Epic, ROI & Quality

I was just reading how other practices have increase revenue and improve efficiency with having an EMR.  After reading Epic update this past week, it confirms what we have always known; a lot of things that are on our wish list are not things Epic could not do, but that it was not the system's priority (even though it was the end users' priority) and thus was not done and for the past year made us more inefficient!!! 

So the following are what others are doing & my thoughts on how to make us more efficient:
- Choose an EMR that provide good workflow.  For Epic this will be the system's design, we get what our system planned for.  For me to
     have to add a stapler to replace my hole puncture was not a step forward. 
- Reminders can actually improve quality of care and increase revenue. 
     Examples like: Vaccines, colonoscopies, ECG, mammograms, US for abdominal aortic aneurysm.........   
     When I talked to patients about tobacco abuse, I always forget about billing for counseling, that should also be part of the reminders.
     Sending out mass messaging to patients for influenza vaccines, will improve our vaccine rates and use up all the vaccines we have. 
     Reminders for preventive care at the month of the patients birthday, will increase preventive care and a lot of what is done for preventive
     care can be done without seeing patients, even in a fee for service environment. 
     Setting reminders on patients on high risk medications like Coumadin, Methotrexate, amiodarone ....  with system build in recalls even if
     the patients are lost to follow up or did not have their INR, CBC, TSH done, will definitely improve patient care and prevent disasters from
     happening.   
     Concern about too much reminders could be eliminated by planning well, adding small reminders at a time; and of course it has to be
     timely and accurate.  A reminder placed for something that was performed resulted in more frustration and aggravation, as happened
     recently.  
- Decreasing paper thus decreasing overhead (paper, toner, doctors walking to the printer to get the papers).   If one really need to print,
     printer should be in the exam room.
- When AVS (after visit summary), lab orders, x-ray orders got printed, the tests should be on the AVS and locations should be on there, one
     do not have to print the orders as they are already on the AVS.  
     For those patients who do not have on line access, the system should print out a copy of the AVS.
     Those that have access to MyChart, should get their information directly from MyChart.  
- Physicians need to consistently retire their paper charts, thus decrease workload (filing and pulling charts and checking if that has been
     retired) on our clerical staff so they can concentrate on other more important tasks and opening up workspace in the clinic. 
- Eliminating duplicate work and only order and charge via Epic, thus increase charge capture. 
- PQRS (PQRI) money.  A lot of people are getting reimburse through the ABFM, this may be an better option that we can look into.  
- Make it easy for daily work: 
     SmartPhrases:  Make good SmartPhrases for messages and notes.
     Letters:  Designs good letters templates for letters we sent out frequently.  Don't forget to autofill reason and if one can comment.  It does
     not make sense one still has to fill in "reason" for "work excuse."  This is not a problem when we just started but as more and more letters
     are generated, time is wasted when one had to review the letters.
     Make SmartPhrases or letters for all the forms one use to communicate with other medical specialists, vendors.
- Empower your patients, staff and let them function at the top of their capability & license:
     Encourage your patients to reconcile their own medications on MyChart (patient portal).
     Nurses and certain staff should understand protocols and can order and pend tests, vaccines and do diabetic foot exam.

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