Planting your EMR The world of electronic medical records can be very difficult to navigate. Unless you are a technical expert, most of the jargon used to explain how a system works or what is required to operate it, you will find yourself confused and lost. Seek help, turn to industry experts and the internet for that much needed clarity. The number one failure of electronic medical records in most organizations is the lack of homework the administration performs. Implementing an EMR is not an easy task, nor one that should be taken lightly. There are many things to consider and prepare well before you even select the right product. Learning about an EMR and the process required to successfully implement one is much like planting a seedling tree. You must first decide what type of tree to plant, how to grow the tree in your ecosystem, and what is required to nurture the tree until it is established. Without laying the proper ground and building a developed root system, attempting to implement an EMR can become a very daunting task. The Facts By definition, Electronic Medical Records are computerized systems that keep track of a patient s medical information. What you will soon learn is that understanding the different electronic records in the market is not that simple. One thing that you should keep in mind at all times is that most people refer to all electronic records as EMR or EHR even though they represent two different products. With the many different electronic records on the market, it necessary to define each one including the functions it performs. AMR Automated Medical Record Paper based record with some computer generated documents CMR Computerized Medical Record AMR with all documents electronic EPR Electronic Patient Record Patient record with documents from several institutions (specific to disease control) EHR Electronic Health Record EPR with additional health related information EMR Electronic Medical Record Patient record on all medical issues that integrates interoperability of all documentation systems Keeping all of the different types of EMRs in mind while you are shopping around will assist you in your selection. Not only should you consider what different type will suit your organizational needs, but also look at the pros and cons of implementing an EMR. By making a wish list of what you would like to see your perfect EMR perform you can create a list to lead you in the right direction. Some pros to EMRs include things like: -Improved efficiency and quality of care given -Access of patient data by staff at any location -Automated audits with built-in checks and balance -Standardization of care pathways and protocols -Accurate records and complete claims processing for billing
While the pros of implementing an EMR far outweigh the cons, they are an item that must be considered and prepared for before beginning the process. Most of the cons are issues that arise because as humans we are comfortable in the norm we create and they promote change within the workflow we become accustom to. Each issue can be easily over come with the proper planning and team work not only from within your organization, but with your EMR vendor. Some of the cons are: The Right One -Potential downtime during learning curve period training -Increased need for upfront capital to cover equipment -Pricing of software -Slow progression of national standards The first thing you should know about searching for the right EMR is that you are NOT alone. There are many other organizations within the industry that are also searching for the solution to best meet their needs. With this increased interest and need of EMRs there has grown an unlimited number of resources to aid you in the search. Develop strong research methods that will assist you, but do not reinvent the wheel. Turn to established Health IT, National, Local, and Regional organizations in your area that have gone down this road. They will be able to provide you with the tools necessary to start building your base, as well as serve as a sounding board to go to with questions and ideas. The stronger and close knit the health industry becomes in searching for EMRs, the faster the industry will settle on standards to aid everyone in the future. Below is a very short list of some helpful website you can turn to for assistance to establish research and selection methods. www.himss.org www.hss.gov www.ahrq.gov www.emrworld.net Remember, be organized. The worst thing you can do is begin your search and not know what you are looking for. The countless sites and references will confuse you unless you have a plan to weed through them. Take the wish list you created and fine tune it. Create a list of questions or items you want to discuss when reviewing an EMR. Add additional items to the list as you discover more items you would like to cover. Nothing is ever set in stone, as you move through the process your questions and selection methods will change as your knowledge grows. The amount of EMRs available in today s market place far outweighs the number of facilities needing them. Before you begin narrowing your search make sure you have keyed in on a product that will suit your needs. Most of the available EMRs cater to physicians and hospitals. These vendors try to mesh the school based services into the mold they have created for larger facilities or trauma care units. Search for EMRs that are available for use in adolescent or school based care applications, these programs will be on the same page with your needs and goals. Now that you have the perfect EMR in mind, forget it. Set aside everything regarding the EMR software itself and focus on your organizational goals. Where does your organization want and need to be in the next 5 years? Are you moving to a fully funded model? Needing to expand you staff 20% to provide quality care? All of these items play a large role in the final selection of your EMR. Start by setting realistic expectations. All too often you will find that organizations over or under estimate what they are looking for and are left holding the bag. To avoid complications and road blocks develop a plan with obtainable goals. Involve key staff and map out what is vital, necessary, and important to the organization as a whole. Break your list into those three categories and focus on each one individually.
One of the most important questions you must ask yourself when considering the implementation of an EMR is: Do you know your staff? If the answer is no, get to know them. Your staff can be the number one cause of implementation failure when it comes to EMRs. Do not simply know their name, rank, and serial number; but really get to know them as people. Find out what makes them tick. Important items you are going to need to know about your staff are computer skills, comfort level with change, and greatest fear. Normally these are items that would not directly impact strategic planning; however, an EMR is not only a tool to make your organization more efficient but is also a change of workflow. Use this information to develop training sessions and focus groups prior to implementing the EMR. This opportunity will not only allow them to ease into the changes to come, but it will also provide you with valuable information needed in your selection process. No matter how may upper level management meetings you have, there is always something that was overlooked that your staff may require on a daily basis to perform properly. Through these discussions and training you will be able to set goals for the staff that can be reached and will in turn build a better team. Now that the ground work has been laid from the organization aspect, you can refocus on the EMR software itself. Finding the all illusive right EMR can be difficult. You have the ground work laid, so moving into the next step will be effortless. Based on your goals you will already have an idea of your budget and grant needs to maintain you organization for the next several years. Now, looking at the overall budget determine which portion if any can be allocated to the EMR. If you are going to require additional funds to sustain the EMR, how much do you need? What funding source will provide those funds? Most EMR vendors have a price structure set up on a recurring basis, which may at first seem appealing. If you are considering an EMR that has no upfront cost involved you are able to get started without a large capital outlay. Look closer. The standard pricing for an EMR is based on the number of users, combined with the numbers of patients, and the number of locations. Once you compound all of these factors the monthly expense is usually well out of reach for your normal non-profit. There are vendors out there that offer a onetime upfront cost, with a more manageable monthly fee for user support. Consider the structure of your potential EMRs and how they will fit into your organization. Determine what features you will need and how they should operate to fit your needs. This will add you in the selection, but keep in mind that some EMRs call for different modules required to perform necessary functions that are additional to the base software. Security and Interoperability are two of the hot topics in the EMR world. A good EMR will have several security layers to ensure the patients records can only be accessed by your staff. Remember, while software may be secure you should still take measures on your organization network to further protect the EMR. Consulting with your IT director and staff prior to purchasing an EMR is a wise decision. Organizations such as HL7 have been created to provide guidelines not only for security, but also interoperability. Being able to transfer patient information between facilities is an important piece of any EMR. With growing trend in EMR utilization, this factor should play a large part in your decisions. Most existing EMR vendors with developed products did not prepare for this trend. However many have made the jump and new arising EMR vendors are ready to tackle this issue. This not only addresses school to school or district to district, but also doctors offices, hospitals, state, local, and federal agencies. Having an EMR without this functionality could greatly hinder your organizational growth and also leave you with wasted dollars. While the standards are still being set and changed daily, a good EMR vendor will have a grasp on the important need of this function.
The Game Plan As with any task, preparation is the key. The better prepared you are to tackle the situation, the more likely you are to succeed. Implementing an EMR is a large undertaking and should not be taken lightly. Remove all emotion or personal agendas and set realistic goals to guide you through the process. Communication, Communication, Communication. Gather that committee of key players and include them in the decision process. Long before you decide on the EMR for you, dollars should be considered greatly. Many funding sources are available, however they can have limits as to what they are used for. Be on the lookout for high monthly recurring costs as they can add up fast, and ruin even the best budget. Plan a budget for several years in advance, this will give you an idea of what it will cost your organization. When planning the budget think of items such as equipment, training, support, suppliers, needed services (i.e. internet, server space, etc). A common mistake organizations make is assuming all of these expenses are included in the EMR vendor cost so they focus on that but forget about all else. Preparing you administrative staff can be the most time consuming but is a wonderful investment. This group should consist of strong leaders that can mold the staff and help guide them through the change. They should be prepared not only for the best case but also worst. In a perfect world implementing an EMR will happen without a problem, but there is always something that will crop up that they should be ready to handle. As the backbone of your organization, they will lead the others through all of the changes to come. Use this group to assist you in determining how the EMR will impact the organization. Daily operations such as job functions and work flow will forever be different after you have put the software in place. Expand your view to outside your organization. Consider all of the third party services you use such as a clearing house for billing or printer and copy machines. All of these services will be impacted and their use should be considered before implementation. Many times these services are forgotten when selecting an EMR which can lead to the unnecessary renewal of service contracts and ultimately lost funds. Once you consider everything that has been considered thus far the next step will not be a surprise. Preplanning the implementation of an EMR is just as important as selecting the right one. Developing time lines and roll out plans in advance will save precious time when you are ready to get the staff set up and using the EMR. When determining time lines think: School year schedule Staff readiness & availability Organization strength Milestones throughout the year ( screenings, drives) Holiday schedules Do not rush the process. Work with staff and EMR vendor to develop time lines that will meet all needs. Speeding along the process can cause unnecessary setbacks that will in turn disrupt the entire project, create chaos, and push staff to lose focus on the end goal of full implementation. A steady forward momentum is critical to the success of the project. Only after a strong time line is set can you determine the most effective rollout of the EMR. Now that most products are web based, the rollout process is more efficient and less time consuming. A consultant from the EMR vendor should be able to assist you in determining a rollout best suited for your organization. Normally you will implement a phased rollout if proceeding during a school year and a blanket roll out during the summer. The difference between the two is,
a phased rollout moves groups of staff onto the EMR at scheduled intervals and a blanket rollout moves the entire staff onto the EMR at the same time. Unfortunately, training is the last thing most people consider when they think EMR implementation. However, this is the step of the entire process that when handled incorrectly could compromise the success of implementing an EMR. There are two clear areas of training that should be executed but there is also a third that should not be overlooked. First, the ever so important administrative staff training should be precise and complete long before implementation begins. This is who all other staff will turn to with questions or problems. They must not only know your EMR inside and out but they must also be trained to handle issues arising with staff working in the EMR. Contingency plans, such as what to do when the EMR fails due to a power outage or how to handle an influx of students due to natural disasters, are plans that the administrative staff should be knowledgeable and well versed. Training the staff could possibly be the most daunting task your organization has ever encountered. The general staff is where you will come across your toughest problems and most resistance. People in general do not like change and therefore are not willing to participate in anything that will uproot the norm. I always keep in mind and share with staff this model to go by: Change = Pain = Growth You must consider the goals and needs of the staff covered earlier, remembering that they will only be as proficient as they are trained to be. Determine first what additional training they need prior to implementing an EMR, such as basic computer skills, Word, or Excel. Start early! The longer staff has to get used to working on the computer, the more comfortable they will be using the EMR. When you begin training for the EMR itself, group staff together based on function. This will allow them to learn the functions of the program with their peers and stimulate thoughts and questions that will assist them in learning a new process. Along with the restricting of the organization previously discussed, it must also be trained. This training does not focus on actually using the EMR but rather how the organization will function once the EMR is in place. Here is where you will implement all of the well laid out plans determined when restructuring the organization. You are basically learning to ride the bike all over again, but now with extra arms and legs to help. One of the best ways to lead into the organization training is to maintain an open line of communication throughout the EMR selection process with the entire staff. Work into your regular staff meetings different ways that the day to day operations are going to change. Getting the buy in from the staff will assist in making the implementation successful. Remember, you are not only changing a workflow but more importantly, a culture.