Diane Sofranec

What makes a patient experience great? The attitude of a practice's staff members plays a large role, according to 70% of the participants in a PricewaterhouseCoopers (PwC) Health Research Institute. (For more information on that study, see 

									http://www.MedicalEconomics.com/patientretention

.) So, what can you do to improve the patient experience in your practice? 

 asked practice management experts for tips. Here's what they said. 

When you're hiring, screen candidates by phone first to get a sense of their personality before you meet them. "Then, when you actually see their faces, see whether they brighten up the room," Zetter says.  

Quiz a prospective employee about the last time he or she got upset, and ask for details, he advises. "Previous performance is a very accurate predictor of future performance, so get specifics about exactly how that candidate performed under certain situations," Zetter says. Don't ask how the candidate would handle a specific situation, because he or she simply will tell you what you want to hear, he adds. 

If your practice is fully staffed, it's not too late to improve your current employees' attitudes. "Measure your staff members' performance based on what's important to you and what's important to your patients," Zetter says. 

If you receive complaints, quit giving raises. Instead, offer rewards for improving the practice or patient experience, he says. "Everybody should be measured on [his or her] performance, from the front-desk person to the billers." 

To accomplish this task, ask staff members about the issues that affect your practice. They know what you're doing right and what you're doing wrong. 

"Listen to your employees," Zetter says. "Find out what they like, what they don't like, and what's going to make their jobs better. Reward the staff for making your practice better, too." 

Train staff on patient relations. Offer scripts of what you want them to say and how to say it. Also, consider requiring staff members to acknowledge patients, even if they are busy with other tasks.  

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What can you do to keep patients happy? Medical Economics asked the practice management experts for their advice.

Improving the patient experience can build up your practice

It didn't take long for Martin B. McClintock, MD, a solo practitioner in Ballwin, Missouri, to achieve meaningful use. But the family physician, who has been practicing medicine for more than 30 years, reveals he had a lot of help. 

In fact, McClintock does not use a computer when seeing patients. Instead, he takes notes on paper, just as he always has, so he can talk to them "face to face." He decided to stick with this system when he discovered that his style of seeing patients doesn't follow the flow of his electronic health record (EHR) system. 

After he sees a patient, his nurses add the information to the EHR using templates that McClintock helped develop. To accomplish this task, he recommends getting help but advises against hiring anyone.  

"[EHRs] cost way too much compared with how much the government possibly is going to pay us," he says. "Having my nurses type in [the information] has made this doable." 

It's to their credit that McClintock met all of the qualifications for meaningful use by the beginning of June when they just began using the Amazing Charts system at the end of December. 

At first, he and his staff simply practiced using the EHR. "After the first 2 to 3 months of practice with this program, we went back and looked at the meaningful use [criteria]," he says. Now the records for every patient he has seen since implementation comply with requirements. 

"We've had our patients help us by handing them a slip to fill out when they come in the door," McClintock says. The pre-printed form ensures patient records are complete by the end of each visit. "It helps make [my nurses'] lives easier because they can type in exactly what the history is-and some of the other things that we need on the chart." 

He has not transferred every patient file into the system, however, and has no plans to do so. Lack of time is one reason. 

"Family practice physicians get paid so little; we almost jog between patient rooms," he says. "We don't have time to sit down at a computer." 

McClintock and his staff spend about 1 hour each day adding information to the EHR and making sure what's there is correct. "[My nurses] put a lot of work into this," he says. To thank them, he plans to share his meaningful use incentive payment with them. 

You don't have to handle EHR implementation on your own. Learn how one doctor depended on others to achieve meaningful use.

How assistance can ease EHR transition

When it's time for you to purchase your electronic health record (EHR) system, remember that knowledge is power.  

"Once you've narrowed it down, get a feel for how [implementation] went for them," he says. He advises against making any purchasing decisions without first doing research. 

So how has he managed to survive the implementation of his athenahealth EHR? Two part-time staff members who worked for him long before he began using his EHR have helped immensely. 

Typically, patient information is added to the system before a visit, but including details about histories and immunizations is time-consuming. "In a lot of cases, I'm still adding the [information] as they come," Denham says. "There's no way to dump all the data into the system, because I wasn't computerized in the first place."    

Eight months after the process began, Denham says almost all of his patients' information is in the system. "I work full time doing medical research, so it's 'catch as catch can' right now," he says. "I'll put a chart or two of information into the system on weekends, evenings, and during the day when work is slow, to catch myself up." 

At first he struggled with how to get the system set up the way he wanted it. But that was no reason to get discouraged. 

"It gets easier as you get more comfortable with it," Denham says. "You've got to plow through it and develop a comfort level with it." 

He admits that learning how to use an EHR in front of your patients requires time. "There will be a period of time when [doctors] will need to schedule fewer appointments," he says. "But once they get more comfortable with the EHR, they will pick up speed and get back to their normal schedules." 

After all, he says, "[Implementing an EHR] is one of those things that you're going to have to do one way or the other if you're going to stay in the game and get paid to be seeing patients." 

Afraid to face the inevitability of EHR Implementation? See the best ways one doctor dealt with it.

How to deal with EHR implementation

A lack of educational mandate is one reason that many medical schools  do not teach their students how to use electronic health record (EHR) systems,  even though use of the systems is increasing in the practice of medicine.

The organization, which has a membership of education leaders from a  variety of medical specialties, was formed to enhance the clinical instruction  medical students receive, and it favors students receiving training on how to  document in EHRs.

About 64% of educational programs let students use EHRs,  but only two-thirds of them allowed students to write notes in them, according  to one of the studies,  “Opportunities  and challenges in integrating electronic health records into undergraduate medical  education: A national survey of clerkship directors ,” citing a survey the alliance developed. Although medical students are using EHRs at higher rates than  practicing physicians, educators must be careful that the limits they place on  students’ use of EHRs does not restrict training, the authors maintain.

The ACE recommends that accrediting bodies such as the Liaison  Committee for Medical Education include stronger language in their educational  guidelines to ensure compliance so that medical students receive the EHR  training and resources they need.

“Previously, students were just able to pick up a physical patient  chart,” says 

, lead author of the study and associate  professor of obstetrics and gynecology at the University of Michigan Medical  School. “Now they need permission to use hospital computers and passwords to  access the EHR.” She says Medicare rules regarding a physician’s use of a trainee’s findings in the EHR are also a concern.

, “Medical student documentation in electronic health records: A collaborative statement from the Alliance for Clinical Education," includes practice guideline recommendations  from the organization:

Students must document in the patient’s chart, and their notes should be reviewed for content and format.

Students must have the opportunity to practice order entry in an EHR-in actual or simulated patient cases-before graduation.

Students should be exposed to using the decision aids that typically accompany EHRs.

Schools must develop a set of medical student competencies related to charting in the EHR.

"Schools have a responsibility to graduate students with the expertise  and sense of duty in the basics of practice. The EHR is now part of that skill  set,” says Lynn Cleary, MD, president of the ACE and professor of medicine at  Upstate Medical University at the State University of New York. “We found a  large majority of students are allowed to write traditional notes in the EHR.  Although this is an encouraging finding overall, concerns remain over those who  do not allow students to use it and those who do not consider these notes part  of the official medical record."

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 Time check: Physicians see fewer patients as they implement EHRs

A lack of educational mandate is one reason that many medical schools do not teach their students how to use electronic health record (EHR) systems, even though use of the systems is increasing in the practice of medicine.

Author | Diane Sofranec

Articles

Improving the patient experience can build up your practice

How assistance can ease EHR transition

How to deal with EHR implementation

Why some medical schools don't teach students how to use EHRs