Failing to Plan is Planning to Fail
The planning phase is the most extensive and time-consuming portion of the implementation process. Planning provides a great opportunity to map out the entire process, which may include the following key topics:
- Conversion of data from paper charts and defining information to be converted
- Current workflow analysis, redesigning new workflows for the EMR
- Deciding on methods of documentation (Examples include: template creation, voice recognition, voice capture and partial dictation)
- Staff training strategies
- Software testing
- Hardware testing
- Consideration to use mobile devices and wireless technology
- Security rights, authorized access and system piloting
EMR adoption should be an evolution not a revolution
With proper planning you can get your EMR up and running smoothly, with a minimal amount of staff frustration and loss of productivity. To get there, we first identify broad goals for the EMR:
- Identify and follow-up all patients who are not meeting the preventive health maintenance guidelines
- Analyze patient profiles based on demographics
- Create a referral tracking system
- Create tight security controls to reduce the risk of compromising the integrity of the chart
- Ensure that the hardware configuration will allow the provider to maintain eye contact with the patient and other variables
- Identify specific areas within the EMR to reach and successfully share goals with the staff
It is common for practices to begin entering data into an EMR only to discover that the data is a non-reportable format. The data has not been consistently entered or not entered in a standardized manner by all providers. This data is not reportable or incomplete, rendering it useless for queries.
Identify what data will be useful for reporting purposes such as certain diagnoses and medications prescribed per physician. Some examples include:
- Graph of BMI in a pediatric population after a pediatric exercise program was introduced
- Incidence of tobacco use within the patient population
- Diabetic patients who have not received a HbgA1c in a specified period of time etc
Your pre-determined goals and data that you want captured for reporting purposes should drive the decisions made during the planning phase. Utilize this information to create customized libraries, pick-lists, standardized and/or required data fields that everyone will use consistently for desired reportable information. Ask the vendor how data in certain areas of the system is stored and ask if this data is reportable in that format.
Be aware ‘Free-Text’ may not be reportable
Text for many EMR programs, if the data is not in discrete data fields, cannot be captured by an internal report writing program or a third-party report writing program. Utilizing a fully-integrated speech recognition software programs within the EMR, (which captures voice dictated text) is in a Free-text format as well and therefore may be non-reportable. There is a growing trend in the industry at utilizing artificial intelligence to attempt to capture ‘Free-text’ as discrete data usable by the EMR for reporting. This functionality may be available in the not too distant future.
Small Smart Steps
Phased implementation is highly recommended. Most EMR’s lend themselves well for phased implementation because many of their functions are in discrete modules such as lab order entry, messaging, E&M coding, preventive health maintenance, patient tracking, e-prescribing etc. If a phased implementation is chosen, map out the phasing and rationale for the order of implementation. The staff will appreciate adding additional modules after they have adequately digested previous modules.
Timelines are powerful tools for project planning but be aware that they must constantly be re-evaluated, especially, if you are designing timelines for phased implementation. Continue to assess progress as the implementation phase proceeds, ensuring staff that timelines are adaptable to current situations. This will help reduce their stress level. A complete implementation phase, which included training, can span a couple of weeks for small practices (1-2 physicians) to several months for larger practices.
Analyze existing work processes while looking for opportunities to improved productivity and efficiency. Design new workflows that could be accomplished with the tools available in the EMR and develop a transition plan.