Operational efficiency, patient safety, ePrescribing and pay-for-performance represent past criteria used to establish a case for electronic medical records (EMR) deployment. With the onset of the Health Information Technology for Economic and Clinical Health Act (HITECH) by way of the American Recovery and Reinvestment Act (ARRA), we can add practice sustainability to the list.
Before you pick up the phone and contact your first vendor, take a step back. This is not your ordinary IT project. In fact, if you view this solely as an IT project, you will miss the mark. To help you focus and minimize risk, consider the following exercises before the project kick-off.
1. Organize your thoughts to formulate concrete, measurable project goals.
2. With these goals in mind, assess the practice’s readiness.
3. Consider the resources necessary to complete the project.
Project Goals
Before a template is built or a project manager assigned, define project success. What are your expectations?
Given the onset of HITECH, project scope and underlying goals have broadened. Aligning your strategy with the federal definition of “meaningful use” will be mandatory in securing available Medicare/Medicaid bonus dollars. As usage is bolstered by monetary incentives, government standards will become ingrained in a majority of medical practices and become the new norm. Consequently, here are some items to consider.
EMR deployment will include many work-flow changes. Consider clinical best practices and standardization. Decisions made regarding standardization of clinical care should make a positive impact on practice efficiencies and could have a major impact on project implementation planning.
What will happen to your old paper charts? When a practice implements an EMR, existing patients move forward with two charts: The new electronic chart and the old paper version. Your goal of removing paper can be accomplished through a scanning/archiving process, which can link the old medical record to the existing patient.
Now may be a good time to replace your practice management system (PMS). Many EMRs sold today include a PMS. Scheduling and revenue cycle functions work seamlessly with clinical encounters in an integrated PMS and EMR system. A single shared database eliminates unnecessary interfacing and database administration efforts.
There will be many decisions to be made going forward with an EMR. It is important to document strategies to ensure the goals are understood, the project scope is controlled and the end product meets expectations.
Practice Culture
Conceptually, use of EMR represents a paradigm shift for your practice. This shift will affect physicians and staff alike. Your assessment of culture in your practice will significantly impact your approach to implementation. Consider the following in your assessment.
- You have probably given a lot of thought to the impact an EMR would have on your medical practice. You likely know where your partners stand. Their propensity for change and position on systems usage is likely known from throughout your discussions and interactions. Your understanding of the impact EMR will have on your staff may not be known by any of the physician leaders in the practice.
- In the spirit of change control, many vendors will recommend a phased approach to EMR adoption. As an example, the practice management system would go live as step one. As the staff becomes comfortable, online documentation could be activated. Practice readiness will greatly impact this phasing.
- In a perfect world, dictation would be eliminated from your practice. HITECH requires reporting from codified data. At this point voice recognition systems are not able to convert dictation into discernable data elements. Thus, dictation will remain as a tool to document certain clinical interactions not enabled during the templating process.
Issues within the practice could negatively impact the implementation and usage of the EMR. This in turn could affect the ability for the practice to achieve meaningful use and expected results. Regular communication through all project phases, to all users, is critical to project success.
Project Resources
Your project will likely require the need for desktop devices and servers to support the application, database and storage hardware. You may also need portable devices and a wireless network. You will need project management, application super-users and training resources. Where will you find these resources?
Your most obvious resources will come from the EMR vendor. They should provide you with a point of contact or project manager. This person is responsible for the vendor resources, at a minimum, but generally may be contracted for managing your resources as well.
Under HITECH, the federal government has funded Regional Extension Centers (RECs). These nonprofit centers are accountable for supporting small physician practices as they deploy an EMR. Locally, Wisconsin Health Information Technology Extension Center (WHITEC) will provide services to small practices, with a focus on the primary care.
Beyond the RECs, your practice may need to supplement current staff with contracted consultants. This may include assistance with network deployment, project management and/or building the database. For many practices this will be necessary because current staff may lack the time and the expertise to fill these roles. Hiring staff to implement the EMR may leave you overstaffed upon completion of the project.
Conclusion
Planning and communication are critical factors to a successful EMR deployment. This system represents a paradigm shift within your practice. Many, including physicians, will have deeply rooted negative opinions that will need to be addressed. Be sure to assess the readiness of your practice as part of your planning process. This information will be invaluable in setting goals and selecting the appropriate resources.
For more information, please contact
Sue Denzine, CPA, CHCC, Kolb+Co. Shareholder and Health Care Consultant
Kolb+Co. Shareholder and Managing Director of Heath Care Services
262/754-9400 or sdenzine@KolbCo.com
