Electronic Health Records selection for the dental practice ... the ultimate team sport

In more than a decade of helping practices select, purchase, and implement electronic health records, I can emphatically say that the practices that used a team approach and encouraged their staff members to be involved typically had the most success. When it comes to the use of electronic health records in a dental practice, the explosive growth of "next generation" features help improve practice operations, workflow, and patient care, so all team members utilize the technology one way or another.

There are a number of opportunities to get everyone involved in adopting EHR systems, but the initial phase of evaluation and selection is one particularly critical time. Just as dentists, hygienists, dental assistants, office managers, and front and back office staff members contribute their part to the overall operations of an efficient dental practice, staff members will use EHRs in different ways to contribute to the overall workflow of your practice. Over the years, I have sat in on numerous selection meetings with practice clients in which the old saying, "You can't satisfy everyone all the time" kept running through in my head. People have different tastes … and when it comes to evaluating features of an EHR system some might like certain features and others different features. So, at the end of the day, there might need to be a little compromise in order to get a system that works for everyone.

However, without getting different team members involved to represent their interests, there is a possibility that the system might work well for some, but not others. No one person can make these decisions for everyone else.

Also, by bringing in the team at this early stage, it gives them some ownership. I have had team members in the practice come up to me at some of my seminars and workshops and tell me that they were initially resistant to implementing EHR technology. However, after being part of the whole process, along with the recognition that their input was valuable, they felt a sense of ownership and more vested in the success of the EHR adoption in their practice. The point is that, since everyone will be using the system, then everyone needs to feel and touch it before purchase. When I work with a practice, the first thing I do is to try to discern from each individual what the important features are that will help them on a daily basis. We then build on that as we evaluate and select various vendors.

When I put together a vendor Request for Proposal (RFP) for a practice evaluating "next generation" electronic health records, I always include sections that address the functional needs of different roles in the practice. Sections can include clinical features needed by the dentists, hygienists, and assistants, operational and administrative features needed by the office manager, front desk and back office staff, financial and reporting features, and task management and workflow features that cross all team member boundaries.

So, how do the needs and uses of the EHR differ between team members in the practice? Here are a few examples of the types of EHR features. Please note that there are many features that need to be evaluated by the team when selecting a "next generation" electronic health record system. For purposes of this article, I have illustrated just a few for each team member role.

Dentists

First and foremost, how a dentist does progress notes and general documentation will be positively impacted by the use of structured, customizable templates and other automated documentation tools.

With so much information and so many tasks to deal with every day, the amount of information available on the screen simultaneously and the easy-to-use design of the screen will be the basis of a dentist’s digital dashboard.

Evidence-based information will be available for use in treatments and protocols.

Images will become more integrated within the chart instead of having to switch between applications.

Managing clinical tasks and workflow.

Hygienists

EHRs via ePrescribing will present updated medication lists aggregated from various providers that the patient has seen.

Health (medical and dental) histories, diagnoses, procedures, treatments, etc., will be aggregated for viewing in one place at the point of care.

There will be more sophisticated, well-designed, structured perio charting and documentation.

Patient education multimedia materials will be easily presentable at chairside and easily retrievable based on a patient’s problems and treatments.

Managing clinical tasks and workflow.

Dental assistants

Recording vitals, health histories, patient problems, etc., at chairside.

Initiating lab features in EHR.

Using imaging features in EHR.

EHR-based patient education.

Managing clinical tasks and workflow.

Office managers and administrative staff

So, why should administrative staff members who have used their own specific practice management system for years, even be interested in getting involved with the electronic health records evaluation and selection. The answer is twofold:

First, "next generation" EHRs will provide features and efficiencies on the administrative side that previously were not as robust in the present practice management systems.

EHRs will move to more sophisticated claims scrubbing capabilities within the software itself. Billing codes generated chairside will have the ability to have automated scrubbing before it even leaves to go on its claims processing journey. Automated eligibility from point of care will be integrated into EHR systems. This means that the administrative staff who deals with billing should have some input on how this works from both a design and functionality standpoint.

On the patient appointment and scheduling side of things, there will be much more capability to automatically capture clinical information and present this in the form of alerts at the time of appointment or schedule. For example, if a patient has an overdue procedure that was recommended nonetheless clinical visit this will be noted. Other clinical information will find its way into this part of the process. Time recorded on the clinical side to perform certain procedures will find its way into the scheduling system, incorporating analytics to recommend schedule time for various types of appointments. Since these features will be used on a daily basis by the front desk staff, they should have input into its design and functionality. Additionally, sophisticated patient web portals will allow patients to register and described problems and issues prior to their appointments.

Financial and back office staff will have the capabilities to run detailed analytics on their patient populations. Practices will be more efficient by using various benchmarking and business intelligence features that are all too common presently in the medical world, but that will grow exponentially with the introduction of "next generation" dental EHRs.

Office managers, with an integrated electronic health records and practice management system, will have tools such as task management and reporting, to bring about a new awareness of operations within the practice and allow for better control and efficiency. If there any questions about a patient, an office manager will be able to get relevant information at the push of a button, which will lead to better customer service. With this in mind, when evaluating an EHR system, it is critical that the office manager has input into the features, functionality, and design that work to help manage the practice.

Second, there is a good chance that rather than purchase one vendor's EHR system and interface that with your present practice management system, you might purchase what is known is an integrated PM/EHR. If medical EHR adoption is any indication of what's coming in dental EHR, then there will be one vendor chosen that has both an EHR and practice management system. So, your administrative staff will be put in the position of looking at a new practice management system. This came about because having to maintain two systems that interface with each other and pass data back and forth became too arduous and, in many cases, a recipe for disaster as each vendor changed their software. Also, when there were issues, the amount of finger-pointing that was involved was counterproductive.

To facilitate the team approach to selection then, there is a good chance administrative staff will be pulled into the process looking at alternative practice management systems integrated with the new EHR. At the end of the day, again based on how medical EHRs and practice management systems have evolved, an administrative staff would be doing itself a disservice if they didn't take this opportunity to see what's on the market. In many cases, they have found that there are actually "better mousetraps" out there.

Team collaboration = EHR success

So when it comes to selecting and purchasing a "next generation" electronic health record system, you can choose to either have one or two people lead the way, or engage in the selection process which recognizes the needs and input from each member of the team who will ultimately use the EHR. From my experience, I would highly recommend the latter. Whether you're a small practice or large group practice, all staff members will help make EHR adoption a success. To succeed, it is imperative that there is team discussion and ultimate buy-off on which direction to go.

Editor's Note: See more from Mike about this topic by watching the video below...