Surgeons should consider the generation gap when choosing an EMR system

The right system should accommodate the record-keeping needs of orthopedists at all levels.

Orthopedic practices that transition to an electronic medical record system are challenged to meet the unique needs of surgeons of different ages and experience levels.

In most cases, it is a matter of respecting the record-keeping preferences of older, established surgeons (ie, paper charts) while gradually introducing more computer-based approaches, said Andrew Keenan of Stryker Imaging.

“Since physicians practice medicine in so many different ways, it is important to find an electronic medical record (EMR) system that doesn’t try to be the ‘catch-all’ EMR,” he said. “Start off by narrowing your search to orthopedic EMRs. While the list [of systems] may be shorter, these systems are more likely to offer you the tools, simplicity and workflow functions that you require.”

Keenan recalled one orthopedic practice he consulted that had clinicians who ranged widely in their age and specialty areas. Not surprisingly, designing an EMR system that met everyone’s needs was a challenge.

“We had one trainer assigned to each physician for about 3 weeks. During this time, the trainers were able to learn the intricate nuances of how each surgeon practiced medicine and interacted with patients,” Keenan said.

During the course of those 3 weeks, “We were able to morph their EMR from a separate patient-charting system to a more natural extension of their individual practice. In the end, each surgeon developed his own unique way of using the EMR. The practice now no longer creates new patient charts, and all the physicians are happy they made to move to digital charts,” he said.

Hybrid systems

In working with surgeons throughout Pennsylvania, “I have had success implementing hybrid document management/EMRs that can adapt to the way each surgeon practices, thereby minimizing the change,” Keenan said. “I found that even physicians who are highly skeptical of EMRs eventually become advocates of a system that doesn?t interfere with their patient interaction, [especially if] it is set up with a short learning curve that allows them to see as many or more patients as they did with paper.”

Ideally, “Implementing a hybrid system like this allows you to create an EMR system that can meet the needs of your information technology-savvy physicians, your staunch paper chart supporters and everyone in between.”

Keenan also recommends appointing one staff member and one physician as project leaders. “They will help facilitate the selection process, and these ‘go-to’ people will be critical advocates to have during the initial few months the system is in place,” he said.

And while it is normal for your staff to have varying degrees of interest in an EMR system, “It is important to get everyone involved somehow. This system will impact your entire practice. Therefore, it is critical to get input from nurses, administration, surgery schedulers, etc.,” he said.

More patients, more records

At South Hills Orthopaedic Surgery Associates in Pittsburgh, Eric Nabors, MD, considered implementing an EMR system several years ago, but he and his colleagues finally made the decision to do so about 18 months ago. The reason: They added new surgeons and, not surprisingly, a substantial number of new patients in a very short time.

“This heightened the inefficiencies of using paper charts,” Nabors said. “Knowing that we had a mix of computer skill and comfort levels among the physicians and staff, we established a request for proposal (RFP) for vendors to reply to our wish list of system features. At the top of that list was ease of use, increased efficiency of patient flow in the office, and cost savings to justify the capital expense of the new system. Most importantly, we did not want the use of computers to detract in any way from our interactions with our patients.”

After receiving proposals from five vendors, Nabors and his colleagues scheduled the vendors to come to their office and demonstrate their systems to the partners and administrator.

“Everyone had a voice in this process, because we felt it was important to get initial support from all the physicians in the selection of a system,” Nabors said. “After the selection process was completed, we [recognized] key staff members who were true champions for our EMR system? as the resident experts on EMR, who could answer other staff members” questions.

Increased efficiency

His colleague, Christopher Manning, MD, agrees that implementing an EMR system has had a significant impact on the clinic’s efficiency.

“The ability to view a patient’s information from anywhere makes it easier to deliver quality patient care when I am on call for the practice,” Manning said. “Eliminating paper charts has saved the office staff many hours of searching for a patient’s information and has freed them to take on additional responsibilities. Daily tasks are completed with much less effort, charts are more current, and patient flow has improved due to the ability to write an order for a cast, X-ray or prescription and not needing to verbally communicate that request to our technicians. They are simply notified through the system.”

Nabors was quick to point out that these benefits applied equally to both the seasoned and less-experienced surgeons.

“We have two physicians who are within 2 years of retirement, two physicians who joined us right after completion of their fellowships 3 years ago, and I’m in the middle of my career,” Nabors said. “What made this decision work for us was asking for input from everyone from the beginning of the process. It could have been more of a challenge if we didn’t have that initial support. And we are lucky that the individuals in this group try to make decisions based on the good of the whole, and not simply what may be best for any individual.”

In order to meet the sometimes very different preferences of established vs. younger patients, “The most important advice we have is to do your research on the various systems … and then solicit input from all physicians throughout the process, from drafting the RFP through system selection, and finally through training and implementation,” Nabors said.

For more information:
Eric Nabors, MD, and Christopher Manning, MD, can be reached at South Hills Orthopaedic Surgery Associates PC, 363 Vanadium Road, Pittsburgh, PA 15243; 412-429-0880; e-mail: pevans@shosa.org. They do not have a financial interest in any company or product listed in this article. Andrew Keenan can be reached at Stryker Imaging, 402 Waynebrook Drive, Chester Springs, PA 19425; 610-836-2277; e-mail: andy.keenan@stryker.com. He is an employee of Stryker Imaging.