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A successful EHR implementation should begin well before the vendor arrives at your practice
A successful EHR implementation should begin well before your selected vendor partner arrives at your practice to install your system. Even before you choose an EHR, your practice should conduct its due diligence by making a careful assessment of staff needs and wants.
Saroj Misra, associate program director for a family medicine residency at St. John Providence health system, in southeast Michigan, said, "Most physicians or offices, when they take on an EHR, they don't do the appropriate prep work before starting to talk with the EHR company-which [means] they don't examine their work flow." One way to do this is to separately review both physician and staff work flows, as each can be significantly different. The process can be as simple as having a practice administrator shadow a physician and a staff member throughout their day.
Experts say an EHR should accommodate clinic work flows, rather than forcing physicians and staff to adapt to the EHR's templates and structure. That's why it is so vital to examine work flow before selecting a system. Misra recommends doing work flow studies both pre-implementation and post-implementation of the EHR, so that the practice can communicate hard data to its EHR vendor. He said the vendor will look at the practice's work flow and tell it what will and won't work with its EHR, and what might need to be changed to function efficiently.
Even small hitches in work flow can aggregate to become large irritants for physicians. Marissa Rogers is the program director for a family medicine residency at a large integrated health system in mid-Michigan. She said it is the little things that often become the biggest frustrations.
Because her residents see patients when they are hospitalized as well as in clinic, they are forced to use two different EHRs, each of which must be logged into separately. "The problem is that [the EHR] logs you out after a certain amount of time. So anything that you are not looking at consistently (I think there is a 15-minute lag time), it will just automatically log you out," said Rogers.
Atlanta-based consultant Elizabeth Woodcock advised practices to compile a "wish list" of features and functionality well before they pick a vendor. She also recommended calling similar practices in the community that are using the same EHR system and asking them how they like it. Calling references supplied by the vendor is convenient, but you won't hear the bad things, she said. "I always say, 'See what went wrong, not just the benefits … [Ask] if [that practice] had to do something over again, what would [it] do?'"
Another important consideration that practices' fail to look closely at is their technical infrastructure. Factors like the computer's processing speed (hardware), Internet connection, broadband width, even battery life can contribute to poor EHR performance. Woodcock said too often physicians and staff will incorrectly blame the EHR's software for balky performance, when it has more to do with existing hardware and technology.
For instance, the pediatric practice that Woodcock uses has laptops which are carried throughout the clinic from room to room. She said staff members struggle with portability, "If you think about your arm curled about the laptop, [staff] are having issues with their arms. It has to be open, so you are almost lifting with your elbow up. If you close it, you have to re-log in." In this case, Woodcock said, one possible solution might be using "workstations on wheels" to transport the laptops.
That's why experts say it is helpful to assemble a work group composed of an administrator, physician, administrative staff member, and clinical staff member, to put together a list of required EHR functions and capabilities. Make sure to do this well before beginning your practice's selection process.