Implementing a new electronic health record (EHR) system is no easy task—and one that a physician shouldn’t tackle alone. From the onset, you need to get buy-in from your practice’s colleagues. To do this, designate a physician champion to take charge of the effort.
“This is a challenging position, because it’s difficult to convince people who are used to doing things a certain way to change,” says Alan K. Matsumoto, MD, FACR, FACP, partner, Arthritis and Rheumatism Associates, Wheaton, Md. “The champion must initiate procedures and protocols that their physician colleagues view as unnecessary or burdensome.” The champion should also serve as a point person to answer questions related to EHR implementation.
Prior to purchasing an EHR system, the physician champion should fully disclose all of its pros and cons so other physicians aren’t blindsided about what it can and cannot do. “Make sure it is compatible with what your rheumatologist colleagues want, so you can get better buy-in,” says Jeffrey G. Lawson, MD, physician, Piedmont Arthritis Clinic, Greenville, S.C., who serves as his practice’s EHR champion.
After you choose an EHR system, the key first step to a smooth transition is to examine your office’s workflow and assign responsibilities to other staff members, such as collecting and entering clinical data. “The more tasks you can delegate to others, the faster and better the workflow will be,” Dr. Matsumoto says.
Get Staff on Board
Employing a new EHR system is an event that you must plan for. Get employees on board by first creating a positive attitude among physicians. “In most practices, attitudes come from the top down,” Dr. Matsumoto says. “If physicians and staff in charge of the implementation aren’t positive, it will trickle down to staff and turn an already challenging task into a miserable experience.
“Be up front with staff about a system’s positive and negative features,” Dr. Matsumoto says. “Let them know that you will have regular staff meetings to discuss challenges before and after implementation. Assure them that EHR implementation will be a process.”
Along with having a physician champion, Dr. Lawson suggests having an EHR implementation committee comprising staff member champions. In addition, designate a super user (e.g., as an office manager) at each of your practice locations to determine what information is entered into the system. This person should also be responsible for providing additional training and troubleshooting. For example, if someone is having difficulty with data entry or the system locks up, the super user could assist.
Ease the Transition
It may be possible to transfer data from your old EHR system to the new one. “Ascertain this compatibility before implementing a new system,” Dr. Lawson says. “In most cases, your EHR vendor and IT manager should be able to design a system that enables you to transfer previous data. Try to move as much data as possible from the old system to the new one.”
Dr. Lawson suggests having mandatory onsite training for at least one week. Provide training manuals that include proper data-entry instructions. “Sometimes, staff members will suggest shortcuts when entering data into charts, but when the record is sent out for billing, a glitch occurs because certain pieces of information are missing,” he says. “Let staff know that it’s critical to follow the vendor’s instructions.”
Allot extra time for the transition, factoring in an adjustment period. Dr. Lawson reduced his patient load substantially during this time, seeing four to six patients a day rather than the usual 25 or so. “Before a patient’s appointment, have personnel review their chart and input as much data into the record as possible, [information] that doesn’t require the doctor’s input, such as medications, past medical history, patient diagnosis and so forth,” he says. This approach, “seeing fewer patients,” means “staff have time to build data into charts and get up to speed. Because they are not in a rush, [fewer] data-entry errors will occur. Start slow and add momentum. Consider hiring a scribe who is comfortable with computers to assist providers who are struggling with the process.”
Resolve Issues
Being proactive can give you the upper hand when resolving issues. Dr. Matsumoto’s practice has an EHR committee (which he heads) with a physician representative from each practice location that meets by WebEx once a month along with the IT manager. If necessary, the system’s vendor attends. “This allows for better communication and helps us better troubleshoot problems,” he says. “It also helps politically to move concepts and ideas forward. And as the physician champion, I don’t take all the blame when something goes wrong.”
Having an EHR team worked well when Dr. Matsumoto’s practice had connectivity problems. “We have multiple offices, and getting the system up to speed was a long process,” he says. “It took a combination of our IT staff, our Internet service provider, the company that manages our network and our EHR vendor to resolve things. There are still occasional issues, such as the system doesn’t always run optimally or it crashes, so having someone designated to call appropriate individuals to fix the problem and knowing who to call is important.”
Another way to more quickly resolve issues is to develop a relationship with specific staff employed by your system’s vendor, because large vendors may not make rheumatology practices a top priority, Dr. Matsumoto says. “You should try to identify an ally or champion within that company that you can call on to help you navigate the system,” he says.
In another effort to overcome this problem, Dr. Matsumoto’s practice partnered with a subvendor of the EHR’s vendor, which caters to rheumatology practices. “Now, all of our issues go through the subvendor,” he says. “This has been very helpful, [because] we are now a bigger fish in the pond.” The subvendor designs templates that are rheumatology specific and assists with problems and submissions related to CMS’ Meaningful Use requirements.
One of the rheumatologists at Dr. Lawson’s practice always attends the EHR vendor’s annual meeting, alternating who goes every year. “This way, each doctor has the experience,” he says. “That person fills in staff about what advances are being proposed for the EHR, as well as other gleaned information.”
Conclusion
Implementing an EHR system should be a team effort. Create a committee to spearhead the effort, get buy-in, provide proper staff training and allot time for employees to learn the new system. This should help generate a positive attitude in house and make for a more pleasant and easier transition for everyone.
Karen Appold is a medical writer in Pennsylvania.
