Top EHR Features Small Practices Need, Part 2

Lea Chatham April 8th, 2013

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By Ron Sterling

Small practices are at a significant disadvantage when choosing an electronic health record (EHR). The wide range of products and the dizzying array of EHR capabilities lead to skirmishes about features and technological wars with your practice caught in the middle. For example, the ability to print a list of patients any one of 100 different ways may be a minor benefit to your practice when what you really want is an online listing of important messages.

To select the right product, you need to focus in on specific capabilities that will help you manage patient services and care. In my first post, Top EHR Features Small Practice Need, I reviewed some of the key things to look for a vendor and type of EHR software. In addition, these specific EHR software features should be at the top of your list:

  1. Orders: Clinical orders are typically recorded in the paper chart to avoid liability issues. EHR orders are a critical feature to support your involvement in accountable care organizations (ACO), and patient centered medical home (PCMH) as well as meeting the evolving standards of care. Clinical orders should include the status and due date of the plan item for the patient. For example, a treatment order may be pending for a future time, have been completed, or even refused by the patient. To efficiently manage services, you should be able to view all patients with selected types of open orders (Ex. A1C) for selected due dates as well as review orders on the patient summary screen.
  2. Health Maintenance: Health maintenance items are care standards that apply to patients based on their age, sex, diagnosis and previous treatments. Immunizations for children, colonoscopies for patients over the age of 50 and annual checkups on hip replacements are examples of health maintenance items. The PCMH and ACO strategies include attention to health maintenance items as an important proactive strategy to avoid more serious problems. Health maintenance items should be automatically and clearly displayed when the patient qualifies for the care standard.
  3. Procedure Scheduling Management: Specialists need a tool to monitor the progress of patients through the surgery or procedure scheduling process. The EHR should provide the ability to schedule multiple resources or recurring visits as well as recording and managing patient-specific information about the procedure and services.
  4. Referral Management: Primary care practices need to track patients who are referred to other providers and the status of those care recommendations. The EHR should be able to assign a patient service to an outside party and track the status of the referral up to and including receipt of the referral clinical report.
  5. Messages: You will need to record messages to transfer patient issues to other staff or to remind the practice about an important patient issue. The message should document the cycle of events associated with the issue such as passing a question to the doctor to be followed up by the nurse. Additionally, the message should include an “alarm” feature so it does not show up on your to do list if it is an item with a future activation date.
  6. Diagnostic Interfaces: Many doctors rely on information from a variety of diagnostic devices to support clinical analysis and patient care. At some point, the diagnostic results, and/or images will have to make their way to your EHR. Ideally, the EHR should send your diagnostic order to the lab information system as well as receive the results into the EHR for review and inclusion in the patient record. Note that some orders and results are part of the Meaningful Use measures.
  7. Image Upload, Scanning & Annotation: Images include incoming diagnostic images, reports from other parties and even scanned portions of the patient’s paper chart. Your doctors need to be able to determine whether the image is waiting to be reviewed as well as where the image came from. As important, the ability to directly draw on the image and save the annotated view is helpful to highlight important observations. The doctor and staff should be able to attach a note to the image and include the image in patient or referring doctor correspondence.
  8. Patient Summary Screen: Patient summary screens display key information about a patient status or situation. Note that requirements can vary by specialty. For example, pediatricians are interested in immunizations while surgeons may want to see a list of prior surgeries. All doctors want to see a list of medications, current conditions and outstanding care items. The patient summary screen should offer options to present views that will be relevant to your doctors without cluttering up the presentation.
  9. View Options: When looking for patient information you want to have different view options that are built into the EHR. For example, you may want to see the patient chart in chronological, or reverse chronological order as well as grouped by type of information (Ex. Lab tests, radiology tests.)
  10. Patient Portal Integration: Patient portals support interactions with the doctor and provide immediate patient access to important care information. Patient portals support PCMH and ACO strategies as well as certain Stage 2 Meaningful Use Measures. Secured messages between doctors and patients are supported through patient portals. The EHR should be able to send patient information such as the clinical summary, reminders and results to the patient portal. Additionally, patient information entered in the patient portal should be accepted into the EHR to allow you to fully document your interactions with patients in the EHR.
  11. Authorization and Disclosure Tracking: The recent changes to handling and disclosure of patient information through the HIPAA Omnibus rules as well as the more complicated rules for impermissible use and disclosure of protected health information (PHI) increase the importance of keeping appropriate records for disclosures and uses of PHI. The more information one can record on the status of the disclosures for a patient, the less chance of a problem. The EHR should record patient limitations on distribution of PHI as well as document when information is distributed.

Small practices need easy-to-use and comprehensive solutions to clinical operation and patient service challenges. Focusing on the key features needed to improve workflow and support staff and doctors will provide the right tool and a practical solution to the needs of the small practice.

About the Author

Ron Sterling, EHR consultant, discusses the EHR features small pratices need Ron Sterling publishes the popular EHR Blog, and authored the HIMSS Book of the Year Award Winning Keys to EMR/EHR Success. He is an independent EHR consultant. Find out more at

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