Do Specialists Need Specialized EHR Technology?

Physicians often wonder whether they should use Electronic Health Record (EHR) technology designed explicitly for their particular specialty. For family and internal medicine physicians, the answer is easy since most EHRs are designed to accommodate the requirements of general practice/primary care.

 

But what about other specialties with large numbers of physicians, such as cardiology, neurology, podiatry, pain, pediatrics, and surgery? What kinds of EHR options do they have?

Where are all the EHR technology systems for specialists?

Google the words “best EHR for neurology” and pages of results appear. But none of the EHR systems listed are specifically designed for neurologists. Instead, they are general-purpose EHRs with a dozen or so templates for common complaints such as headaches or fainting.

 

You could substitute virtually any other non-primary care medical specialty or subspecialty in the Google search and get the same results. For simplicity’s sake, let’s continue to use neurology as an example.

 

Laws of economics demand general-purpose EHR technology

 

Why is there no ambulatory EHR designed just for neurologists? There are approximately 20,000 neurologists in the U.S., but the majority of them are employed by health systems, hospitals, and large practices where they are compelled to use whatever EHR is already in place. That leaves fewer than 10,000 providers in physician-owned independent practices where they can choose their own EHR technology.

 

Software vendors simply cannot afford to develop and support EHR systems for such a relatively small potential market, especially with the added burden of today’s rigorous government certification standards. The laws of economics force vendors to build EHR systems that can be used by a wide range of practice types.

 

Pediatrics is the major exception to this rule. A few EHR systems cater almost exclusively to a market of over 90,000 pediatric generalists and subspecialists. These EHR systems customize billing, documentation, and workflow, making them worth consideration by pediatricians.

What do specialists really need from EHR technology?

Like all health care providers, medical specialists want an EHR system that is easy to learn and efficient to use. Affordability is usually another important consideration for small practices. Comparing affordability is relatively easy, but how do you define and judge efficiency?

When thinking about EHR technology efficiency for specialists, we see three key areas to consider:

  • Documentation
  • Workflow
  • Integration

Documentation

As mentioned in the introduction, many general-purpose EHR systems include sets of pre-written templates for specialists.

Templates (sometimes called macros) are a powerful productivity tool, allowing physicians to insert commonly used words and phrases into the patient record. Templates can be used as complete exam notes that you modify as the visit progresses, allowing you to spend more time interacting with the patient than on typing.

When used appropriately, templates can be valuable in improving the completeness and efficiency of documentation, particularly where that documentation is primarily limited to standardized terminology, such as the Review of Systems (ROS) and physical examination findings.

How good are predefined templates?

The biggest problem with pre-written templates is that no two providers document in exactly the same way. Providers nearly always want to customize the canned templates that came with their EHR system. If every canned template is going to be reviewed and edited anyway, are providers better off starting from scratch with their own style and choice of words?

Overuse of templates can also result in cookie-cutter notes that all look and sound the same. This raises red flags if clinical documentation is audited. Additionally, templates don’t always support good documentation. This is especially true for more complex patients whose stories don’t fit within the confines of standard templates.

A better approach to templates

It is imperative for specialists to create templates that document the information that has value to them, and to do it with flexibility and simplicity. General-purpose EHR technology with a superior template creation tool may satisfy this requirement better than an EHR system with a set of canned templates for specialists but an inferior approach to creating templates.

As an example of a highly rated general-purpose EHR system for independent practices, let’s look at how Amazing Charts handles templates.

There is a two-click process to create, name, and categorize a new template; a user simply highlights any free-form text entered into the system and then right-clicks to save it as a template.

To use templates, a user simply right-clicks in any text box in Amazing Charts and a list of prefabricated templates pops open. They double-click on the template they wish to use and it appears in the chosen section.

The user admin function allows for practice-wide control of templates. Users can create, modify, and delete templates, which can be sorted and viewed by person, location, or topic. Templates can be copied and sent from one provider-level user to another.

Workflow

EHR technology workflow is defined as the sequence of steps or processes required to complete a task from initiation to completion. These tasks can be complex and demanding, such as documenting an assessment and plan during a patient visit, or relatively simple, such as writing an e-RX refill.

All providers—whether they are specialists or general practitioners—want to complete a task with as few steps as possible. This often translates into having fewer fields to fill out, fewer boxes to check, and fewer windows to click through.

A highly rated general-purpose EHR system such as Amazing Charts offers the same level of efficiency across all workflows. For specialists, it is important to select an EHR system with workflows conducive to different types of encounters. Specialists need a workflow that works well for treating patients either one time, episodically, or repetitively. The same is true for a workflow that is designed around treating patient problems, which may be acute or chronic.

Integration

To achieve maximum practice efficiency, EHR technology must be integrated with other tools and systems, both inside and outside the office.

For some specialists, the main priority is ordering tests and studies electronically, and then getting the results back into the patient’s record with minimal intervention. This requires connections with hospitals, independent labs, and radiology providers. Some EHR systems can also integrate with exam room equipment such as spirometers or EKG halters.

An interface with a speech recognition system, such as Dragon Naturally Speaking, Medical Edition, allows for hands-free dictation and fast documentation.

Most specialists need flexible ways to manage images and documentation, which requires optical scanning and fax integration. Specialists also need to manage referrals from primary care physicians and coordinate patient care with other providers. A well-designed general-purpose EHR system will make it easy to summarize notes and send assessments and plans back to referring physicians.

The billing and reimbursement requirements of most specialties are no different from those of primary care providers. General-purpose EHR technology with a comprehensive and flexible approach, such as the one underlying Amazing Charts, can handle virtually any billing situation, from printing a CMS-1500 form to exporting data files to an outside biller to  connections with third-party practice management systems to turnkey revenue cycle management (RCM) with financial analysis and reporting.

Finally make the switch!

Switching isn’t as difficult as you probably think. There are migration tools that can help you move patient data from one EHR system to another. Many EHR technology vendors will provide these free switching tools and other services as an incentive.

Amazing Charts EHR Technology - Designed for Independent Practices

Amazing Charts EHR was designed by an independent physician who needed EHR technology that was easy to use and that he could afford. Join other small practices who have already made the switch!