Considering that the federal government has dispersed more than $4.4 billion in EHR Incentive Program payments to over 76,000 eligible providers, it makes sense to examine what may be holding back the rest of the physicians in this country who need to implement an EHR system.
Many physicians are not ready to take the technological leap because they are either not fully educated on the process of adopting an EHR system, or they may see implementing an EHR as a hassle and a waste of time and money without improving patient care.
In the simplest terms, some physicians are hesitant while others are skeptical. We need to provide tips that really work for both camps of physicians.
Let’s first address physicians who want to implement an EHR system but just don’t know where to begin. Your first stop should be your local Regional Extension Center (REC). Your local REC will provide you with a great deal of information on the EHR adoption process. Many RECs provide subsidized (free) services to help you select and implement your EHR system. Most RECs also have pre-negotiated rates and terms with the top EHR vendors. Many RECs have hired health IT consultants to help you through the process, as well. Take advantage of your local REC and build a relationship with a health IT firm. You’ll need health IT Consultants who specialize in your system for years to come since EHR systems and government requirements tend to change. To find your local REC, Google “Regional Extension Centers” and select the first search result “HealthIT.hhs.gov: REC Program.”
Now for you skeptics out there: Let’s see how we can help you. If you think you’ll wait until the big groups or practices have ironed out the kinks of implementing an EHR system, you will be waiting a very long time. In most cases, the projects you’ve heard about lacked leadership and were poorly managed. Change management is all too often not considered. We’ve seen projects that went through the motions of the implementation but the clinicians and staff were not engaged and not supportive of making the change to the new system. As you can see, these are problems that will never go away, but with the right leadership in place, your project will be a success.
Here is a list of EHR implementation tips that I’ve gathered from the field that really work. These tips come directly from consultants who are out in the field every day assisting providers in an ambulatory care setting with implementation of various EHR systems.
1) Build your team. Chances are, your CEO, COO or CMO has tasked someone in IT or administration to search out and find the best EHR for the organization. It’s time to build your team. To get started, hire a health IT consultant to help you and your physicians through the process of selecting the right EHR. Once your EHR is selected, hire a project manager who has previously implemented your system and make sure s/he follows a solid project management methodology. Find a health IT service firm that can help lead your team and work with your vendor to implement the new system. Ensure that you have a physician champion who can advise the project team and rally the other physicians and clinical staff around the EHR implementation. Everyone on the team must be professional and have a positive attitude.
2) Choose the right partners. Don’t try to do everything on your own. Figure out what you’re good at or what you can commit to learning and outsource everything else. Look for companies that fit your practice’s culture; ensure their company values match yours. Negotiating first on cost instead of the value that the partner brings to the table is a mistake.
3) Choose the right software. This is where your consultant will help you through the process. Make sure your consultant forces you to evaluate the clinical aspects, as well as the software vendor’s financial viability. Also, make certain there are people in your area who know the system or who at least have access to a company who is certified and trained on the product.
4) Understand and document all workflows. Ensure that all workflows from check-in to checkout are evaluated and documented. Communications between medical assistants/nursing staff and providers must be evaluated as well. Once all of your workflows are documented, ask the team to walk through how those workflows will be executed in the new system. After you “go-live,” walk through all of the workflows at the end of the first week again and make sure they still make sense. If any changes are made, update your documentation and communicate the changes to everyone.
5) Accept that paper charts will be phased out. The end goal of your EHR project is to chart electronically and not on paper. Develop a good strategy for abstracting data from the patient’s chart and move your clinicians off of paper as soon as possible. Investigate a strategy where the data is lifted from the chart and placed back on the shelf rather than scanning all documents into the EHR system. You want as much discreet data lifted off the paper chart and entered into the system as possible. It is perfectly OK to mark charts as being abstracted and let them follow the normal course provided by your record retention policy.
6) Develop training manuals and create an ongoing training program. Develop training manuals for your system that takes into account your workflows. Develop a training program for new hires, as well as re-training for existing staff (including clinicians).
7) Join or build a community. When selecting your EHR software, understand who else in your area is using the same system. If a local user group has been formed, join it right away. If a local user group doesn’t exist yet, plan on forming one. It is extremely important to network with others who are using the same system. You will learn best practices from each other and avoid many pitfalls.
Lastly, the most important key to success is choosing the right team, partners and software. As Benjamin Franklin once said, “We must hang together or assuredly we will all hang separately.” So let’s focus our collective efforts to help this next wave of physicians adopt an EHR system, meet Stage 1 Meaningful Use and continue this momentum on into Stage 2 Meaningful Use.
James Deck is president of MTS Healthcare.