How to Manage an EMR Implementation

The use of electronic medical records (EMR) can have a transformational effect on health care in the United States. As more medical practices implement EMR systems, it is possible to use data to coordinate care, reduce inefficiencies and improve quality of care. There are some basic steps for managing an EMR implementation in a primary care setting.

Instructions

Planning

• 1

  Decide on an end goal. Before starting any EMR implementation project, your medical practice must have clear and realistic expectations about goals and priorities. Use this framework to create an implementation plan that will best meet your needs.

• 2

  Build a multidisciplinary planning and implementation team. The team can make or break an implementation. A physician or other clinician should have a lead role on the team, ensuring that there is buy-in among the clinical staff and that implementation decisions are in line with patient care.

• 3

  Evaluate your practice. It is important to collect current and historical information about patient demographics, practice patterns, finances, staff composition and other key data. This allows you to refine your goals and expectations and identifies some of the potential areas of your practice that need to be redesigned using an EMR system.

• 4

  Evaluate your practice workflow. Implementation of an EMR always involves "remodeling" practice procedures and physical space. Evaluating the existing daily patterns will help you identify the best possible design for the new system.

• 5

  Do your homework before selecting an EMR product vendor. Use your planning framework to clearly identify the key goals and outcomes your expect from a system and prioritize functions accordingly. In addition, there are some trusted entities that can provide reliable guidelines to vendor selection. The Institute of Medicine has issued a list of key functions for all EMR systems. The Certification Commission for Healthcare Information Technology certifies EMR systems. In addition, medical societies and associations also often provide guidance to members who are considering EMR implementation.

Implementation Phase One---Getting Prepared

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  Install the physical infrastructure required for EMR. This might include wiring, wireless capability, computer stations, laptops and servers.

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  Test that the hardware, wiring and network are working properly. It is better to take time in advance to verify that all components are functional than to start an implementation, only to find that there are hardware problems.

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  Conduct ongoing computer training for staff at all levels of the organization. Implementing a standardized training checklist is often the best way to ensure that all staff have the knowledge and capability they need to begin the EMR implementation process. This is also a good time to solicit staff feedback about potential problems or ideas to improve the process. It is critical that the staff team be working well together and understand expectations before beginning to use the new system.

Implementation Phase Two---Right Before Launch

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  Establish and communicate protocols for system use and for information exchange. Staff should be clear about privacy rules and how they interface with the new system.

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  Continue to provide training based on earlier staff feedback. As more staff train and practice with the system, more details will emerge that require modification. Now is the time to make changes to proposed workflow plans and protocols.

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  Test add-on programs or modules to make sure the system is functioning smoothly. For example, electronic prescribing and other tools are often extra modules that interface with the main system.

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  Communicate with your patients. Now is the time to "warn" your patients that your practice will be undergoing a big change and that workflow may be slowed or interrupted. Patients will likely be more understanding if they know what to expect.

Implementation Phase Three---Using the New System

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  Install and test the system software. At least a few days prior to the "go live" date when the system will be up and running the first time, do a real-time run through with staff. Some practices use staff as stand-in patients to test the system in as realistic conditions as possible. This is your last chance to work out any bugs before using the system with real patients.

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  Pre-load some data for patients who have appointments in the first few weeks. This will reduce some of the stress on the first day of EMR use.

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  Make sure your patients are aware that everyone is in learning mode and that things will smooth out once staff become accustomed to the new system.

Review and Revise

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  Continue team meetings to solicit ongoing feedback. Even the smoothest implementation will require some continual modifications until the system works for everyone. It is important to keep the implementation team intact even after the initial rollout to maintain staff morale and help make necessary modifications.

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  Evaluate workflow. It is impossible to anticipate every detail of the workflow changes required to implement an EMR system. Ongoing evaluation and staff feedback are important in order to make modifications along the way.

• 18

  Continue communicating with your patients. There will always be glitches with any new system. The best way to prevent problems is to keep patients well informed, reassure them that staff are working hard to create an efficient system of care and that patience is appreciated.