Things to Think About Before EHR Implementation

Objectives:

  • Learn how setting a goal to be paperless is essential in planning your EHR implementation
  • Learn the characteristics of a successful implementation
  • Learn how e-prescribing can boost your productivity

Steps to Take Before EHR Implementation

Goal: No Paper Charts

Congratulations on your purchase of that shiny new electronic health record for your office. You've made your decision and your expectations are high. However, your work is just beginning.

The difference between an efficient, harmonious, computerized office and computerized chaos is all about implementation. You owe it to yourself to sit back for a few minutes and take some time to think about how you, your staff, and your office will function with this new system. It is useful to think that your office will not just be computerized, but you will be implementing a complete health information technology system. If you think in terms of the new system and how everything works within the system, success is much easier. Good luck, everything is about to change!

Over the next few months, continue to keep in mind and work toward the primary goal: an office with no paper charts.

No paper charts the prime directive, and all good things flow from this accomplishment. Certainly there are other accomplishments such as efficient workflow, elimination of wasted steps, and improved office communication– but none of this can happen if paper charts are not eliminated. We continue to live in a paper-based world and many strategies will be needed to deal with the great amount of paper coming into and flowing from your office.

Office/Physician Characteristics of a Successful EHR Implementation

We have found that many characteristics that enable successful implementation of information technology projects (or any office projects, for that matter) are human rather than technological factors.

Medical offices that have had successful EHR implementations have the following characteristics:

  1. Excellent teamwork
  2. Excellent communication skills
  3. A spirit of adventure and continual improvement
  4. The ability to handle adversity and bumps in the road well.
  5. Excellent problem solving skills
  6. A willingness and flexibility for individuals to go outside their job descriptions in order to make things work.

Family physicians who have had successful electronic health record implementations have the following characteristics:

  1. An interest in how their entire practice works as well as parts of the practice that are inefficient and may be subject for improvement with an electronic health record system.
  2. A teamwork mentality and the ability to trust employees as well as delegate appropriately.
  3. An appreciation of the work involved in transitioning from paper charts to electronic charts and a willingness to perform this work.
  4. A willingness to change their work process from a paper-based system to a new work process that takes advantage of information technology.

Things to Think About Before Going Live with Your EHR

Workstation Setup

Will you be using workstations in the examination rooms or will you be using wireless laptops or tablets that you carry around?

If you'll be using workstations, pay strict attention to workstation set up in the room so that you can interact with the computer and interact with the patient in a reasonable way. The computers in the room can be very small these days using small form factor computers. Flat screens varying from 15 to 19 inches plus are now standard. One good idea that seems to work well for many offices is putting the flat screens on a swivel arm so that they can be readjusted easily.

Network Setup

Accommodations need to be made in the room for ethernet connectors, outlets, etc. Do not be too concerned about patients and children messing with the computers. This has been found by many to be a minimal problem. If you are using a tablet or laptop computer you need to be concerned about your wireless set up and make sure this works appropriately.

Power/Operation Issues

Battery life is also a concern and many have docking stations within the room to provide a stable platform for entering data. Other offices use mobile carts to carry the tablets or laptops from room to room. Your ancillary staff will also need mobile computers. This may seem obvious, but test your hardware extensively and make sure it works reliably and quickly before going live. Also test your electronic health record software extensively and make sure it works well with the hardware that you have selected.

EHR/Practice Management Integration

If at all possible, you will want to have your practice management and billing system connected to your electronic health record. Many electronic health records are installed as a complete solution containing both practice management and electronic medical record. If this is not the case, an interface could possibly be built between the two pieces of software.

Lab Connectivity

Establish digital connections with the laboratories you deal with, if possible. These may also require an interface. Interfaces can be expensive, but the flow of information in your office and the digital format of data that come from it (especially laboratory) makes it very worthwhile. Having digital connections from end to end and information flowing into your office in a digital format at the time that you start to implement your record makes things much easier.

Dealing With Paper from Outside Sources

You may be on the verge of having a paperless office, but most of the world is still using paper. Therefore, you must think extensively about how you will deal with the paper that presently comes into your office and the paper that you produce that goes out of your office.

There are multiple ways to deal with this, some more efficient than others.

  • Faxing - The ability to fax prescriptions and other electronic documents is an absolute essential element to your strategy.
    • The faxing ability will either be integrated into your electronic record or you will need to install a modem and network fax software which will allow you to fax any electronic document that can be printed from anywhere in your office. You can accomplish this by bringing up the print dialog box and instead of printing to a printer, you "print to the fax modem."
    • You can also use this same fax modem or if you have a lot of incoming fax traffic as separate incoming fax modem to electronically capture faxes. That is, instead of coming out of your fax machine in paper format at which point it would need to be scanned into your record, it can be captured in digital format and inserted into the record directly. This saves a number of steps.
  • Scanning - You also need a robust scanning solution as paper will be coming into your office from the mail which will need to be scanned into the record.
  • Messaging - Your electronic health record should contain a robust messaging system for interoffice messaging. After all, you no longer have paper charts to attach sticky notes. Robust messaging capability is absolutely essential and is the glue that holds everything together especially within a larger office. You will find it essential.
  • Printing - While you want to minimize the amount of paper coming into your office either through the front door or from the paper fax machine, you still need the capability of printing prescriptions, patient information, and other documents. Consider carefully where you want to position your printers within the office space. Many practices have found it useful to have printers in each examination room where prescriptions, instructions, and information can be printed real-time and handed directly to the patient.
    • If you have the printers in a more central location or at the front of the office, consider carefully the workflow that this entails. The patients must remember to pick up their instructions or prescriptions and/or someone must remember to give it to them before they leave the office. Also, having the provider leave the examination room multiple times to retrieve paper is somewhat inefficient.