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Untangling Your EHR Conversion Mess

What you need to know before, during and after implementation.

By   Joy Krush, Jon Ault

January 21, 2016

If you’re like most critical access hospitals you have either recently converted to a parent organization’s EHR system (such as Epic or Cerner) or contracted one on your own. And now you find that what was supposed to be an improvement in efficiency has become a tangled mess. Staff do not understand how the system works, reports aren’t being generated as they need to be, and if the contract wasn’t negotiated properly, you can’t change a CPT code without submitting a ticket to the User Group and waiting three months for your request to be addressed.

Whether you are converting to an EHR system, in the process or have already done so, we have some points that should be considered and addressed to ensure that your critical access hospital is capturing every charge appropriately and completely.

Know What You Need to Negotiate
It doesn’t do you any good if you end up with a standardized chargemaster that works fine for a PPS system, but doesn’t reflect the needs of a critical access hospital. Here are the top items you need to be aware of and negotiate in the contract:

  • Ability to make changes. This is critical. We have seen critical access hospitals not be able to change a revenue code, pricing or a CPT code without going through a User Group or change control and waiting an inordinate amount of time to have the change addressed. The ability to make changes is essential to ensure that you can capture all charges in a timely manner and keep revenue flowing in your critical access hospital.

  • Responsiveness to change requests. In the event that a parent organization will not allow you to make changes, then you need to set the expectations up-front for timeframes that issues are addressed. We recommend outlining common requests, such as system enhancements, chargemaster changes and compliance issues and then setting an expected turnaround time for each category of request. For example, three months for a system enhancement, but three business days for a chargemaster change that affects reimbursement or compliance.

  • On-going training. The common scenario is that staff is provided an up-front training on the system and then more or less left on their own to implement it and figure it out. We highly recommend that you negotiate ongoing training for at least the first year; ideally with someone coming onsite on a regular basis who knows how the system works, such as a SuperUser, and can address challenges and provide additional training.

  • Interface with add-ons. None of the major EHR software systems will interface with every ancillary system add-on. Know what add-ons you need and whether or not they will work with the new system. If not, how will this be addressed?

  • Maintenance fees. Most contracts contain considerable maintenance fees that often do not get carried out. Pin down the details on maintenance and negotiate a better fee for the actual service you will receive.

Set A Forward-Thinking Mindset
Change is never easy, especially as it requires staff to step outside their comfort zone and learn and operate a new system. Most staff hold on to the ways of how the “old system” used to work, instead of letting go of how things used to be and embracing a forward-thinking mindset. You can help staff embrace change by providing adequate training and support so that their workdays do not become sheer frustration. Also, involve staff in some of the decision-making process. Staff that feel their opinion is valued are more likely to “buy-in” to the new system and not fight it.

Temporarily Lower Productivity Expectations
Staff will feel pressured to keep up productivity while undergoing the learning curve of a new system. It’s wise to temporarily lower productivity standards for up to six months during the implementation phase and then ramp them up again afterward. This will give staff the breathing room they need to really engage in learning the system well.

Remember You Are Responsible for the Bill, Not the Parent Organization
Your provider number goes on every bill and ultimately, you, not the parent company who owns the system, are responsible for ensuring the patient’s bill is accurate. All the more reason why staff need to be continually trained until they are proficient at operating the system.

Verify the System Is Working Properly
We’ve seen critical access hospitals get burned by believing that the system is working properly for a critical access hospital without verifying that it actually is. The new system needs to be audited to make sure it is flowing as expected. Performing a post implementation charge capture audit is a good start to identifying any build and process related issues.

Learn How to Generate Reports
This is by far the biggest point of frustration we hear from staff. The lack of training on how to pull reports can create major disruption. Staff need to be well trained with continual support to ensure that they can provide the same and/or better reports than the old system.

Monitor Days In A/R
During the first year of conversion, it’s important to monitor the days in A/R and ensure that claims are not sitting in queues or being unaddressed. During the conversion process, there are claims that are brought over—but may not get processed. These need to be monitored.

Don’t Just Drag Over Your Garbage. Clean House!
It’s easy to just default to moving everything from the old system to the new one. Department heads should review their charges and inactivate any charge items not being utilized before dumping these charges into a new system. Conversion is the perfect time to ensure that efficiencies and not work-arounds are addressed. Some organizations use this opportunity to review their current processes to create greater efficiencies and then build these new efficiencies into the new system.

With careful consideration up-front, conversion to an EHR system can be achieved with minimal disruption and maximum efficiency. But, if you’re stuck in a conversion mess, there are ways to address the issues and find solutions to ensure your facility is capturing all charges and not losing revenue.