My last conversation addressed the challenges of attracting and keeping a competent and loyal cadre of clinicians. I noted the perhaps obvious point that, because your clinic is only as good as the people who work there, it’s important to keep a close eye on how they’re doing. I then explored what might not be so obvious a point – that your EHR/practice management software can and should play a major role in monitoring your staff’s effectiveness and morale. I talked about various indicators you can follow – the no-show rate for both patients and staff, the size of caseloads, the case acuity index, and so on. My basic message was that your software solution should help you track of factors that might point to opportunities for supervision and support.
Now I’d like to touch on other ways an EHR can keep your clinicians productive and reasonably content. I know that sounds like an odd concept, given the extent to which EHR packages are typically – and, often, fairly – vilified. Some practitioners and clinic manager regard EHRs more as sources of pain and frustration than beneficial to them and their practice. If you’re a clinic administrator, you know that staff start from a position of not wanting much to do with anything that isn’t tied directly to their work with clients. They’d rather have nothing to do with billing, scheduling, and -- more than anything -- all the paperwork that’s required by regulations and good practice. Generating progress notes, admission notes, treatment summaries, and discharge notes is an inherent burden on all of us, especially those of us who write slowly or are better at treating mental health problems than keeping up with documentation requirements. It’s even worse if you have to get signatures from supervisors or you run large therapy groups. Everyone hates the paperwork. And they’ll hate it even more if the software they’re supposed to use makes matters worse, not better.
As a matter of fact, I had to quell a small rebellion when some of our staff got wind of my efforts to implement a way of tracking our cases and helping with the paperwork. There’s a strategy to buy into using an EHR/practice management system. I needed to convince them that: 1) I had no option because I couldn’t get contracts unless I could track our deliverables reliably; 2) I would only develop a program that was intuitive and practical; and 3) I would expect, actually demand, that they let me know at every turn what worked, what didn’t work, and what could be done better.
In our case, we were able to work our way to a system that served as a tool for retention rather than as a prod for people to leave. Everything we came up with had to survive this question: Does this feature make it easier for our staff to get their work done? Asking that question at every turn is what led to a system that staff came to see as their ally.
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I’ve got lots of examples of how our EHR helped staff. Here are three.
The first feature that staff realized made their life easier is that the EHR kept all the information in one place – on their computer that was tied to a central database. No more hunting down paper files in file cabinets, in other people’s offices, or on someone’s desk in the billing or compliance offices. No more having to ask someone to look something up in an Excel spreadsheet or the hospital’s billing system. All the information we had on a particular case was easily accessible at any time. And staff came to realize how much more easily they could get their work done in their chair as opposed to hunting through three floors of offices.
Second, everything we computerized was in one software package. In other words, we didn’t create one program for scheduling, another for billing, another for compliance, and yet another for completing paperwork. That would have created all kinds of inefficiencies – logging into different programs and entering demographic (and other) information two or more times. We developed our program so that it did everything we needed it to do, without ever having to leave it. That made it much simpler for our staff to learn the processes and get what they needed done and done easily.
Finally, staff came to realize that it was much easier to collaborate with others involved in the case and with the administrative staff. I ran child psychiatric services. That meant that there were often at least two clinicians involved in a case. And often information from others (like pediatricians and teachers) came to one of those clinicians but not the other. I had always believed that cases were most likely to go well if everyone involved could collaborate easily. I wanted the psychiatrist doing the prescribing to know what was going on in the various non-medical therapies. I wanted the clinician working with the child to know what was going on with the prescriber, but also what was happening with the mother’s treatment with another clinician, and so on. I felt that our providers should have no excuse for being unaware of what was happening in all aspects of the case. To put it simply: It’s a lot easier to maintain quality of care when everyone involved in that care is on the same proverbial page.