Over the past week, AmericanEHR has received hundreds of EHR ratings and comments from physicians across the US as part of a survey that we are conducting with the American Medical Association. Having both used an EHR for many years as well as going through a recent implementation in an Addiction Medicine practice, I have had the opportunity to see EHRs perform in a wide range of clinical settings. A vexing problem that faces the EHR industry and our patients is why some physicians love their EHR while others detest exactly the same system implemented in very similar practice settings. What factor, or collection of factors, makes one physician satisfied, while another complains vehemently about the disruption to his/her practice.
My recent EHR implementation experience may provide some insight. The EHR system was implemented in a 6 physician practice with 5 support staff including 2 counselors. The implementation went very smoothly, so much so that by the end of the first week, the practice was back to normal levels of productivity and staff left happy at their regular time on a Friday afternoon. How did we do this and what were the insights that could help others with satisfaction levels?
- A significant amount of time was invested in correctly documenting the workflows in the practice and determining which workflows could be directly translated into the EHR and which would need to change. This process began 4 months prior to implementation. For example, new patient intakes were split so that the counselors collected some of the information that they originally collected in paper format and the physicians imported that data directly into their clinical notes and documented some information that was previously provided to them, however which made more sense to be collected by the physician. Similarly with all other workflows;
- Data to be collected was designated as discrete data or narrative information and the side-bars were configured accordingly, ensuring that all important data (HIV, Hep C, Immunization status, Active drug use etc.) were in the format that made the most practical and clinical sense for patient management;
- The order and layout of the information, including demographics, flags and alerts were also configured to ensure that they were viewable in a logical order and in a format that could easily be imported into consultation reports and referral letters and used for analytical queries;
- Every form used within the practice (registration, special request, referral, diagnostic requisition) was configured to allow for rapid and consistent information entry;
- Templates were identified and developed to cover as many scenarios as possible to ensure that the data could be recorded easily and in the correct clinical format;
- Reference databases (pharmacies, drugs, provider directory) were all installed and checked to ensure that they were up to date and accurate.
While this list is not comprehensive and complete, it does provide a good sense of the preparatory work that went into getting the EHR ready for implementation. Even at the point of go-live, the system was about 60% configured. We still made a number of changes and updates and tweaked the processes carefully over the first week. By that time, the system was 80% configured and all clinical and administrative workflows that were necessary for effective operation were in place.
The last, and most important, preparation element was for all staff to receive adequate training. We had a trainer come in to the practice for 2 solid days of training on the weekend prior to our go-live Monday and then had a senior trainer on site for that day.
All of these factors contributed significantly to the smoothness of our the implementation as well as the initial and ongoing satisfaction with the system.
My key learning: A great deal of satisfaction is derived from a correctly configured EHR system. This made all of the difference for our practice and I suspect that it will mirror the experience of others who have had successful implementations.
My recommendation: Your EHR probably has functionality that you have not yet even discovered. These are sophisticated systems that can be very effective in supporting good patient care. However, they need to be configured correctly to do the job well. Spend the time at the front-end configuring the system to meet your needs and then make sure you get adequate training.