Presenters: Set an EHR conversion date and stick to it

Two practitioners share their experiences with introducing electronic health record systems in their offices.

ATLANTA – Once you decide to make the switch to electronic health records, set a “go live” date and do not allow reluctance from staff or doctors to prevent the conversion. Two clinicians who recently began using such new technology offered tips to attendees here at the SECO meeting.

“A groundswell of negativity in the office could shut down the deployment of a system,” Gary Farley, OD, of Colonial Heights, Va., said.

Justin Bazan

“The hardest part for me was my own attitude the first few days,” Justin Bazan, OD, of Brooklyn, N.Y., added. “Keep your frustration to yourself, and don’t let it out in the exam room.”

Dr. Farley said his office cut the doctors’ patient loads by one-third for the first few days of implementation.

“Patients understood about us getting backed up because of the new system,” he said. “They like seeing you doing something new. We ran behind the first few days, but by the end of the second week, we were starting to feel our legs again.”

Dr. Farley said several doctors in his practice input three or four patients a day before going live. “We wiped the slate clean on the ‘go live’ date, but then they were more comfortable moving forward,” he said.

Dr. Bazan added: “A few companies gave me live demo versions to practice with, so it was like I was seeing real patients. That helped me make my decision to go ahead with it.”

Decide what is important for your practice

The presenters cautioned against over-analyzing the available EHR systems.

“All of the systems have warts,” Dr. Farley said. “It’s just a matter of which one is the prettiest at the end of the day.”

“Decide what features are most important to you,” Dr. Bazan said. “There are 30 programs available. You can get that down to a handful if you make a list of what’s most important to you.”

Dr. Farley recommended consulting www.ehrcompare.com. “It looks at all of the vendors,” he said. “Reports are from end users. They have rated and ranked different types of areas and the pros and cons of the systems. It will provide the implementation cost.”

Some EHR vendors can capture images from diagnostic equipment, and there are also standalone systems that do only that. “It depends on how much that’s important to you,” Dr. Farley said. “It was important to us, so we have a separate system just for document imaging.”

Dr. Farley said he also wanted to convert data from his existing practice management system into the new system. “Once you have the data, you can send it to your vendor, and they will convert it,” he said. “Your system will be down during this process, and they need some time to convert it. Once you start using the new system, the old system is dead. You might still run it in the background for archival information, such as looking up an old bill.”

Dr. Farley said he pulled the old information out and put it in an Excel spread sheet, which the new vendor worked with.

He noted that information such as lens materials or prices for old frames was not worth cluttering the new system, but data such as birth date, insurance information and chart numbers was.

“You need to go through your database and find out what’s important to you,” he said. “When you talk to your vendors, make sure they can convert that data.”

Financial concerns include possibly having account receivables on the new system while patients are still paying off the old system’s account receivables and keeping your insurance claims flowing, Dr. Farley said.

“You need to be sure insurance is ready to go on day 1,” he said. “We did an initial test claim. And as updates were coming on, there were mapping issues. Things weren’t going into the right field on the computer, and the whole claim was being thrown out. We have a significant Medicare population and do a lot of filing, so this became our most significant deployment problem.”

Dr. Farley urged his staff to be comfortable calling the vendor’s support staff.

“You want to evaluate not only the software, but the customer service,” Dr. Bazan added.

“Don’t let your staff try to make the new system do what the old one did,” Dr. Farley said. “We told them the new system may not be easier at first, but it would eventually allow us to do things we couldn’t do before.”

Choosing a back-up system

Both doctors stressed the importance of having a back-up system.

“There are a number of options: mirror systems, an extra server, off-site storage,” Dr. Farley said. “Have a written plan or policy on who does the back-up and how it’s done.”

Dr. Bazan started out with a web-based solution.

“If your Internet goes down,” Dr. Farley said, “You can just pull out a paper chart and then scan it to enter it into the system.”

Dr. Farley said his practice still has all of their paper records. “You could scan all of the old documents and destroy them as you scan them,” he said. “However, that’s labor intensive and memory consuming.

“The other option is to let it be taken care of by attrition,” he continued. “In Virginia you have to keep records for 5 years, and we have kept them for 7 years, then we destroy them. One decision we’ll have to make is whether we want to scan part of those records and archive them. You want to look for significant information, such as foreign body removal or surgery.” – Nancy Hemphill, ELS

• Justin Bazan, OD, is in private practice in Brooklyn, N.Y. He can be reached at Dr.Bazan@ParkSlopeEye.com.
• Gary Farley, OD, is in private practice in Colonial Heights, Va. He can be reached at (804) 526-3676; farleyg@erols.com.
• Disclosures: Neither Dr. Bazan nor Dr. Farley has a direct financial interest in the products mentioned in this article, nor is either a paid consultant for any companies mentioned.