EMR / EHR Implementation: Minimize the Problems and Pitfalls

By Sheldon Needle

No one can promise you that Implementing an EMR, however good, can be easy and without false starts and problems. The changes you are planning to make – both in the way your practice does business, the workflow, and the change from paper trail to electronic documentation – are so major. Finding the right intersect between the needs of your medical practice and the features and strengths of a particular EMR/EHR will make this implementation go more smoothly. But it helps to know which EMR implementation problems you can surely anticipate, and which you can hope to avoid .

Here are some ideas to help avoid major disasters within your implementation:

1. Plan to Implement in Phases: no one can hope to integrate all functions and modules of an EMR at once. Identify an easier function for starters -- some functions that are close to stand-alone -- and implement that first. Think out the order for implementation of modules, so that the successful outputs from one modules can feed another. The nature of your practice or medical group will determine what makes most sense.
2. Flow chart your medical practice functions, as the programmers of old used to do, so that the visual presentation will help you make sense of the order of implementation. Look at your employees – your doctors, your nurses, your technicians, your medical billing specialists. See where their functions intersect and overlap. Look at the modules available, and see how they can be divided up according to your workflow chart.
3. Map staff into your flowchart and implementation plan, so that you know who will be involved in each stage of the EMR implementation and who will need the most extensive training in the use of your EMR.
4. Think about how you will get “free text” into your EMR/EHR– that is, data that is not sitting in a database somewhere. Notes that you take via speech recognition software will not be discrete fields that can easily be picked up and “reported” on by an EMR’s report writing function.. Some EMR’s are beginning to use AI (artificial intelligence functions) to capture free text data, convert it to discrete and “reportable” data to come out of the EMR’s reporting functions.
5. Have end-users involved in the design and implementation phase of the EMR. For instance, the technicians most involved with processing and handing over x-rays need to be involved in the design of the scan and capture of x-rays, MRI results, etc. into the EMR. The end users are the people who will actually use the modules and the reports from the EMR. Design decisions must be reviewed by the end users to make sure interfaces are workable and practical. Make sure that your medical billing specialists are on-board in the use of the system, and the importing of codes from your clinical information to your billing modules.
6. Allocate plenty of time for training your medical end-user staff. That time should be broken up, rather than administered in one serious “gulp”. People need time to assimilate and test out what they have learned about using the EMR. Give staff time and a place to practice methods so that they are not rushed through procedures that they do not feel confident using.
7. Provide good local computer support. Not everything can be resolved using remote help desks. Make sure there is someone physically available for hard/ware software issues on a regular basis. This person does not have to be available 24 / 7 but must be available on a daily basis, even if it is for an hour a day.
8. Keep a close eye on the system interfaces before you commit to using them: This is the likeliest place for gross problems to crop up. Interfaces between different medical software systems must be examined before the EMR/ EHR goes anywhere near live: Have your I T person , whether in-house or hired, investigate the interfaces between your EMR or EHR and any external systems very carefully. Do not make assumptions about system compatibility. Do not believe the vendor literature without testing the interface.

There are so many critical planning and training factors to keep in mind in planning for your EMR/EHR, but these are critical ones. Look at the CTS Demos Scorecard to help you compare EMR/EHR software and find the right fit for your practice. Your practice – and your patients – stand to gain the most from a good EMR/HER fit and a semi-calm implementation.

Come back to this blog for additional EMR implementation and integration ideas and planning issues

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