The hard part is done. You've made the decision,
signed the contract and you are taking the plunge
into the world of electronic medical records (EMR).
Now you just have to install the software and start
doing all those wonderful things promised to you,
right? Not so fast. In fact, there remains the
rather large task of implementing your new EMR and
changing how your practice operates on a daily
basis. Though numerous EMR software products are
available, many of the implementation tasks are
common to any practice setting, large or small.
Leaving as little as possible to chance is the key
to a successful EMR implementation.
What to expect?
Although an EMR will help you
improve care, reduce costs, and improve
efficiency, do expect moving a practice
from “paper” to “paperless” to take
major amounts of time. You should expect
it to take longer to do the things you
swiftly do now at the beginning of the
implementation process. There is a
learning curve that your practice must
endure. A reasonable time-frame
expectation to any EMR varies from 3 to
9 months. Any other expectation should
be rendered as “easier said than done”.
So please, plan accordingly.
Be Prepared to
Do the Work
There is a considerable amount of work
required to prepare an EMR product to go
live. It is a common mistake for most
practices to assume that the vendor will do
all the work for them. In reality, your
practice will be responsible for completing
time-consuming tasks such as personalizing
common encounter templates to accommodate
each provider’s style, maintaining ICD-9 and
CPT codes, creating short lists or
quick-pick lists favorites and naming common
lab tests. Although EMRs come with a defined
set of templates, most providers end up
creating templates to match their own
personal styles. It is not unreasonable to
find a multi-provider practice with
completely different writing styles for each
provider. The EMR templates should be used
as a starting point and not as a master
piece. It should be clear that the vendor is
purely providing training and support to
learn how to use the EMR or to solve any
issues.
Creating your own encounter templates is the key
to success. Allow a reasonable amount of time to
complete this customization work. Otherwise, you
will slow down the implementation process or simply
end up adding implementation costs to your practice.
Have at hand any pre-implementations issues.
Discuss possible solutions and have an easy to
follow plan. Make sure everyone in your staff is
informed of what steps to follow when any problems
come up. Make sure everyone is following the same
protocol in your practice and note any changes that
need to be made.
Be Realistic
Practices often underestimate the amount
of work required to prepare an EMR product
to go live. It is vital to accurately assess
the amount of work and time that is
required. Plan ahead the practice’s
work-flow, facility modifications, hardware
installation, staff requirements, software
configuration, back-up and recovery, old
data, dealing with existing paper and
training. Have a clear definition of what
you want the EMR to accomplish and making
decisions throughout the process that
support that goal.
Work-flow
Analysis
Analyze existing work processes, look for
opportunities to improve efficiency, put
together new work flows that could be
accomplished with the tools available in the
EMR and develop a transition plan. Discuss
the work-flow changes with your staff and
consider suggested changes that would make
the best use of the EMR system. For example,
replace paper phone messages with electronic
ones.
Facility
Modifications
Most practices will have to fit the EMR
system into the existing office space. Your
practice needs to plan where to put the new
EMR equipment. To fully retire the paper
records, have computers in every location in
the office where staff would need to look up
or enter data into the electronic medical
record. Have printers available where staff
members would be handing printed materials
to patients. Review your facility for any
necessary electrical and network wiring for
the new hardware equipment.
Hardware
Do invest in good, reliable technology.
Saving a $100 on a computer system could
cause your practice thousands of dollars
down the road due to equipment malfunction
and/or down time. The choice of hardware is
mainly driven by the technology and pricing
available on the market today. After
considering how fast hardware changes, make
sure your have the our latest
recommendations before purchasing any
hardware.
Hardwired
Desktops or Mobile Wireless Devices?
Although, an EMR can be used with a
Tablet PC or wireless device, it is our
recommendation to install a workstation in
each exam room. Use a pull-out arm mounted
on the wall for the keyboard and mouse to
save space. Wireless devices, depending on
many factors, lose their signals causing
data corruption, are more vulnerable to
signal interference from other wireless
devices in your office, can easily be
stolen, must be carried from room to room,
are battery life dependent, can be damaged
if dropped or fluid spills and require an
additional layer of technology needed for
wireless connections and security.
New Technology
and the Practice Staff
Allow enough time for office staff with
less computer experience to become familiar
with the new computer equipment such as
scanners, printers, modems and computers.
All EMR have a set of minimum computer
skills requirements. Your practice needs to
plan for users that cannot and will not
adjust to the new technology due to their
limited computer skills. These cases vary
from practice to practice. Remember it is a
drastic change to go from complete paper to
completely paperless.
Software
Configuration
The EMR software can be adapted to your
practice environment. However, plan to
configure the software to meet your needs
before you can start using it:
- Security: Plan to limit user access
to various portions of the EMR program.
Restrict access for intentional or
accidental compromise of the integrity
of the medical record, such as the
ability to delete progress notes or
prescriptions.
- Laboratory Data Management: Plan on
how this data is to be available to
providers. This requires either an
electronic interface with each lab, a
manual data entry into the EMR or simply
scanning the results into the patient’s
paperless chart.
- Encounter Templates: EMRs run around
templates for data entry. Determine how
the providers and users will enter their
data into the EMR: by using templates,
direct typing into templates or voice
recognition software such as Dragon
Naturally Speaking. Your practice should
plan on creating and customizing your
own templates and/or modifying the
existing templates. This requires
considerable time and effort. Allow
providers to become familiar with the
EMR software and then encourage template
development. Average users began to ask
about using templates after 1 to 3
months.
Backups
The key is to have multiple methods of
backup and recovery and test them before
going live. Your backup system should
include hard drive data redundancy on your
file server, offsite backups such as an
Internet backup provider, external backup
devices and server shadowing if possible.
Backups should be able to go back at least a
6 weeks on the data.
Internet
Security
Antivirus, Firewalls and Network security
must be in place before going live. Limit
internet access to users based on their
roles within the practice. A good firewall
should allow you to accomplish this task.
Monitor Internet activity by each user and
make sure email, chatting, games,
entertainment, music, gambling sites are
blocked from all users since this creates a
door for possible data loss and disaster.
Old Data
The amount of old data to load into the
EMR before going live depends on available
time and money, and the needs and desires of
the providers.
Our recommendation is to scan only
patients that are coming for a visit based
on the appointment book from the live date
forward.
Other options range from no preloaded
data to extensive abstraction and data entry
or simply loading only the past three months
or so.
After going live, all data should be entered
electronically. Since completing the past
medical, social and family history sections
of an EMR is time-consuming at first, you
should plan on scheduling comprehensive
examinations 5-10 minutes longer to allow
for this data entry. As this requirements
ease through time, you could plan on
eliminating the extra time about 8 months
after going live.
Plan on stopping pulling charts for
telephone messages after six months and for
most office visits after 18 months.
Paper
If "going paperless" is your goal, you
must be sure that enough scanners are setup
throughout your practice to be able to do
this. Scanning outside documents into the
EMR should be easy and readily available to
all users. Dealing with the massive amount
of patient-related paper that comes into a
practice is one of the biggest challenges.
Every patient-related document has to be
reviewed, scanned, electronically filed, and
destroyed. Once the documents are scanned
and electronically filed, keep them for at
least a week to ensure reliable computer
backup, and then dispose of them.
