OP’s Pediatric Success Series
Article
by Nancy Babbitt, FACMPE

Bye-Bye Paper. Hello Technology.

In 2009, Congress passed the law providing incentives for providers to adopt electronic medical records (EMR). It worked! In 2007 only 34.8 percent of providers had any type of EMR compared to 86.9 percent in 2015. Those with a fully functional EMR increased from 3.8 percent in 2007 to 40.6 percent in 2015.1 These providers have led the way to streamlined and user-friendly EMRs, rising to the challenges placed on our industry by government program requirements and specialty advancements in care.

If you are a pediatric practice still using paper charts what are you to do? It can be easy to justify not making the change to an EMR – lack of funds, providers close to retirement, previous EMR implementation failed miserably –but I would argue that the reasons to change outweigh the reasons not to. Let’s face it, the biggest obstacle to any change is “FEAR” or “False Evidence Appearing Real”.   

FEAR #1: We don’t have the funds

If we address the FEARs, the case to move away from paper is there, clinically and financially.2 For example, a lack of funds can be offset by moving to a cloud-based pediatric-specific EMR vendor that offers monthly subscription plans. This means that you can pay for the EMR overtime vs. upfront in one lump sum. In addition, with a cloud-based solution, there is no need to purchase servers, which can be very expensive to buy and maintain.

If the EMR is implemented correctly and your staff uses the robust functionality and workflow shortcuts a pediatric-specific EMR provides, the productivity of all members in the practice will improve. These specialty-specific software systems often come pre-loaded with functionality like vaccine management, growth charts, well-visit guidelines from the American Academy of Pediatrics, and adolescent privacy functionality, which help pediatric practices improve clinical accuracy and workflow efficiency. In addition, secure online patient portals provide parents the ability to complete forms prior to their child’s appointment. All of the information captured on the form flows into the patient chart within the EMR, saving staff time and increasing parent satisfaction. Pediatric-specific EMRs also have built-in revenue cycle enhancement features that capture all “add-on” charges (e.g., vaccine administration codes) 100 percent of the time.

FEAR #2: Our provider(s) is retiring

If you are putting off making the transition to an EMR because your provider(s) is nearing retirement, you may want to reconsider this decision. It’s important to take into account the type of succession plan you have in place for your practice before choosing paper over technology. Is someone going to be recruited to take the provider’s place? Is the practice going to be sold? If the practice is going to be shut down, it may not make sense to transition to an EMR. However, you may be planning to hire a younger physician who is interested in buying into the practice or selling your charts to another local practice. If your succession plan includes one of these options, having an EMR that enhances patient care, improves the revenue cycle, and enables participation in current incentive programs like Patient-Centered Medical Home, Population Health Management, and Shared Savings Programs can be beneficial on many fronts. It will not only make your practice more attractive to potential partners/buyers, but also set up the “new” practice for success as they tackle future endeavors and challenges that will require technology to participate.

FEAR #3: Our previous EMR implementation was a disaster

If you had a failed EMR implementation experience, and it is holding you back from trying again, hit the “Stop It” button. You learned a great deal from this attempt and will not make the same mistakes again. Whether you picked the wrong business partners, purchased an EMR that was not pediatric-specific, or did a poor job of planning on your end, fix it and try again. You are way ahead of those who have not tried before. Don’t be scared of saying goodbye to all the paper filing, shuffling, and searching. Yes, this is a BIG CHANGE, but if you understand the 5 Stages of Change listed below, you’ll be better prepared to effectively manage and lead a project of this size and minimize the risk.  

5 Stages of Change

1. Pre-contemplation – no intention to make a change, lack of information, fear of failure, demoralized. The pain and need are not there yet, either in the bottom line or level of service.
2. Contemplation – considering a change in six months or so, but it is easy to find reason to delay the change and tend to put it off
3. Preparation – the time has come, know you must make the change, pain from not changing outweighs the status quo, starting to believe you can succeed, planning starts
4. Action – change happens, challenges arise, prepare alternatives and support, keep focused on the goal and celebrate successes
5. Maintenance – six months to turn the corner on basics, now time to reevaluate and optimize functionality to realize benefits  

Take the lead on change management, and recognize the stages you and your staff will go through. Be mindful of your team’s emotional responses as you go through this change together. Let’s face it, the staff can make or break this project. If they do not want it to work, they can sabotage it so it’s imperative that you get their buy-in and address any fears or concerns they may have. This will set you up to successfully manage this large and complicated project.

The return on investment (ROI) from saying “bye-bye” to paper and “hello” to an EMR is positive financially, clinically, and personally. Take the plunge and lead your team into a bright with a pediatric-specific EMR.


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Endnotes

1 The Office of the National Coordinator for Health Information Technology: https://dashboard.healthit.gov/quickstats/pages/physician-ehr-adoption-trends.php

2 The Office of the National Coordinator for Health Information Technology: https://www.healthit.gov/topic/health-it-basics/improved-diagnostics-patient-outcomes. Thomas Bodenheimer and Christine Sinsky, From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine. Available at:  http://www.annfammed.org/content/12/6/573.full

US National Library of Medicine, National Institutes of Health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3918096/