10 mistakes practices make in implementing information technology

What is the measure of successful technology adoption? Is it never having to hunt for a missing chart? Is it a reduction in specific operating cost line items? Is it about access to clinical information when you need it and where you need it?

Technology implementation has a significant effect on profitability. The Medical Group Management Association Cost Survey Report beginning with 2010 data shows that total medical revenue after operating and nonphysician provider costs per FTE physician actually increased as total IT expense per FTE physician increased. For multispecialty groups, for instance, among groups that invested less than $10,000 per FTE physician in IT revenue was $230,968; it was $313,900 in groups that spent between $10,000 and 20,000.

But simply acquiring technology is not enough; it is essential to implement the technology effectively to achieve those types of results.

Here, then, are the top 10 mistakes practices make in implementing information technology — and how to avoid making them.

10. Selecting a system based primarily on a demonstration session. Better to be thorough than fast in the practice management/EHR selection process.

Apply structure to the process.
Incorporate your workflow into the vendor’s application by defining a sample patient case in advance.
Don’t sign a contract without a reference site visit — no matter how busy the physician claims to be in order to avoid the visit!

9. Going live with your EHR without a lab interface. Viewing lab results via PDF is cumbersome for providers and trending a patient’s labs without a lab interface requires staff to enter test result values as discrete data, which is problematic and too labor intensive to be cost effective.

Identify the lab that provides the most results to your practice and test the interface with that lab prior to a go-live implementation.

8. Waiting to implement the patient portal. Implement the patient portal first, even before you convert your practice management system or go live with your EHR.

Save staff data entry time and effort by encouraging patients to self-register.
The patient’s past medical, social, and family history can be captured in the portal and “accepted” or imported into the PM/EHR system.

Getting information into the system will also save the patient time by reducing time in the waiting room. Patients are also usually more accurate and comprehensive when using the portal than they are with paper and pen.

7. Accepting the vendor’s “train the trainer” plan. Your trainer must understand the application of the system, not just which screens to go to to perform which function. Your own standards and processes are critical to how to use the new technology in your practice workflow.

6. Allowing physicians access without training. Don’t issue any physician a login/password without completing the required training. Provide test-out options to the physicians that demonstrate adequate system knowledge to prevent the dissatisfaction that will ultimately arise from not having sufficient training.

Provide one-on-two sessions specific to nurse/physician workflow.
Include procedural training along with the system know-how training. Answer the question “How does this apply to what we do?”

5. Assigning the project to the wrong person. Do not assign responsibilities for implementation based on seniority or loyalty or because you have no other position available for a long-term employee. The clinical application project manager must have some clinical background or understanding. He or she must understand what a provider sees (and grasps) when they open a chart.

Characteristics necessary for successful project management:

Commands authority and respect
Able to delegate tasks and lead others
Creative problem-solver and analytical thinker
Has high level of energy and self-direction.

4. Not including nursing in the selection process. Nurses touch the chart more than physicians do. Messaging and nurse workflow are critical to the successful use by physicians (nurses must do more of it so that physicians do less of it).

Nurses can facilitate the implementation or create barriers to the implementation; get them involved to get the best result.

3. Not elevating the EHR project in the organization. The EHR Project Manager/Director should report directly to the CEO/COO and work in conjunction with the physician champion(s). The manager should participate in the EHR governing body to establish standards and policies and procedures.

2. Making the EHR implementation an IT project. The implementation is about clinical operations and workflow changes. It is about improving operations with the use of a new tool. The EHR is no more IT than the front desk reception is. IT supports the infrastructure, just like the telephone infrastructure.

1. Not investing in ongoing optimization. Technology implementation is not a once-and-done project; it is an evolutionary process. Technology changes what is feasible. Technology adoption is iterative. Static templates will not satisfy changing needs of the end-users.

Implement a formal rounding plan to observe users and to prioritize ongoing development, training, and required modifications.

The initial goal of an implementation should be to acquire enough knowledge to get through the day. Users don’t know what they don’t know and need support as their use of the technology becomes routine.

Remember: Optimize your technology adoption and improve your profitability.

Rosemarie Nelson is principal, MGMA Health Care Consulting Group and blogs at Practice Pointers.