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Anticipating and solving problems in EHR implementation and training
Changing over to an electronic health record system in your office has numerous and varied benefits, ranging from greater efficiency and elimination of lost charts to government payouts for compliance. But how do you get from point A to B in your practice’s implementation?
My office employs one part-time clinician and eight staff members, and we started our conversion to a complete electronic system in 2006. The following three key areas can lead to the greatest success in EHR implementation.
Don’t rush it
Like so many others things in life, implementation is a marathon, not a sprint. Once you have evaluated all the options and chosen the EHR system that works best for you, you still need significant lead time to transition your practice to an online system. I recommend 3 to 6 months to dissect patient flow and decide how you will handle each step, price capital expenditures, secure financing and determine how an EHR system will function ideally in your office. We used only the scheduling and billing modules of Compulink’s Ophthalmology Advantage for 5 years before we were ready to jump into a fully certified EHR capability that meets our needs and ensures we are eligible for the Medicare and Medicaid EHR incentives.
When the implementation date arrives, the process should be approached at a relaxed pace. It is like the reverse of weaning a patient from a drug. The first day, plan to work with the electronic records only half of the day. Cut your schedule back to 25% to 50% and have your trainer there to help with any issues that may arise. Return to paper for the second half of the day and the following day as a breather. Give yourself and your staff time to digest what you have learned. On the third day, choose the morning or afternoon and again cut back your schedule to 25% to 50% and have your trainer present again. It is much better to have the extra time and not need it than to need more time and not have it. You and your staff will feel much more confident and relaxed after the first 2 days.
On the fourth day, again repeat the half-day schedule, but this time without the trainer. The next day, try a full day at 50% patient capacity. Increase this as tolerated by you and your staff. Remember that it takes much more time for you and your staff to enter a new patient that an existing one. In the beginning, all of your patients will be “new” to the computer system. If all of the patients that you entered in a day were new, you would be exhausted at the end of the day and feel like giving up.
This is not a process that can be rushed. The software has many facets and capabilities and so many ways to be customized to your practice, and you should not try to bite off more than you can chew at any one given time.
Use only what works for you
I find that the most important first step is to thoroughly dissect and analyze patient flow. An exhaustive review of each type of patient and every possible scenario is essential before implementation of your EHR system can begin. If this is not completed beforehand, you will end up doing it your first day live on the system — and you do not want that.
Starting with the initial greeting or phone conversation, you must determine if the patient’s history will be taken online with Web registration, via mailed forms before the appointment or in the office on the first visit. Leading into the exam portion of the visit, any peripheral equipment that you have needs to be evaluated for compatibility with the EHR system. After the exam is finished, careful consideration of the checkout process will determine how informational materials for the patient, prescriptions, scheduling of the next visit and referrals out, if needed, can all be part of your EHR system. Once you have this information, you can customize your EHR system to work specifically for you. In addition to drop-down menus, we have enabled a feature that tells us when a patient is due to be refracted. This way we are not relying on memory or flipping through old charts. Your vendor will be your biggest support in helping you customize your system so it is most efficient for your practice.
A patient tracking module can result in huge efficiency gains. It allows you to monitor and analyze the flow of patients through the office, customized to your particular office and the type of visit. Workstations within your office network are identified as tracking points. The patient’s reason for his or her appointment determines the stations or tracking points he or she will encounter during the visit, and a timer keeps track of the total visit length and the time between stops.
All hands on deck
One of the best things we did was to wait until our office staff was stable before we started to implement this kind of a change. Then, not only was I highly involved in every step, but I also chose an office “champion” — a staff member who was in charge of the switchover. It is probably best that it be someone other than a doctor who can “sell” the system to the employees. This person can meet with you to decide on a day to go live and work directly with the vendor to make sure that all goes smoothly.
Get each employee involved with the system — everyone from billing to optical to the front desk will use it in some way. We gave everyone small notebooks and asked them to write down any problems, bugs or error messages they encountered. The problems were reviewed after each workday and fixed so that the next day went more smoothly. This helped us to customize the system so that it worked for everyone and made the whole experience more positive.
Additionally, we had a trainer from our vendor available not just for training but present on our first days of going live with the system. Not only did it make the staff more comfortable, but having the trainer present helped us to quickly resolve any issues that came up. We also had an IT person on call for any technological shortfalls during the entire implementation process. As a result, going live was smooth and successful.
Moving forward
Implementing an EHR system is a commitment, not just in terms of financial resources and technology, but also in terms of time. For a relatively painless transition, it is important to be a team, take it slow and motivate the whole practice to be part of the new system. Above all, careful evaluation and planning can help avoid any pitfalls on the way to successful implementation of a new EHR system.
Today, not only are we more efficient, but patients are impressed by the organization and overall benefits the technology provides, as well as with the technology itself. We have had patients say they feel they are getting a higher level of care because we always know exactly where they are and what they are being seen for, and we are able to make their prescription and checkout process easy. We are also currently looking at how to get even greater return on investment through the targeted marketing functions in our system — targeting specific client populations with follow-up information, special promotions and so on.
Andrew M. Norris, MD, FACS, can be reached at the Eye and Laser Center of Fort Collins, 2121 East Harmony Road, Suite 190, Fort Collins, CO 80528; 970-224-2020; fax: 970-224-2236.
Disclosure: Dr. Norris has received travel support from Compulink.