7 golden rules to optimize EHR implementation

Eligible physicians are dropping out of the HITECH incentive program. Why? Often, it’s because a practice implements an EHR and then tries to mimic all their old paper processes and workflows.

That can get them through the vendor’s initial implementation, but it is not sustainable for the long term.

Workflows and operational processes must be modified to optimize the new tool. Technology changes what is feasible, and to adapt, we need to change what we do every day.

To get the most out of your EHR, adopt these seven Golden Rules:

1. Include the nursing staff! The EHR 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 EHR. In fact, nurses account for about 75% of the use of the chart, and a successful EHR implementation focuses on how the nurse can assist the physician in the integration of the EHR into clinical workflow. Too often, an EHR committee is created in a medical practice with no nursing representative. Bring in the nurses!

2. Schedule MORE training specific to process, not just how to fill in a screen. Schedule time outside of office hours for you and your staff to get on the EHR and actually walk through the tasks you perform each day with an eye to how to minimize the number of touches to accomplish each task. That means it will cost you overtime, or lost productivity if you close office hours, so budget accordingly. The additional training costs will help your investment in the EHR pay off in the end.

3. Anticipate the stress and effort required over several months. The adoption of technology is an iterative process. The EHRs are full of features and functions that will bring efficiency to your operations but it is impossible to take advantage of it all in the first two months of your go-live. Typically, groups will be in the learning and adoption transition for about a year. Be prepared for the long haul!

4. Round on users (providers and clinical support staff). Round on everyone in the practice just as you’d round on your patients in the hospital. Visit each user 30 days after your go-live and again after 6 months — even if it’s only for a few minutes. Observe how they’re using the system and identify short-cuts or tips you can offer on how they can use the EHR more effectively. Learning elbow-to-elbow is quick and nonthreatening. Make rounding a regular activity — every user should be observed at least twice a year.

5. Personalize and recognize the differences among physicians. Don’t try to 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 email and word processing differently. The EHR applications provide several ways to accomplish the same task (which adds to the training complexity) so be sure to offer providers the variety to choose what will fit their practice style the best.

6. Get your EHR-integrated patient portal up and running with interactive services for your patients. Invite your patients to sign on with the portal at the teachable moment — in the exam room. Providing test results and allowing patients to request appointments and prescription refills online will save your staff time and increase patient satisfaction.

7. Don’t become a drop-out. Stick with it. You didn’t learn to ride a bike in a day either.

Follow these golden rules to optimize your EHR implementation, earn all the potential incentives, and increase your operating efficiency and your practice profitability.

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

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  • buzzkillerjsmith

    Workflows must be changed. Indeed. We must stay and extra hour or two per day for no more money and no improvement in pt outcomes.

    Stress over several months. Try several years.

    Be prepared for the long haul. Uh, we’re haulin’ enough already.

    EHRs, given the current state of their technology, are downgrades, not upgrades. Some docs are coming around to that.

  • http://www.thehappymd.com/ Dike Drummond MD

    There is a culture aspect to this as well. Quality documentation is mandatory no matter what system you use. The mantra “Every User a Power User” is key.

    There will also be people in your system who take to the EMR like a duck takes to water. These are your “native” power users. They can be tapped to teach the rest of your team the techniques they use to be the most efficient documentors in your group. In my experience they love to share the keystrokes they use automatically that you will never discover any other way.

    Here is an article on all three ways to take the struggle out of EMR implementation.


    Dike Drummond MD
    117 Ways to Prevent Physician Burnout in the MATRIX Report here

    • M. O’r.

      And spend time evaluating the software you are buying. Some programs are very intuitive. If you are migrating from a legacy system, which many people are doing now, the data can be transferred. Otherwise there is a painful period of input.

      I went into a clinic and during my registration was given a pad to input the data – worked well, easy to see. My meds and other info was then verified – not input. And, there was a survey asking about how it worked for me. GOOD!

      In my experience the most difficult systems are the ones in the hospitals that have been custom designed over time – and you can see layers of needing to put the same info – I can hear the turf battles as I type. So management and IT capitulates and pleases everyone. And the system is a big old dinosaur that the docs and students spend more time learning than on patient care.

      So for a hospital or a clinic… there are different systems and they are not all created equal. How new is the channel partner?

      Right now is madness. With the pending ICD-10 implementation, people are panicking and screaming for EHR with certification from a specific company – or a project management certificate. These are generally young professionals with little to NO experience in the medical field and they will not understand what needs to be done for the implementation. Not to mention ICD-10 “expertise” of which, unless you were on a conversion project, your training is minimal.

      But that is another nightmare – getting your coders up to speed. And your CNA’s.

  • southerndoc1

    8. Every year you stick with paper is one more year of your professional life you don’t ruin by dealing with EMRs.

    • drgn

      You seem to have a sense of humor. It is pretty wild but the AMA just answered my post on Why the Accuracy In Medicare Physician Payment Act should pass by Brian Keppler. Please read it. I would love to hear your response.

    • buzzkillerjsmith

      Beautiful. I’m going to steal that line and try to make people believe I thought of it. Hope you don’t mind.

      • southerndoc1

        Didn’t you already steal my ACO = HMO + EMR? Just keep those royalty checks coming.

  • guest

    Oh, interesting. For some reason the technology cannot be created to accommodate my workflow, so I must “adapt” to the workflow that best suits the technology? The solution to slow adoption is for us to suck it up and spend more time (and money) in training sessions?

    Who is master of whom, then? If we really can’t create technological solutions that provide efficiency or improved clinical care, where is the benefit?

    • guest

      And to add insult to injury is the assertion that EMR doesn’t work for us because “we” are not tech-savvy, not because….EMR doesn’t work.

      I always find it hilarious to hear “but…a PROGRAMMER would have to do that” in our various EPIC meetings when I make a suggestion about how the system could be customized to promote efficiency in some function or another. Clearly the PROGRAMMER’s time is much more valuable than that of us mere MDs.

  • MarylandMD

    So typical of IT and management types. They couch everything in teamwork-speak (Include the nurses! Round on the users!) to pretend they are oh so very supportive while they impose the destructive inefficiencies of the EMR on front-line staff.

    The kicker: “Workflows and operational processes must be modified to optimize the new tool.” Instead of the obscenely expensive computer program being able to adapt to the provider and staff workflows, we all have to adapt to the arbitrary rigidity imposed by poor programming and lack of vision by the software designers.

    • LesCarter

      Agreed. Facile gibberish.

  • drgn

    Any PCP would be interested ( and everyone else here) to the American Medical Associations Response under the posts of Why the Accuracy In Medicare Physician Payment Act should pass by Brian Keppler. Please read it. You will all be most interested.

  • LesCarter

    A quick tally of responses preceding this suggests considerable skepticism about this article, not counting those who want to sell something.
    The truth about myself and (I suspect) the majority of Docs is that we want IT systems to work. We perceive they could add considerably to our ability to provide good care AND even make our use of time more efficient. In practice they do the opposite. The Cerner system I use is ridiculously inconsistent and burdensome. And while many problems continue to plague us, the hospital rolls out new modules or updates that at least require getting used to if not formal training, so we devote more time, not to our patients but to the Cult of IT, at whose altar we must sacrifice every day.

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