The Computer Support People, LLC (ePractice EMR)

Implementation

The hard part is done. You've made the decision, signed the contract and you are taking the plunge into the world of electronic medical records (EMR). Now you just have to install the software and start doing all those wonderful things promised to you, right? Not so fast. In fact, there remains the rather large task of implementing your new EMR and changing how your practice operates on a daily basis. Though numerous EMR software products are available, many of the implementation tasks are common to any practice setting, large or small. Leaving as little as possible to chance is the key to a successful EMR implementation.

	What to expect		Be Prepared to Do the Work
	Be Realistic		Work-flow Analysis
	Facility Modifications		Hardware
	Hardwired Desktops or Mobile Wireless Devices?		New Technology and the Practice Staff
	Software Configuration		Backups
	Internet Security		Old Data
	Paper

What to expect?

Although an EMR will help you improve care, reduce costs, and improve efficiency, do expect moving a practice from “paper” to “paperless” to take major amounts of time. You should expect it to take longer to do the things you swiftly do now at the beginning of the implementation process. There is a learning curve that your practice must endure. A reasonable time-frame expectation to any EMR varies from 3 to 9 months. Any other expectation should be rendered as “easier said than done”. So please, plan accordingly.

Be Prepared to Do the Work

There is a considerable amount of work required to prepare an EMR product to go live. It is a common mistake for most practices to assume that the vendor will do all the work for them. In reality, your practice will be responsible for completing time-consuming tasks such as personalizing common encounter templates to accommodate each provider’s style, maintaining ICD-9 and CPT codes, creating short lists or quick-pick lists favorites and naming common lab tests. Although EMRs come with a defined set of templates, most providers end up creating templates to match their own personal styles. It is not unreasonable to find a multi-provider practice with completely different writing styles for each provider. The EMR templates should be used as a starting point and not as a master piece. It should be clear that the vendor is purely providing training and support to learn how to use the EMR or to solve any issues.

Creating your own encounter templates is the key to success. Allow a reasonable amount of time to complete this customization work. Otherwise, you will slow down the implementation process or simply end up adding implementation costs to your practice.

Have at hand any pre-implementations issues. Discuss possible solutions and have an easy to follow plan. Make sure everyone in your staff is informed of what steps to follow when any problems come up. Make sure everyone is following the same protocol in your practice and note any changes that need to be made.

Be Realistic

Practices often underestimate the amount of work required to prepare an EMR product to go live. It is vital to accurately assess the amount of work and time that is required. Plan ahead the practice’s work-flow, facility modifications, hardware installation, staff requirements, software configuration, back-up and recovery, old data, dealing with existing paper and training. Have a clear definition of what you want the EMR to accomplish and making decisions throughout the process that support that goal.

Work-flow Analysis

Analyze existing work processes, look for opportunities to improve efficiency, put together new work flows that could be accomplished with the tools available in the EMR and develop a transition plan. Discuss the work-flow changes with your staff and consider suggested changes that would make the best use of the EMR system. For example, replace paper phone messages with electronic ones.

Facility Modifications

Most practices will have to fit the EMR system into the existing office space. Your practice needs to plan where to put the new EMR equipment. To fully retire the paper records, have computers in every location in the office where staff would need to look up or enter data into the electronic medical record. Have printers available where staff members would be handing printed materials to patients. Review your facility for any necessary electrical and network wiring for the new hardware equipment.

Hardware

Do invest in good, reliable technology. Saving a $100 on a computer system could cause your practice thousands of dollars down the road due to equipment malfunction and/or down time. The choice of hardware is mainly driven by the technology and pricing available on the market today. After considering how fast hardware changes, make sure your have the our latest recommendations before purchasing any hardware.

Hardwired Desktops or Mobile Wireless Devices?

Although, an EMR can be used with a Tablet PC or wireless device, it is our recommendation to install a workstation in each exam room. Use a pull-out arm mounted on the wall for the keyboard and mouse to save space. Wireless devices, depending on many factors, lose their signals causing data corruption, are more vulnerable to signal interference from other wireless devices in your office, can easily be stolen, must be carried from room to room, are battery life dependent, can be damaged if dropped or fluid spills and require an additional layer of technology needed for wireless connections and security.

New Technology and the Practice Staff

Allow enough time for office staff with less computer experience to become familiar with the new computer equipment such as scanners, printers, modems and computers. All EMR have a set of minimum computer skills requirements. Your practice needs to plan for users that cannot and will not adjust to the new technology due to their limited computer skills. These cases vary from practice to practice. Remember it is a drastic change to go from complete paper to completely paperless.

Software Configuration

The EMR software can be adapted to your practice environment. However, plan to configure the software to meet your needs before you can start using it:

Security: Plan to limit user access to various portions of the EMR program. Restrict access for intentional or accidental compromise of the integrity of the medical record, such as the ability to delete progress notes or prescriptions.
Laboratory Data Management: Plan on how this data is to be available to providers. This requires either an electronic interface with each lab, a manual data entry into the EMR or simply scanning the results into the patient’s paperless chart.
Encounter Templates: EMRs run around templates for data entry. Determine how the providers and users will enter their data into the EMR: by using templates, direct typing into templates or voice recognition software such as Dragon Naturally Speaking. Your practice should plan on creating and customizing your own templates and/or modifying the existing templates. This requires considerable time and effort. Allow providers to become familiar with the EMR software and then encourage template development. Average users began to ask about using templates after 1 to 3 months.

Backups

The key is to have multiple methods of backup and recovery and test them before going live. Your backup system should include hard drive data redundancy on your file server, offsite backups such as an Internet backup provider, external backup devices and server shadowing if possible. Backups should be able to go back at least a 6 weeks on the data.

Internet Security

Antivirus, Firewalls and Network security must be in place before going live. Limit internet access to users based on their roles within the practice. A good firewall should allow you to accomplish this task. Monitor Internet activity by each user and make sure email, chatting, games, entertainment, music, gambling sites are blocked from all users since this creates a door for possible data loss and disaster.

Old Data

The amount of old data to load into the EMR before going live depends on available time and money, and the needs and desires of the providers.

Our recommendation is to scan only patients that are coming for a visit based on the appointment book from the live date forward.

Other options range from no preloaded data to extensive abstraction and data entry or simply loading only the past three months or so.

After going live, all data should be entered electronically. Since completing the past medical, social and family history sections of an EMR is time-consuming at first, you should plan on scheduling comprehensive examinations 5-10 minutes longer to allow for this data entry. As this requirements ease through time, you could plan on eliminating the extra time about 8 months after going live.

Plan on stopping pulling charts for telephone messages after six months and for most office visits after 18 months.

Paper

If "going paperless" is your goal, you must be sure that enough scanners are setup throughout your practice to be able to do this. Scanning outside documents into the EMR should be easy and readily available to all users. Dealing with the massive amount of patient-related paper that comes into a practice is one of the biggest challenges. Every patient-related document has to be reviewed, scanned, electronically filed, and destroyed. Once the documents are scanned and electronically filed, keep them for at least a week to ensure reliable computer backup, and then dispose of them.

Implementation

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