One physician, recounting how his practice had done little reconfiguration of workflow prior to implementing an EHR, compared catching up after the fact to trying to repair an airplane in the middle of a flight. Effective change management, planning, and workflow analysis are critical to the EHR implementation process.
Remember to celebrate your successes during the project, and congratulate your staff and patients on completing this transition.
- Manage Change
- Create Policies and Procedures
- Transfer Data
- Customize Templates
- Schedule Training
- Remember Your Goals and Monitor Your Progress
Change management involves the planned introduction of new processes and systems into an organization. This approach brings together tools for successfully dealing with the technical and people issues that arise during major change. Tips include:
- Identify a physician champion and gain/generate support and buy-in from others.
- Communicate regularly within the practice.
Communication activities must strongly reinforce the process of change. Discuss the status of HIT acquisition at staff meetings and circulate plans for restructuring of workflow for suggestions. When the HIT project reaches a milestone, tell people about it. During a project that can easily take a year or more (from planning and researching to go-live) reminders about what has been accomplished help to maintain focus and to reinforce the message of change.
- Generate practice-wide buy-in.
Providers and staff need to understand how an EHR benefits their work. In some instances, you will need to let the change happen at each person’s speed; with support, and time to adjust, even hold-outs can become proponents of the EHR adoption. Achieve buy-in through:
- Facilitating open, clear communication
- Actively seeking feedback
- Reassuring employees about their job security
- Demonstrating benefits, such as eliminating tedious tasks
- Praising suggestions for improving clinical and operational efficiencies
- Reinforcing important information during lunches and meetings and by using email messages and bulletin board postings
- Thanking your staff for their efforts and offering periodic rewards
- Communicate with patients.
- As your practice moves closer to full implementation, let your patients know that you are implementing an EHR in your practice. Let them know there may be temporary delays during the process and perhaps reduced hours or some practice down-time. Present the idea of an EHR to them as an important way for the practice to enhance the quality of care and service.
- Inform and educate your patients about your EHR using a letter, newsletter, e-mail, and/or an on-hold phone message. Indicate if and when the practice may be closed or operating at reduced capacity during the implementation and whom to contact for their medical needs during that time.
Integrating an EHR into your practice requires creating policies and procedures that ensure compliance with your new workflow. This is especially important during the transition from a paper-based to an electronic system, when questions arise about how to handle different situations, and when errors are likely to occur.
Set up policies and procedures for:
- How to assign access, editing, and customization privileges in the EHR
- How long before a note automatically locks
- Who will monitor the system and address problems as they occur
- How and whom to contact for help—identify the appropriate staff member and contact information for all of your vendors
- How to define IT security, backups, and troubleshooting policies
Established medical practices have mountains of data stored in paper charts, so it is neither practical nor reasonable to transfer all that information to an EHR. Create a clear plan for defining what portions of your current patient charts you will transfer and how many years of records you want to keep.
Your decisions depend on practice preferences, physician needs, and available time and money. The more data loaded into the EHR at the beginning—whether by you or a vendor—the sooner you see the benefits.
There are three options for dealing with legacy data:
- Do not pre-load.
In this scenario, paper charts are retained for reference. All visits after the go-live date use the EHR.
- Pre-load limited data.
With this plan, the EHR is pre-loaded with commonly referenced data such as current medications, chronic conditions, immunization history, and allergies. This approach reduces the need to pull paper charts for most visits.
- Pre-load all information from the last year.
Ideally, your vendor will assist you in this scenario, since the data input volume is high. In this case, older paper charts are retained for reference only.
Another option is to have the information from paper charts abstracted or summarized into key data sets and entered into the EHR. This option allows for a streamlined chart that contains key data elements searchable for quality reporting. Be aware that in the process of converting paper files to electronic, the more time you spend working with both systems, the more likely the project will stall and fail. Have your migration plan worked out in advance and quickly implement that plan so that your practice is not performing dual work and processes.
Among other things, an EHR helps your practice standardize its workflow and procedures. It simplifies documentation by using templates. Templates save time by structuring patient encounters and reducing the need for narrative; they also promote more accurate coding and billing of services. A uniform format also provides a level of clarity that justifies the more frequent use of higher-level codes.
Most EHR systems allow the use of customized templates, and many developers have simplified the creation of templates to the point where medical practices can build them without outside assistance. Plan to customize your forms and templates for your practice’s workflow once you have your EHR software. Your templates should offer:
- Easy-to-access lists of common medications and diagnostic codes
- Historical notes
- Charting by exception, for findings that deviate from the norm
Consider having your physician champion or someone proficient in IT customize the templates for maximum efficiency.
Training is perhaps the most crucial factor in the success of your EHR implementation. It ensures that all staff know how to use the software. Because of this, implementation and training can be costly—an estimated 20 to 33% of the total costs for your EHR.
To avoid spending training money unnecessarily, introduce your staff to the most common features of the system and let them play with it prior to your go-live date. Use this time to generate and collect questions. During training, answer questions and make sure that all staff know how to perform their key tasks.
Consider saving money by having particularly proficient staff train others. Staff members who demonstrate advanced ability with the software can become key resources for their peers and a point of contact for vendors.
Pay attention to the goals you set in your EHR planning process, and make sure that they align with your implementation plans. Decide the following:
- Schedule for implementation
- Date to go paperless
- Timeline to establish process manuals, medication formulary, etc.
- Deadline for customizing five basic templates
- Target and timeline for outside transcription cost reduction
- Dates for formal staff training
- Timeline for testing interfaces with medical equipment, vendors, and services (such as laboratories)