Electronic medical records (EMRs) are going to be used in your practice. The decision was made to use them but do you know how that is going to affect you? Are you prepared? What shall you expect? Many practices that I have worked with have asked these very same questions. The truth is that although it is impossible to predict exactly how each practice will be affected there are a couple of important points to consider are.
1) Whether you have used EMRs before or not. The evidence shows that practices/providers that have used EMRs before usually have some sort of process or procedures established that facilitate recording patient data on the computer versus the paper. This is important because the vendor or consulting company that will help you implement the EMR needs to know which user will be doing what in the EMR. One of the first steps will be to do a workflow analysis.
2) What hardware is available and where/how will it be placed in your office. Are you going to use desktops only, laptops only, tablets or a combination of these? Will the computers placed inside each room? At the nurse's station and doctor's desk? Both places? Do you have a fax workstation set-up for receiving in-coming faxes into the EMR? There are many more such issues to think about.
3) Who is going to use the EMR and when? Do you want only the main providers and nurses to start off? Everyone? For small practices (1-2 providers) this may not need to be a big deal. For large practices a phased implementation may be more logical.
4) What is the timeline for me to start using the EMR? Am I supposed to meet any government mandate deadlines ? In the IT world we call the start date a "Go-Live" date. Usually, all the preparation for setting up the necessary hardware, training schedule and achieving other important milestones are temporally related to the Go-Live Date. Also, if you are going to try to get Medicare or Medicaid money through the Meaningful Use Program there are dates by which you must demonstrate that you are recording patient data according to specific guidelines.
So there is a lot of food for thought. Answering all of the questions I raise above or going into specific details of EMR implementation is the the subject of future article or white paper. However, I will provide some tips you or your practice can employ to prepare yourselves for EMR implementation.
1 ) Establish and maintain good communication with your vendor or consulting company. As I mentioned before, there will be experts who will guide you through the process. They will usually advise on how to change your workflow to use the system properly. Also, a training schedule will be set-up. You will be told what the hardware requirements are and, in some cases, the set-up will be done for you. You must be clear on your goals, constraints (both time-wise and financially) and expectations. Write emails, talk on the phone with them on a set basis until you are using the EMR fairly independently and comfortable with it.
2) Establish and maintain a good communication plan with your internal staff. Often times, the vendor or consultant will be mostly meeting with the provider(s) or administrator(s) prior to and during the first phase of implementation. This could be for a variety of reasons- designing templates (providers), buying more hardware (administrator), etc. Then suddenly we hit training and the nurses/front desk staff are brought it. I have seen situations where poor communication from the administrator or lead provider causes frustration among the staff. A lot of the EMR data will be recorded by nurses/front desk and they don't understand the implementation timelines and reasons for doing what they do. Keep it a good practice to hold regular meetings or send detailed emails.
3) Expect changes in productivity, volume and time spent. Usually, there will be some slowing down of how quickly you can see a patient if you now have to enter the data into the computer rather than jot information on a form. Occasionally, there may be network or connectivity issues- just part of using a computer. Finally, you many get an error or have a question on how to use a particular function upon which you may need to write to or call the vendor support team. Some EMRs such as EPIC, Centricity EMR and the Allscripts EMRs are feature-rich but may take a longer time to fill out and not or are not user-friendly. On the other hand, products like Patagonia’s EMR have much less features but a simple user interface. Set expectations in your mind and among your staff of how the EMR may change your practice early so as to not cause undue frustration.
In conclusion, getting an EMR is exciting and can ultimately help your practice delivering greater patient safety during care, increase volume/revenue and meet government mandates or reporting requirements. In future articles, I will delve into specific topics regarding EMRs such as the EMR readiness assessment, ensuring privacy/security of patient data, health information exchange and many other