Once you have selected an EMR, signed your contract with the vendor, and scheduled a date to implement the system, the real hard work begins. Implementation can be a smooth and streamlined process if you are well prepared or it can be disruptive and difficult. Preparation and attention to detail are the keys to success. The following are some tips to consider when implementing your EHR that should help you through the process:
- Understand the different types of implementation:
- Big Bang: turn on everything at once
Theoretically a shorter implementation
- Staged: start using new features gradually, e.g. e-prescribing, PMS, Medications
Theoretically longer implementation
Our recommendation is to start your implementation with the make it or break it systems first like the (PM/Billing systems) before moving to other systems
- Develop a plan for your implementation that includes when you will start and complete training, and when you will start and finish chart conversion. The plan should also solidify how you plan on evaluating your practice’s workflows and your expectation on how they will change. EHR implementation has a habit of dragging out if you don’t have defined goals, so once you have developed your plan stick to it.
- When setting up a schedule for your implementation try to schedule it for a period of time when you expect a slower pace. You should recognize that vendors are busy as a result of the federal government incentive program, so you may not be able to get your ideal schedule.
- Communication is the key to success. You should have regular meetings with the other providers in your practice as well as your staff. Using an EHR in your practice will change how you communicate. For instance, due to internal communications through email, you may lose the verbal and physical cues you used to communicate. As a result, it is important to ensure you and your immediate practice team (e.g. your MA or nurse) talk on a daily basis like you did in medical school with pre-rounds.
- Make sure you all clearly understand how you plan to convert your practice’s records (both charts and billing records) to your new system. If you are converting from paper charts and want more guidance, take a look at our blog posting on chart conversion. Regardless of what your strategies are, make sure to talk to your vendor about your plans and whether they have any suggestions or requirements. It is important that you and your vendor agree to the plan, including due dates. If you are importing data from an old system, make sure the vendor will be comprehensively testing to ensure the data transfer is accurate.
- Provider (physician, NP, PA) buy-in is CRITICAL. This buy-in is an all or nothing situation. If a provider refuses to use the EHR system, this can result in a practice maintaining multiple processes for the same task resulting in decreased efficiency and frequently an inability for your practice to meet the demands of new care models.
- Staff buy-in is also critical. Having a recalcitrant nurse who refuses to use the EHR or change how he/she does things may end in a failed implementation. You and your practice leadership should make sure you have a plan for staff who refuse to use the new system.
- Your practice should plan on having initial training that teaches basic use of the system and prepares you for go live. Advanced training takes place typically three to six months after your go live date in order to optimize your use and perform advanced tasks. Dividing up the training works more effectively since you will likely not remember the nuances of the system when you are struggling to document a note.
- Appoint “Super Users” (individuals who can help train you and your staff and be a point person for any technical issues). These super users should get more training on the system and if possible start their training well in advance of the go live date.
- Recognize that there is likely a significant variation in computer skills of staff and physicians and understand how you are going to improve skills for those individuals.
- Identify who is going to provide technical support (e.g. for hardware and non-EHR software) for your practice. Is this an internal skill-set or do you want to hire a local technical support provider? Try (wherever possible) to identify support services in your local community. Before assigning this to an existing staff member or doctor make sure it is really the best and most cost-effective use of their time.
- Identify user groups and/or practices in your community that are using the same EHR — you can use them as an additional resource.
- Remember that EHR implementations will affect your practice’s productivity. You should anticipate a 50% loss in productivity for the first two weeks and decreased productivity for three to four months. As such you will need to either reduce physician schedules and/or expect longer workdays.
- Practice, practice, practice. Don’t settle for the initial path of least resistance with your implementation; refine it and keep optimizing your use. One frequent mistake is to enter your notes in narrative format rather than entering the information using templates and dynamic fields in your EHR. While this may seem easier, without discrete data you will be unable to use the more advanced functions within your EHR in order to meet meaningful use.
This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.