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Plenty of stories exist about horrible EHR implementation, and you might be especially worried if you run a small practice. Learn how to successfully implement a new system in a small practice setting.
Q: I’ve been hearing horror stories from colleagues about their experiences implementing electronic health record (EHR) systems. Do you have suggestions for ways to make the process easier for small (two-physician) practices like mine?
A: You are not alone. Unfortunately, practices of all sizes frequently encounter frustration, delays, and lost productivity during the transition to using EHRs. But the guidelines below may help to ease the process for you.
Stay committed to your goal, but be flexible in your approach. Don’t use your EHR just to duplicate the existing paper flow in your practice. The key is removing wasted effort and opportunities for error or failure by leveraging the EHR technology for routine functions and using your trained staff for tasks that require thinking. Successful implementation requires that you not be married to familiar ways of doing things on paper. Instead, step back and try to find an approach that aligns with your practice’s “big-picture” goals.
Accept that implementation will take time, and plan accordingly. EHRs represent a paradigm shift, and their use initially can be disruptive. Underestimating the training requirements and time commitment required to achieve basic proficiency can create chaos, productivity drags, and unhappy physicians and staff.
Plan out your implementation schedule. Doing so may require modifying work schedules slightly or investing in additional hours for your staff. It is important to allocate time for training and learning the new system, both the application and changes to your workflow. Don’t expect just to spend a few hours or one weekend learning a new system and workflow. It simply does not work this way.
Identify an EHR champion in your practice-someone who can help others adapt to the new system. This champion can become an internal resource and advocate, helping you improve overall success. Remember, it’s not just about implementing, it’s about actually using the system over time. The champion can help you do this and create employee engagement.
Get everyone involved. Implementing an EHR affects everyone in the practice, so it’s important to engage all your practice’s staff and resources in the transition process. Agree on your objectives, approach, outcomes, and what roles everyone can play in attaining the outcomes. Understand that it’s important to address the impact an EHR will have on your practice’s entire workflow.
Test the system before going live. Test the new workflows and use of an EHR system before fully implementing it. This recommendation applies whether you are a solo provider or part of a large, multi-location practice.
Test the system and your redesigned workflows before the start of a normal workday or on a weekend. If you are migrating from paper, perform parallel processes. By that I mean, carry the paper chart with you and use the EHR application as you ramp up the system during the first week or so. Doing this will allow you to find out whether you have designed the electronic chart appropriately. It also provides you with access to historical information without negatively affecting the patient experience.
In a multiple-physician practice, it is best to have one physician test the EHR application and workflow first. This physician can then work through any challenges without negatively affecting the workflow of the entire practice, then help get the other physicians up and running with the system.
Optimize your system. It’s important to remember that every practice is different, and no system is going to meet the needs of a practice entirely.
Identify what is most important to your practice and remember that it is not just the physicians who stand to benefit from using an EHR. For example, an integrated EHR system allows you to capture charges in real time that pass seamlessly to your billing operation. This allows your office staff to become more productive, eliminates lost superbills, and increases the likelihood of getting paid more quickly.
Some providers find it more productive to document and code in real time in the application, whereas others will document in the EHR following a patient visit. Variations in use typically depend on expected patient volumes, patient demographics, and physicians’ comfort and familiarity with technology, among other variables.
The key is to understand your practice’s people and processes thoroughly, so that you can use your EHR to its full capacity and enhance your practice’s efficiency-and profitability.
The author is director of implementation services for a practice management software developer and vendor. Send your tech questions to firstname.lastname@example.org. Also engage at www.twitter.com/MedEconomics and www.facebook.com/MedicalEconomics.