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| 1. Regardless of whether an office is using EHR or paper-based records, the office visit workflow consists of five steps: pre-visit, pre-exam, exam, post-exam, and post-visit. While paper-based offices accomplish the same tasks, offices that use an EHR complete the tasks in less time, often with increased patient safety and health care quality.2. During Step 1, pre-visit, a patient schedules an appointment and completes patient information forms online. This takes the place of filling out paper forms in the waiting room and saves time, since the office staff does not have to manually enter the patient's information into the billing program and file the paper forms.3. Step 2 is completed at a computer in the waiting room. The patient confirms the demographic and insurance data he or she has already entered. The EHR checks insurance eligibility, and the patient has the option of making a copayment via computer or paying at the front desk. The medical assistant then escorts the patient to an exam room.4. Step 3 consists of two parts. During the first phase, the medical assistant checks the patient's vital signs and gathers information relevant to the current visit as well as allergy and medication information. The MA enters this information in the EHR while the exam is taking place. In the second phase, the physician reviews the patient's chart in the EHR and examines the patient. The physician documents the visit by typing in free text or responding to templates that contain commonly used clinical words and phrases. Since data are entered while the physician is with the patient, it is less likely for information to be left out or forgotten, as sometimes happens when doctors wait until after the exam to record their observations and findings. Using an EHR allows the doctor to order tests and medications electronically, without the use of paper forms.5. In Step 4, the patient stops at the front desk to pick up radiology or laboratory test orders, prescriptions, and educational materials. The front desk reviews the billing module of the HER to see whether additional payment is due and schedules followup appointments before the patient leaves.6. In Step 5, post-visit, two different tasks are completed. The coding staff reviews the codes assigned by the EHR, makes any required changes, and finalizes the codes. A member of the billing department uses the coding and visit information to prepare and submit an electronic claim to the patient's health plan. Reimbursement is electronically deposited into the practice's bank account. Also during Step 5, reports from radiology and laboratory facilities arrive in electronic form and are reviewed by the physician. Any abnormal results are indicated by a special alert that appears on the physician's EHR screen.7. Every service submitted for payment must be documented in the patient's medical record, including medical care, diagnostic tests, consultations, surgeries, and other services eligible for payment. To be reimbursed for services, the provider must document each service provided to the patient. Electronic health records contain tools that make it easier for clinicians to document patient encounters. With an EHR, physicians can efficiently document all the services they provide at the point-of-care, using structured templates, unformatted text, or a number of other choices. As a result, documentation is completed sooner, and the elimination of physician dictation means that there is no transcription expense. Whether physicians are reimbursed for the services they provide is directly linked to the codes submitted to the payer on the insurance claim. When a payer receives a claim, the codes are reviewed. Payers want to know whether a service was appropriate for the patient's condition and whether the treatment was necessary. In a paper-based office, the coding, billing, and reimbursement cycle normally takes anywhere from three to fourteen days. The process of coding with software is known as computerassisted coding. Initial codes are suggested by the software and are later reviewed and verified by a professional coder. The integration of automated coding with the billing system ensures documentation of services billed, aids in the selection of appropriate codes, reduces number of unbilled procedures, and shortens the time between a patient visit and receipt of reimbursement.8. Electronic health records are much more than a computerized form of a paper medical record. In addition to streamlining the workflow in a physician practice, EHRs contain features that aid clinicians in providing patients with safe, effective health care. Some of these features include access to current clinical information at the point-of-care, decision-support tools that help confirm or rule out a diagnosis, ability to track patient compliance with care plans, ability to ensure that patients receive appropriate wellness screenings, identification of patients at risk for a specific disease, management of patients with chronic diseases, and evidence-based clinical guidelines to improve the quality of care.9. The ability to write a prescription and transmit it to a pharmacy electronically, known as e-prescribing, is a feature of most EHRs. By writing prescriptions electronically, providers can avoid many of the mistakes that occur with handwritten prescriptions. E-prescribing also makes it possible to determine ahead of time whether a medication is included in the formulary of the patient's health plan. One of the main advantages of e-prescribing is its ability to rapidly perform important safety checks. As the provider selects a patient's new medication, the EHR provides real-time alerts about potential problems, including drug-allergy conflicts, drug-drug conflicts, and incorrect dosages. In addition to increasing the safety of prescribed medications, e-prescribing saves the provider and the support staff time, with fewer calls from pharmacies to clarify prescriptions and no need to pull a patient chart when a refill request is made. |