vary, depending on the practice setting, staff roles and the sequence of its processes. But generally, workflow detail typically includes the following steps:

  • Before / preparing for the patient visit: This is where the physician and support staff must review lab findings, patient history and clinical information in order to determine areas of focus during the patient visit. The office also needs to include scheduling in this step in order to balance patient workload.
  • During the patient visit: This area of the workflow includes check-in, vital signs, review of symptoms, and verification of patient history. This could also include ordering or review of lab results, medications, patient education, and corresponding documentation. Within this step, workflow varies tremendously, depending on the patient, the clinician’s approach and the number of shared personnel handling aspects of the patient visit (nurse, case manager, medical assistant, etc.). Some of the workflow issues stem from managing the patient flow as well as how best to process orders and communicate time-sensitive information, while not creating a bottleneck in the process flow.
  • Physician interaction: During the physician meeting, EHR systems need to guide physicians toward logical decision-making based on the patient information in the system. This could include a patient diagnosis, treatment plan, lab result summary, explicit orders for tests, prescribed medication or recommended procedures.
  • Discharge: This step includes patient discharge activities occurring as a result of the physician interaction, such as additional patient education, patient summary, follow-up appointments or explicit orders, or a clinical procedure.
  • Documentation: One of the most challenging workflow areas within the ambulatory care setting involves time the physician as well as the support team spends on documentation. This includes documenting the details of the patient visit, communication and referrals to specialists, and tracking and review of lab results. While time-consuming, this aspect of the workflow remains crucial to maintaining an accurate patient care record.

Designing an ideal EHR workflow

While no two workflows within a practice are the same, IT integrators must recognize how EHR technology can support the current workflow of an ambulatory care practice. In creating a system that works, integrators need to build a system that is easy to use and allows for a flexible process flow, depending on the clinical team, patient load and tasks involved in a typical patient scenario.

Many of today’s EMR systems encompass features intended to improve workflow, allow for physician personalization, support value-based care models, and even incorporate other applications. A technology partner such as CoreTech Revolution, along with your internal IT staff, can help you choose which EHR makes the most sense for your practice, as well as customize the EHR with added features and enhancements to support your workflow. In addition, your technology team can help you integrate your EHR with other systems, and train your staff to use the new system effectively so that it enhances your workflow and patient experience. As experts in implementing and upgrading EHR systems, particularly in the ambulatory care setting, we understand the perspective and unique concerns of this group, and can address them as we complete your integration.

In time, ambulatory care practices will catch up with industry leaders in implementing EHR solutions that can streamline the workflow as well as use technology to improve patient care. As EHR providers and IT implementation teams recognize and resolve workflow concerns during the integration process, groups within the ambulatory care setting will begin to see the benefits of interoperability.