Toolkit Helps Optimize EHRs for Physician Assistants

Optimize EHR systems now to allow PAs to practice at the top of their licensure and ensure the best patient safety standards, says an AAPA regulatory and practice director.

It's important to include input from all stakeholders when choosing an EHR system for your healthcare organization, including physician assistants, who often face different regulations and requirements depending on where they're practicing.

That's why the American Academy of PAs has released a new toolkit that helps PAs advocate for EHR systems that meet their unique practice needs.

"We are 10% of the current clinician provider population," says Sondra DePalma, MHS, PA-C, CLS, DFAAPA, AACC, director of regulatory and professional practice at the AAPA.

She also points out that according to the Bureau of Labor Statistics, the profession is projected to see 37.4% growth over the 2016–2026 decade, putting it in the top five of the fast-growing professions.

She said the opportunity is here to make sure EHR systems are optimized to allow PAs to practice at the top of their licensure and ensure the best patient safety standards.

"We're not talking about big redesigns of EHR systems. This isn't going to take a lot of money," she says. "It doesn't take big investment in IT resources and IT redesign."

Instead, it involves asking the right questions to ensure top functionality and getting the right systems implemented.

That's why it's important to have PAs at the decision-making table, from the development and design of the program, to deciding which EHR system to use, to implementation and ongoing system management, DePalma says.

"We really think that PAs … should be involved in all aspects," says DePalma. "There's a lot of evidence that says when people are involved in the process they're able to avoid workarounds and other issues that might involve efficiency and patient safety."

Although many hospitals and health systems have EHR systems in place, DePalma says it's not too late to involve PAs.

"It still is relevant, I believe, for a number of reasons," DePalma says. For example, mergers and acquisitions often require organizations to choose one EHR system from two different ones, and PAs can be involved with that decision.

According to the AAPA, there are four main issues to consider in ensuring that EHRs are optimized for PA use:

Compliance: This involves making sure that EHRs are adaptable for different state and federal regulations. DePalma says that the AAPA has heard anecdotal reports of variability about how well systems can adapt to state requirements and different hospital policies. For example, the EHR should be adaptable to assign or subtract certain features or levels of use to account for different privileges. "There needs to be that flexibility," she says.

Design: EHR systems should ensure the best and most efficient workflow for PAs, such as meeting the compliance needs mentioned above. To do that, PAs should be involved in every aspect of the EHR selection and implementation process. For example, narcotic prescribing rules vary by state EHRs, so involving PAs right away will eliminate the need for "people trying to come up with workarounds and fixes after the fact," DePalma says.

Patient care and quality: Flaws in the EHR system can result in care delays and gaps. For example, patient test results may be delivered to the attending physician, instead of the PA who ordered it. "That's really a safety issue," DePalma says. "Sometimes even a day or more delay can definitely affect patient safety and healthcare outcomes."

Transparency: Often care isn't attributed to PAs in the EHR documentation. For instance, split/shared billing scenarios might default to the physician, which not only results in misattribution issues for Medicare and coding compliance, but also could affect employment decisions for hospital executives who don't get a full picture of PAs' contribution. "You really do want to have transparency and see what your healthcare providers are contributing to the care of the patient," DePalma says. "If [executives] can't quantify or see it, they may not be aware of it."

All of these considerations add up to creating the best practice environment for the patient, says DePalma.