Managing Your Practice

EHR Implementation … In Hindsight


DR. MICHAEL WOOLERY is a family physician and MS. ROBIN BROWN is the office manager at Family Physicians of Coshocton (Ohio) Inc.

If there's one thing we've learned about implementing an electronic health record system, it's that it doesn't make sense to train everyone about the big picture.

A brief overview makes sense. But learning all the details about how each employee uses the EHR isn't necessary and it's too much information. It overloads one's capacity to learn what's critical to know for one's job.

Before flipping the switch on our system about a year ago, we devoted 3 half days to training. Our preference had been to avoid closing the office for those days, so training was conducted on-site while the office was kept open for patient appointments. Half of the the staff participated in a morning session and the other half an afternoon session.

But all too often, people felt the tug of their work responsibilities and they couldn't focus on the training. In hindsight, it would have made more sense to close the office for those days and to conduct the training off site.

In our practice, we have seven full-time family physicians, 18 support staff members, seven nurses, one physician assistant, and two nurse practitioners. Attempting to train each of those employee groups together on how to use the EHR proved counterproductive. A better approach would have been to conduct shorter training sessions geared toward what individuals needed to know to get up and running. After 3–4 weeks of using the system, another session would then have been helpful to address problems and help maximize efficiencies.

Among the most helpful aspects of our EHR implementation was the fact that our vendor, iMedica, arranged to speak with us during weekly teleconferences for 10 months. These meetings started as we were gearing up for implementation and continued for several months afterward. Having this routine contact was very helpful and something that wewould encourage anyone considering investing in an EHR system to request.

We also took the opportunity to test-drive the tablet device that we would be using to enter patient information into the system and to request information from a database. Trying out this device for 60 days before we went live helped many of us develop a comfort level with the hardware.

Any practice that goes through the implementation of an EHR has to be prepared to take a temporary financial hit. Every physician in our practice had to cut their number of appointments back by half while they became used to using the EHR system. It took about 2 months for the practice's patient appointment schedule to return to normal.

To minimize the financial burden, we phased in the rollout by having a couple of physicians make the switch from paper to EHR each week, rather than converting everyone all at once. We wisely had our most computer-savvy physicians make the transition first. This most willing and able group went through the growing pains and passed along their tips to the self-described Luddites who watched for a while before having to switch from paper. That tactic worked well and helped the transition go smoothly.

One really nice feature of an EHR system is that it allows labs to automatically send their results to patient medical charts. But this feature is also enormously complicated to arrange.

No matter how many times your EHR vendor has worked with multiple interfaces, it always takes more time than expected to get multiple computer systems to speak to one another. So insist on starting this process early as soon as you select your EHR vendor.

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