Electronic Medical Records (EMR) - Are you ready or not? Featured

Friday, October 14, 2011
Written by Bryan Belden

doctorIf there was a book called “EMR for dummies”, it might have some of the stuff I am about to share with you. I am writing this in hopes that I can help a practice avoid some of the pitfalls and disasters that I have run into in my 25 years in the document management experience.

Here are some simple tips to follow:

Who’s idea is it to do this? An important element of the success of any EMR system is that everyone must be on board with this.  You must have everyone committed to doing it, or it is going to cost you more money to pick up the pieces from a doctor stuck on paper.  This can cause a huge bottleneck in the process, and end up costing the practice a lot more money.  Make sure you get this in check!

Hire a consultant!  Now that everyone is in agreement, where do we go from here?  Consultant, Consultant, Consultant. Need I say more.  DON’T DO THIS YOURSELF!  A good consultant is worth their weight in gold. I have lost track of the number of practices who have not hired technical expertise to do the required homework, and it has cost the practice thousands of additional dollars! This person needs to be someone you trust. It maybe the IT guy on staff, or the guy who stops by now and then to fix computer problems.  Big question. IS HE/SHE QUALIFIED? What experience do they have in this field? You need more than the computer geek.  The ideal consultant should have experience in implementing EMR/EHR.  Ask for references. They should have an in-depth knowledge of your computer system and software.
Establish a time line.  Timelines are like rules. They are meant to be bent not broken.  Make a realistic timeline and stick to it. Delays can sometimes cost money.    The consultant should help with this.

Money/budget.  This is where the consultant earns their keep. He/She should be able to give you a good figure for hardware and software to get the job done.  Software is easy. Hardware can be all over the place cost wise.  DO NOT RELY ON THE EMR VENDOR SPECIFICATIONS FOR BUDGET HARDWARE PURPOSES!  Those specs are the minimum for what it takes to run their software.  You are looking for what it will take to make their software run efficiently in your practice.  If you under budget hardware. It could end up costing you so much more in labor for what you failed to purchase.  Hardware is a one-time purchase. Labor never ends!
Waiting for the stars to line up.  No,  you don’t have to wait for this to happen, but you better make sure you have the time, and resources,  lined up and a commitment to do it. If you don’t, you will never get your project off the ground.  I have met countless practice administrators/CEO’s who tell me they have been working on EMR for the last 5 years because they can never get these three basic items in sync.

Where to start? Ok. The staff is on board, the consultant is hired and you are ready to start grocery shopping for EMR.  The first logical place to start is with your current practice management software. Most , if not all offer EMR solutions. All the major players in healthcare do. You already know the practice management (PM) side, so adding the EMR component will make transition easier. It also makes financial sense. Unless the PM product is not “cutting the mustard” anymore, you cannot financially justify throwing it out and starting over. If you do, you have just pushed your EMR project back almost a full year.
Don’t reinvent the wheel!  EMR has been around long enough that some practice like yours has already been down the path you are about to take. Call your practice management vendor and ask to see a demo of their EMR.  Furthermore, ask for references that are in the same specialty as yours and go see a live EMR. What is good for a family practice may not work well with OBGYN or Pulmonary medicine.

A word about templates.  Every EMR has standard off the shelf templates as well as libraries of templates for specialties. I have yet to see one that is plug and play. Most have to be modified by choice or design to fit with your workflow.  Beware! This can be a budget buster and can delay your go live date.
Speaking of workflow.  As you evaluate each EMR software vendor, you have to pose the question. How much will this change the workflow in the office.  Will it add more steps in certain processes and reduce steps on others?  This is SO important.  If you have not clearly documented your workflow processes, now is the time to do it.  I have seen EMR implemented where the nurse wrote the vital signs of the patient down on a scratch paper, and then went out into the hallway and waited her turn to enter information into the EMR.  Where is the saving and efficiency in that?

Bells and whistles.   Most EMR software has add-ons that can further streamline the workflow process. It is very important to look at ALL the bells and whistles and decide which ones will benefit your practice. This can be a budget buster because some of the interfaces are thousands of dollars.  This might be something that you don’t purchase initially, but can budget for down the road.

What about the charts on the shelf?  This is an area of much debate and requires some thought. Do you scan as the patients schedule an appointment or do you get help with converting from an outside vendor?  Two main factors effecting this decision are: Type of practice, and patient volume. There is a balance between filling your EMR with charts of patients that will never be seen, and making sure you have an electronic chart ready to go when the patient walks in the door. This can create a huge bottle neck if your practice has any kind of patient volume.

Food for thought on patient charts. You now have a hybrid medical record system until all your current charts are converted.  Your staff will now have two places to look for charts vs one when you go live with EMR.  Your staff will have to check every patient to see if they have been converted or not.  I have seen medical practices that have been live on EMR for 3 years, and still have charts on the shelves! If your staff is now working overtime, or you have to hire extra people to get the job done, you need to seriously consider using an outside vendor to help with this process. I suggest getting the current charts converted and at a minimum have them stored on the server so they can quickly be added to the EMR.  This will help improve the return on investment (ROI).

The return on investment (ROI).  Bottom line is that EMR’s are expensive and they must be able to prove a cost savings. They software vendors will always show you a positive ROI. DO YOUR OWN.   EMR’s can add value to your practice when it comes time to sell out.  Are you just spending the doctor’s retirement money, or are you truly adding value to the practice that will improve the bottom line.

I hope the above has given some in-site into the important areas that must be addressed when making the decision to go paperless in your practice. 

Last modified on Friday, November 12, 2010

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