Electronic medical records (EMRs) are going to be used in your practice. The decision has been made. However, between the time of signing the contract and using the product there is a lot that needs to happen. I have heard many practices not understand what goes on during this time and why the vendor or consultant keeps asking so much from them. This article will help you understand the very first part of the implementation process.
There are a few questions that need to be answered before your practice starts using the EMR. In most cases, these questions are answered as part of a process called EMR readiness assessment.
1) What is your practice flow? Who does what, when in the typical patient encounter (aka workflow)? If you are not using an EMR already, then it is important to have your paper forms available so that basic templates or choice lists can be created to match your practice style.
2) What hardware is available and where/how will it be placed in your office. Are you going to use desktops only, laptops only, tabletsor a combination of these? Will the computers placed inside each room? At the nurse's station and doctor's desk? Both places? Do you have a fax workstation set-up for receiving in-coming faxes into the EMR?
3) Have you or your staff used an EMR before? How comfortable are you with using computers? This has implications on how long and in-depth training is. Furthermore, if you or staff has used an EMR before there may be un-learning that needs to happen as no 2 EMRs work the same way.
4) Who is going to starting using the EMR and when in the implementation process? Do you want only the main providers and nurses to start off? Everyone? For small practices (1-2 providers) this may not need to be a big deal. For large practices, a phased implementation may be more logical.
5) What is the timeline for me to start using the EMR? Am I supposed to meet any government mandate deadlines ? In the IT world we call the start date a "Go-Live" date. Usually, all the preparation for setting up the necessary hardware, training schedule and achieving other important milestones are temporally related to the Go-Live Date. Also, if you are going to try to get Medicare or Medicaid money through the Meaningful Use Program there are dates by which you must demonstrate that you are recording patient data according to specific guidelines.
While the above issues will likely be handled by your vendor or consultant, there are a few tips that might be helpful to you and your practice through this phase of implementation, as smoothly as possible.
1. Establish and maintain good communication with your vendor or consulting company. As I mentioned before, there will be experts who will guide you through the process. They will usually advise on how to change your workflow to use the system properly. Also, a training schedule will be set-up. You will be told what the hardware requirements are and, in some cases, the set-up will be done for you. You must be clear on your goals, constraints (both time-wise and financially) and expectations. Write emails, talk on the phone with them on a set basis until you are using the EMR fairly independently and comfortable with it.
2. Establish and maintain a good communication plan with your internal staff. Often times, the vendor or consultant will be mostly meeting with the provider(s) or administrator(s) prior to and during the first phase of implementation. This could be for a variety of reasons- designing templates (providers), buying more hardware (administrator), etc. Then suddenly we hit training and the nurses/front desk staff are brought it. I have seen situations where poor communication from the administrator or lead provider causes frustration among the staff. A lot of the EMR data will be recorded by nurses/front desk and they don't understand the implementation timelines and reasons for doing what they do. Keep it a good practice to hold regular meetings or send detailed emails.
3. Expect changes in productivity, volume and time spent. Usually, there will be some slowing down of how quickly you can see a patient if you now have to enter the data into the computer rather than jot information on a form. Occasionally, there may be network or connectivity issues- just part of using a computer. Finally, you many get an error or have a question on how to use a particular function upon which you may need to write to or call the vendor support team.
It may take months for companies like Allscripts, EPIC, Centricity to prepare the database, create templates or clinical content specific for the practice and customize the screens specific to the practice's workflow. Patagonia Health EMR is completely web-based, SaaS (software as a service) based and we can quickly customized the templates to match your practice's paper forms. Therefore, the time between signing a contract and having the EMR ready to use is very short.
In conclusion, getting an EMR is exciting and can ultimately help your practice delivering greater patient safety during care, increase volume/revenue and meet government mandates or reporting requirements. In future articles, I will delve into specific topics regarding EMRs such as ensuring privacy/security of patient data,health information exchange and many others.
