10 EMR don’ts when choosing electronic medical record

So, you’ve decided to move forward and get an EMR for your practice, but studies and reports of EMR implementation failures are adding to your anxiety levels.

You’ve probably read scores of rules on how to go about the task — some of them in this column. But today I want to share with you some important things you shouldn’t do.

Medical groups of all sizes and specialties across the country make the same mistakes. You can learn from them.

1. Don’t forget to include nursing. The EMR is not all about the physician! Physicians are the owners or the leaders or the key decision makers but they are not the exclusive users of the EMR. Nurses account for about 75% of the use of the chart, and a successful EMR implementation focuses on how the nurse can assist the physician in the integration of the EMR into clinical workflow. Too often, an EMR committee is created in a medical practice and there is no nursing representative — bring in the nurses!

2. Don’t buy the first demo you see. Think of that Little League coach who told you not to swing at the first pitch! Educate yourself and see several products so that you can compare and contrast solutions and determine a best fit for your workflow.

3. Don’t skip the reference site visits. Most demos look good. Go see the product in action in a practice to understand how it will translate into day-to-day activities. Preferably the practice you visit should be in your own specialty.

4. Don’t ignore the opportunity to improve your workflow. Most practices have not optimized processes or workflows. Look at the forms and procedures in your office for different tasks to identify where the EHR technology can help you streamline the workflow and eliminate steps and tasks.

5. Don’t rely exclusively on voice recognition to document your visit note. Most groups want to reduce transcription costs and often look to voice recognition software as the tool to achieve those savings. You don’t need to wait for an EHR to test your compatibility with voice recognition! Experiment with it in your practice by incorporating your transcription service or in-office medical secretary to provide the editing. You’ll reduce your expenses but without investing your own time proofing and editing documents.

6. Don’t skimp on training. Schedule time outside of office hours for you and your staff to get on the EMR and actually walk through the tasks you’ll perform when you go live. That means it will cost you overtime, or lost productivity if you close the office. Budget for the additional training costs so that you and your staff can get the most from your investment.

7. Don’t underestimate the stress and effort required over several months. The adoption of technology is an iterative process. EHRs are full of features and functions that will bring efficiency to your operation but it is impossible to take advantage of it all in the first two weeks of your go-live. Typically, groups will be in the learning and adoption transition for several months. Be prepared for the long haul!

8. Don’t forget to round on users. Round on everyone in the practice — providers and clinical support staff — just as you’d round on your patients in the hospital. A month after your go-live and again six months after that visit each user, even if it’s for only a few minutes, to observe and identify shortcuts or tips you can offer on how they can use the EMR more effectively. Learning elbow-to-elbow is quick and nonthreatening. If there’s someone in the practice who’s more proficient at the new EHR than you are, take him or her along with you on the rounds.

9. Don’t force all physicians to do the same thing. Incorporating technology into personal use is not one-size-fits-all. People approach even the simple technologies like e-mail and word processing differently. Most EMR applications provide several ways to accomplish the same task (which adds to the training complexity) so be sure to offer providers the freedom to choose what will fit their practice style the best.

10. Don’t throw in the towel. It takes time, so don’t give up! You may need some additional outside help — from the vendor or a consultant. Maybe a fresh approach or just stepping back from a long and arduous task can provide insight and inspiration to take your EMR project to the next level. Protect your investment and give it another shot.

Rosemarie Nelson is a principal with the MGMA Health Care Consulting Group.

Originally published in MedPage Today. Visit MedPageToday.com for more practice management news.

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  • http://warmsocks.wordpress.com/ WarmSocks

    Don’t pick the one that allows patients to go online to register in the name of eliminating paperwork, and then tell them that they also have to fill in multiple pages asking the exact same questions when they show up for their appointment. Don’t pick an EMR that’s so inefficient that you’re required to scan all those bubble-sheets of history, thus dupicating the information that the patient already entered straight into your computer.

    Don’t ditch the paper charts until your EMR is functioning efficiently. Don’t walk into an exam room without any clue about your patient’s history. After the switchover, if you can’t get your EMR to pull up a patient’s file, grab the paper chart so you have the information you need to provide good care.

  • http://www.emrconsultant.com EHR Scope

    Excellent advice. My company is very involved with number 3. We have EHRtv, which has virtual site visits to different places using different EMRs, as well as EMR consultant to recommend EMR’s to physicians based on their needs.

    Still, we just help with selecting. There is so much to be done after selection, and it really should be more emphasized. The 44000 dollar stimulus won’t do much for you if you use your EMR in a completely inefficient way, even if you meet meaningful use. EMRs can be a huge helper or a huge pain depending on whether or not you do it right.

  • jsmith

    How about this bit of advice, call it number 11. Don’t get an EHR in the first place. Lots of time and expense, no evidence it improves pt care.

  • http://www.healthplanone.com/blog Lucy Dylan

    Make the EMR system you choose is secure to protect patient privacy! Plus, take your time and make sure that your electronic medical system is right for your practice instead of buying EMR just to have EMR for the new legislation. Plus, making sure you and the rest of your staff know and understand the system You want to be able to save time in the future AND make your practice more efficient, not waste time by using the equipment inappropriately or by purchasing the wrong system.

  • ninguem

    The important thing in business agreements, they say, is not how to get in, it’s how to get out.

    Similar with EMR’s.

    How to get the data out. If it’s on some proprietary database system and you have to pay the company an arm and a leg to get the data transferred to another system, or you do thousands of patients by hand.

    I made that mistake. Fortunately, the new software vendor sort of knew backdoor ways to get the data. Otherwise, it would have been flying in some computer guy and paying thousands to get the data transferred. That’s what the former EMR vendor was threatening.

    Dodged the bullet on that one, and now I insist on being able to get out easily before going in to any new EMR.

  • http://www.mediaspidersusa.com Bill karmis

    Also keep in mind you need to convert your paper charts to reach full compliance.
    Most EMR vendors overlook this part When doing back file conversion ALWAYS use an outsource. I run across so many practices that are scanning internally and breaking all the rules surrounding good record keeping.
    I also recommend keeping your ok’d charts in a separate archive and migrate them over as you need them. This provides the best way to establish proper chain of command to keep your practice safe.
    Lastly start imaging now. The supply and demand of this sector is going to change drastically driving cost up and availability down.
    I just had a doctor that was planning on retiring and was caught in the floods surrounding Chicago. She put off imaging and is now entering retirement wondering if she is going to be sued for losing her patient records.

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