Dental EHR Workflow Transition

Dr. Teknol’s office joined the federal initiative to implement electronic health records (EHRs). When making the decision to transition to an EHR, there’s an awful lot of advice about how it will affect workflow. But how do you actually document, understand, and plan for workflow changes? What steps can you take to minimize disruption and maximize readiness? Can you actually plan to improve your dental care workflow and quality of dental care during an EHR implementation–or is that just crazy dreaming?

According to Cindy Quinn, there are some simple tools you can use to understand and document your workflow. And it’s important: “Bottom line, many changes to the process of paper flow during patient care really manifest as a change in workflow.” The tips and tricks described here come from her article (linked below). She references the Reward Health Sciences’ Care Process Improvement diagram, which is a macroscopic view of workflow processes in healthcare (see Figure). In particular, this breaks down healthcare interactions into two components: care planning and care delivery. In care planning, many options and many types of data are considered to select the best available option. By contract, care delivery is about streamlining a process to efficiently, effectively and without mistakes deliver a particular care option.

As Cindy Quinn puts it,

“These two processes form a cycle for all decisions and subsequent decisions as the patient receives treatment. What is the input? What does the provider bring to the task involved in treatment? Data — data on the patient’s current health, data on procedures that have been scientifically demonstrated as safe and effective, and data on past experiences in a similar situation. What does the provider get from a task? Outcomes.”

Care planning and care delivery thus become the backbone of analysis of workflow and the data needed to support that workflow. Traditional practice management systems focus on care delivery, particularly the financial and administrative components of care delivery. EHRs can bridge the gap, providing coordination of care information, demographics and clinical guidelines in a single location, allowing care planning and care delivery data to be collected. However, the breakdown of tasks for the two will always be different, so Cindy Quinn suggests linking practice management systems with the EHR to provide the best fit for both kinds of tasks.

Using an EHR effectively improves workflow, Quinn argues: “There will be no need for searching through 10-page charts, waiting for forwarded dental records, starting over to replace an illegible periodontal chart, or remembering whether the patient prefers fluoride foam or varnish.” But how do you actually go about making the changes?

First, get everyone on the same page. State the inevitability of electronic records, the importance for patient care and the practice’s viability, and the need for everyone to change behaviors and attitudes. Then document the current workflow, with a focus on inefficiencies and problems. Using the available features of the EHR, ensure that everyone understands and can shift behavior to utilize the EHR instead of familiar behaviors. Then make a new workflow and a timeline to implement it.

For dental practices, Quinn identifies several benefits. First, patient safety. Automated alerts for drugs, allergies, secondary conditions and the like vastly improve patient care, especially because of matching and automated comparison/checking tools. Second, clinical efficiency can skyrocket because of the removal of time and energy spent searching for non-standard, illegible or incomplete files. The very process of implementing an EHR demands workflow examination, which can stimulate great changes for overall efficiency. Email reminders and automated processes can also remove repetitive tasks from the daily schedule.

Lessons Learned:

  • Examine workflow and use the EHR as a catalyst for efficiency.
  • Separate the discrete tasks of care planning and care delivery to understand your data needs.
  • Integrating your Practice Management and EHR software can help support care process improvement
  • Use the EHR to measure clinical process improvement
  • Develop an action plan and determine office’s readiness
  • The dental office team needs to discuss what changes need tol be incorporated with EHR implementation and how best to handle them
  • Talk to potential EHR vendors about how they can help with workflow and process changes during implementation

Quinn, Cindy. (2012) “A click away!” RDH, 32(3) Feature article.