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Implementing an electronic medical record (EMR) is becoming a common process in medical organizations across the country. The process is not as simple as just turning on a computer, however, and there are a few key steps to take to improve your odds of success:
Identify a Champion
Even thinking about moving to EMRs means that your practice needs a "Champion" - someone who has support from the highest levels of your organization and is 100 percent committed to the process. This person should be a leader who others respect, and not someone who will be upset by moments of unpopularity during the project's duration. It is also unrealistic to expect someone with a full-time job to "slip in" oversight of an EMR implementation, so the Champion's work list should be adjusted.
Note that the Champion can be anyone with the clarity of vision and the dedicated time to oversee the initiative and does not need to be a physician. You simply need someone with an understanding of what the EMR will mean to your office setting and an ability to help others believe in that potential. However, in the case where the Champion is not a physician, it is still necessary to identify a doctor willing to participate from a clinical perspective.
Develop a Vision
A "Vision Statement" or value proposition of why your office may want to an implement an EMR is an essential factor for success. The well-developed Vision Statement truly captures your practice's personality and should affect every stage of the EMR selection, implementation and use processes.
For example, your Vision Statement can strongly impact what features of an EMR you will want to prioritize and can influence your choice of hardware or office design. An interest in clinical trials, a desire to get ahead of pay-for-performance initiatives or a goal of simply streaming practice workflow will all possibly lead you toward different systems.
Take a Hard Look Inside
Once your practice's Vision is agreed upon, the Champion can begin active planning. This should occur well before vendor selection, and it might be a little uncomfortable for everyone because the first step in planning is an honest office self-evaluation.
You need to realistically examine how things work in your practice, both clinically and from a business perspective, and assess the impact of an EMR on those functions.
· Generally, what are the workflow processes?
· Are processes efficient, or can an EMR improve upon them?
Additionally, EMRs come in many shapes and sizes, with different feature emphasis. What features of an EMR does the office consider a priority? Are you aiming for a paperless office or do you plan to maintain paper charts, and what related functionality does the EMR require?
Additionally, initiating use of an EMR system is not a change that ends when your system gets turned on. Using the system will necessitate different support from your staff than before, and it is important to prepare for not only the requirements of the implementation period but also the long-term impact on the practice's business.
Embrace the Size of the Change
The Champion needs some understanding of change management and how that will influence the transition to EMR. Even good change carries some sense of uncertainty, and it's important to be aware of who is onboard with the move among physicians and staff, and who may be resistant.
Sharing a realistic timeline can be enormously helpful in setting expectations, with a steady, modular approach often successful in building on small successes to further develop consensus. People will tolerate the "pains" of implementation if they know there is an end and if they experience some of the benefits along the way.
Develop a Focus on the Future
Change is not easy, and frustrated people often fall back to what they are comfortable with. EMR implementations can be undermined by staff members who persist in doing it the old way; however, a "no turning back" attitude coupled with sufficient support can strengthen an office-wide commitment to the new processes. Be prepared to accept feedback during the time of change if a new process is more disruptive than was anticipated. Also, consider the possible need to provide incentives (or eventually disincentives) for change.
Don't Skimp on the Training
Providers and staff will need enough training and support to ensure that they are never embarrassed in front of a patient by a lack of proficiency with the EMR. Everyone needs protected time to train, and the staff must make a commitment to participate, including a promise to forego vacations or personal appointments during training. There are a variety of instructional choices available from most vendors to allow your office to work within your business requirements.
Make Sure You Have Back-up
It is possible that the IT support specialist you've worked with previously may no longer have the skills to support your "wired" practice. Large offices can possibly afford their own IT specialist, but for smaller offices that may have done their own IT support, this is unlikely to be effective once the EMR is live.
Alice Loveys is a Davies Award winner, and Leigh Burchell is director of the Center for Community Health Leadership (a Misys Healthcare Systems organization).
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