EHR implementation requires commitment and planning. When it s done right, everyone benefits.

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2 More and more medical practices are selecting and implementing electronic health records (EHR) than ever before. Statistics indicate that the number of practices purchasing an EHR has doubled over the past three years. But because of Meaningful Use, practices may be focusing more on their software s features than on how it can most effectively integrate into their office workflow. Fact is, even the best EHR software can be more efficient and more effective with the right kind of planning and preparation behind it. For a single health-care facility to be competitive, it must optimize its resources and employ leading-edge technology to raise the bar for efficiency and patient safety. 1 Only about 25 percent of physicians surveyed report that their EHR system has made them more efficient. 2 Nearly 40 percent of physicians surveyed say they would not purchase the same EHR system again. 3 These statistics say less about EHR software than they do about how that software is implemented. A successful EHR implementation requires commitment and planning. When it s done right, everyone benefits. Practices that experience seamless EHR launches report that the keys to their success lie in the steps they took before implementing EHR and in some cases, before even purchasing it. This report details 10 best practices to help you plan your implementation and offers practical options for approaching the ensuing conversion process.

3 PLANNING YOUR IMPLEMENTATION Much of what contributes to effective EHR usage occurs both before the purchase and before the software goes live. The following 10 steps can help you ensure that your EHR implementation and start up are as smooth as possible, and that as a result you reap the greatest rewards from your investment. Build Consensus If someone in your practice remains hesitant about making changes, discuss the possibility of nonresistance. In other words, if everyone else signs on and agrees on a product, the remaining hold out will agree to move forward with the choices made by others. 1. Get buy in. The buy in of every physician and staff member in your practice even if there are only two or three of you is critical to the successful selection and implementation of your EHR software. Allowing one person to single-handedly select the software is one of the most common mistakes small practices make, and it often results in providers and staff who are resistant to making the change. 2. Define your expectations. Before selecting a vendor, define exactly what you expect from your EHR, what your practice needs, and what your resources are. Whether your practice employs two people or ten, obtain input from everyone to ensure your new EHR works for the entire business, not just the physicians or practice manager. Questions to ask include: Are you expecting to be totally paperless? If so, in what timeframe? What do the different areas of the business expect from the EHR? Are your expectations realistic? Switching to an EHR will require some aspects of your practice to change. Flexibility on everyone s part will go a long way toward ensuring a smooth transition. 1

4 Get Extra Help The Office of the National Coordinator for Health Information Technology has funded 62 Regional Extension Centers (RECs) across the United States with the sole goal of helping primary care providers adopt and use electronic health records. Center services include outreach, education, change management support, workflow redesign, and other kinds of technical assistance. One of their primary focuses is practices with fewer than 10 providers. For more information, visit 3. Assess your office workflow. Evaluate your current workflow before you make a change. When you implement your EHR, your workflow will change and those changes will vary depending on how you do things now. Mapping your current workflow will enable you to work with your vendor on identifying the areas that will need adjustment. Once they are identified, staff can ready themselves for upcoming changes, thereby alleviating any unnecessary confusion. This is also an opportunity to reinforce staff buy in offer each staff member a chance to discuss their workflow, their current challenges, and what they hope will improve. Remember, the more comfortable and engaged people are, the easier the transition will be. 4. Establish objectives. Objectives are not the same as expectations; they are specific goals. Setting goals enables you to make sure that the solution you choose and the processes you put in place align to help you reach your objectives. Questions to ask include: Do you want to increase your revenue? If so, how much? Do you want to provide better patient care? If so, in what ways? Do you want to work less or expand your services? Each practice s goals are unique. Determining your goals will position your practice to select an EHR that supports them and makes the most of your time and financial investment. 5. Implement the necessary infrastructure. It s important to have the right infrastructure in place for your EHR upon launch, lack of necessary bandwidth can slow every process in your practice. Confirm that you have the connectivity and speed to complete all your tasks, then choose the right hardware for your needs. A wide variety of options exist from handheld devices to traditional desktop workstations. The right choices will go a long way in supporting your goals and preferred workflow. 2

5 Sample Milestone Checklist GET READY q Set launch date q Set training dates q Gather user names, NPIs, DEA #s, addresses SET UP PRACTICE q Enter and set up users q Register for RX q Submit first prescription q Register for labs q Confirm lab enrollment is complete 6. Set milestones. Once you are ready to start your implementation, don t forget to identify some clear milestones for success. Set realistic dates for achieving specific items like training, scanning, sending electronic prescriptions, and so forth. Then, don t get derailed by implementation challenges. It s easy to get stalled because of a problem that a provider is having with documentation. You may be tempted to put your implementation on hold until your issues are resolved. But stalling may halt your implementation entirely and cause undue frustration for both physicians and office staff. Do everything possible to stick to your schedule and keep moving forward. 7. Schedule training. People who are not adequately trained can slow your transition to EHR. Don t skimp provide as much training as necessary for everyone to feel comfortable and productive from day one. If you have a larger staff, consider electing a super user to support others when the preliminary training is over and to train new staff members as they come on board. q Import patient data q Import clinical data q Scan notes and documents q Enter additional chart data q Upload/complete templates 3

6 Prepare Your Patients for the Switch to EHR 4 Notify patients of the change via , signs in the office, on the phone when scheduling appointments, and in person during check in. 4 Reduce your patient schedules during launch week and ask your patients to be flexible as you get up to speed on your new software. 4 Engage patients with your new EHR. Present it as progress not an obstacle and they ll be curious and interested. 8. Prepare your patients. No matter how well trained and prepared your practice is, transitioning to EHR initially will slow things down. Inform your patients of your transition and request their patience and understanding. Let them know that the transition will benefit them and that you appreciate their feedback. In addition, conduct your implementation during down time or create down time by reducing the number of patients per day for the brief adjustment period. 9. Practice bedside manner. Many healthcare providers fail to consider how EHR will affect their interaction with their patients and it will. Using a computer while you re with a patient affects their experience. Awareness is the first step to addressing this. Think about what type of device will work best and how that device can be used to engage your patients instead of coming between the two of you. Consider practicing with a staff member before your first patient visit. 10. Remember you re never done. Managing your practice and improving your business is an evolving process. Whether it s EHR or billing, there is always something new to integrate or improvements to be made. Expect your vendor to have a robust plan for ongoing product development these new tools and features can help you continue to improve the quality of your patient care and the management of your business. Your solution should both work for your needs today and be able to grow and change as the healthcare industry and your practice evolves. 4

7 THE CONVERSION PROCESS Conversion processes take time and planning. Whether you are converting from paper charts to an EHR or switching from one EHR to another, this may be one of the most challenging steps you ll face. While an unorganized approach or other misstep has the potential to derail your implementation, a successful conversion is not an insurmountable task. Putting in the effort may seem tedious, but you ll be glad you did when your new EHR is launched. Following are a few suggestions that may help you to plan your conversion. It s also important to speak with vendors about your specific needs and options both during the EHR selection process and after your purchase. Paper-Records Conversion If you are converting from paper, you have two basic options: (1) scan your records ahead of time, or (2) scan as you go. A popular way to scan as you go is the you touch it, you scan it approach in which staff scan a patient s records when the patient calls or their chart is pulled. Within both of those options, you may scan all of your charts or only certain parts of them (e.g., only the face sheet, the last two notes, and the last two labs). No matter which approach you choose, set a date for your EHR launch and stick to it. 1. Kerry O Leary, RN, MBA, Chief Executive Officer, Physicians Hospital, Portland, OR. 2. Survey: Physician use of EHRs has met critical mass, FierceEMR, August 28, Survey of Clinicians: User satisfaction with electronic health records has decreased since 2010, AmericanEHR News, March 05, EHR-to-EHR Conversion Talk to your vendor about how best to convert from one software to another. Ideally, you ll be able to export the old Continuity of Care Record (CCR) and import it directly into the new system. If your old EHR allows batch printing of charts, do that as well and print as a.pdf. Then import the.pdf into the document management section of the new patient chart. Be sure to confirm that the CCR import was successful and that all of your information transferred. In some cases, you may need to manually enter details such as medications, allergies, and problem lists. Also consider manually inserting individual lab notes and op reports into the new charts. In addition, if there are images, such as scanned pictures or diagnostic reports, in your old EHR be sure to export them for import into the new system. 5

8 ABOUT KAREO Kareo is committed to providing education and insights to small medical practices. The company works with in-the-trenches influencers, consultants, and Kareo customers to provide relevant tips on how to successfully manage medical practices and medical billing services Michelson Drive, Suite 400 Irvine, CA (888) Kareo, Inc.