The GE Centricity Health User Group conference was held this past weekend in Washington, D.C. Several of the presenters talked about some key issues related to an EMR project. Every phase from planning, acquisition, development, implementation and training, along with post go-live considerations, were broken down into layman’s terms and discussed openly. For those who didn’t make it, I have summarized several key learnings that be applied in any clinic regardless of which EMR software is used.
In one session, Informatics for EMR, the presenters from Westchester Medical Group talked about the importance of business intelligence in a clinical environment. It was a pleasure to hear about a topic that seems to be neglected so often in discussions about EMRs. The presentation was all about how a post-implementation, a live EMR system can be more than just a replacement for the paper chart. Westchester saw a need and an opportunity to deliver an intelligent solution that supports rapid decision-making, improves patient care with the use of dashboards for quality and performance measures, and enables proactive care rather than reactive care. In this case, the goals were achieved by the use of GE’s Business Informatics and custom forms in the EMR built to ensure that data is accurately captured. Some of the improvements seen within a very short time were;
· Improved patient flow
· Care provided as a team within the clinic
· Improved physician response time
· Improved disease management and preventative care
If we can use business intelligence to deliver focused marketing solutions, we can certainly do the same for healthcare delivery.
In another great session, EMR Implementation Without Interrupting Your Clinical Practice, the presenters talked about an implementation done without any reduction or interruption in patient flow and with minimal administration teams for forms development, templates, handouts, etc. Wow, now here is a revolutionary attitude towards an implementation! Let’s drill down into some of the key features of this implementation. The plan was to practice with the single user training for quite a while before go-live in order to improve navigational skills and to practice with templates in the network training environment. The clinic started with EMR entry for only the last patient of the day and filed the same in the paper chart. Gradually, it increased to two, then three patients a day and so on. For e-prescribing, the implementers started with only the physician champion at the clinic and minimized any add-on products like voice recognition. They continued with double documentation in the EMR and the paper chart for this entire period.
There are certainly many pros to this approach and I can see why a clinic would want to do an implementation this way. However, this approach typically requires the doctors in the clinic to be fairly open to the idea of computers in their exam rooms and minimal resistance to the switch from paper to electronic chart. Most importantly, though, the approach requires time. The level of patience needed to do a part paper and part EMR rollout that lasts two years or more before a clinic goes full-time with the EMR, while maintaining paper charts the entire time, is quite possibly more than most people could bear. Considering the majority of implementations are happening in 90 to 120 days, it is hard enough to keep the clinic staff and providers motivated for that long. That being said, there is no fixed, best way to do an EMR implementation. The best implementations are the ones where the voices are heard, needs are met, compromises are made on all ends, buy-in of key personnel is made a requirement, and communication always remains a priority.
If you are thinking about an EMR in your practice, get an internal team together to talk about it. Speak to other practices already on an EMR. If you are not comfortable with vendor dealings, get a consultant to look out for your interest. Good luck.