Managing the EHR Implementation

Objectives:

  • Learn the different stages of implementation
  • Learn how to manage the stages of implementation
  • Become familiar with issues you will face after your launch date

How to Manage Your Electronic Health Record Implementation

General Implementation Guidelines

Here are some general implementation guidelines that other offices have found useful: 

  1. Concentrate on implementing your staff and office first and providers second. While this sounds paradoxical it actually is very useful. Many of the office automation features that electronic health records enable will make the providers life extremely easy.

    The providers have a good deal of learning to do regarding working this new way in the examination room and everything can be set up to help this process ahead of time and to provide information at the time of care, things will go much smoother. So before you go live with the record everything else should be functioning appropriately including scanning, faxing, messaging, and any interfaces that can be brought online quickly.
  2. The providers and staff should be familiar with the hardware and the software as much as is possible before starting to see patients.

Sample Implementation Timeline

This sample implementation timeline represents a conservative guideline for a small medical office. Certainly, it can be done more quickly if desired.

Three to four months before launch

  1. Install hardware in the rooms or purchase wireless equipment including tablets and/or laptops. Depending on your electronic record at this point you may need a server.
  2. Ensure the functionality of your network and hardware and that everything can communicate with each other.
  3. Install and verify your scanning and faxing capability.
  4. Accomplish any basic computer teaching that is necessary and get feedback from your staff and all involved.
  5. Ensure your team is working well together.

Two to three months before launch

  1. Establish your protocols for scanning incoming information and faxing outgoing information.
  2. Continue to build general computer skills and continue to receive staff feedback.
  3. Install and test any ancillary programs which might either be required or be very helpful which includes speech-recognition programs, accessory faxing and scanning programs etc.

One to two months before launch

In an ideal world this would be the time that you're electronic health record software would be installed. This would allow the providers and office staff time to fully check out the system and make sure everything works. Sometimes this is not done because the teaching and installation is done at the same time by the vendor, very close to the go live day. Whatever the exact time between software installation and starting to see patients using the record a few things should be checked out:

  • Ensure the software and hardware function as expected. Make sure that screen transitions are quick and that there is no lag in how the system is performing.
  • Test the interoffice messaging system and make sure you can fax prescriptions.
  • Test printers.
  • Scan some material into the record to test this functionality.

Decide what information needs to be put in to the patient's chart ahead of time and start doing this for patients coming in the first few weeks at least.

Run through some mock patients in order to get a feel for how the system is working and for patient flow through your office.

Launch Day and Beyond

If you have done your homework and preparation, launch day should not create any undue stress or anxiety. Mostly it should go smoothly. Certainly, expect some glitches and problems that were not anticipated. Here are some things to consider for three to nine months after that initial day:

  1. Continue to concentrate on retiring charts. The paper charts should be signed off and retired no later than the second patient visit after the electronic health record is implemented. Establish a protocol for inputting all useful information into the electronic chart. Certainly your staff can do some and you can do the other real-time. Many offices put in medications, allergies, and established a problem list at the time of the first and/or second visit. The provider can tag certain pages that need scanning. By six to nine months there should be very few paper charts left that need to be archived.
  2. Continue to have weekly or biweekly meetings with your staff and certainly be open and honest and address all problems associated with the record. The meeting should be structured such that anyone is an able to speak their mind without fear.
  3. Your new electronic health record mandates a new workflow and a new approach. It can help your office illuminate wasteful work and redundant effort. Continue to be on the lookout for steps that accomplish no useful work and can be eliminated. Continue to think of new ways to use your new record efficiently. This step never ends.
  4. Get help if you need it. The American Academy of Family Physicians has great online resources as well as people willing to help you. Feel free to contact other offices that have been through this same type of start up and have been successful.

Most of all, keep at it. Your electronic health record represents the foundation and nervous system for your new way of working. It enables the future of family medicine to occur.

Measuring EHR Success

It is useful to consider how you are going to tell whether you were successful in your transition to an EHR. Is it that you use the EHR? Is it that you increased revenue? Is it higher job satisfaction? Or is it some combination of these?

You should make time to think about what you consider a successful transition and how you might demonstrate that it was or was not a success. If you are feeling more ambitious, you can develop a detailed framework with pre- and post-measures to determine whether your EHR implementation succeeded.

The COMPETE group developed survey tools to measure medical office processes, including administrative and physician tasks, pre- and post-EMR implementation (See Also box). They included variables that were expected to improve with EMR implementation, as well as those that were not expected to improve as control measures.