In June, MGMA-ACMPE released the results of a questionnaire that ranked members' most pressing practice-management challenges. In this edition of "Practice Makes Perfect," we'll tackle No. 11 on that list: implementing a new electronic health-record system.
Implementing an EHR is one of the most significant projects that a medical practice will ever have to undertake. Although you may think this statement sounds like a hyperbole, it really isn’t far from the truth. An EHR requires providers to change the way they have been doing their job for their entire careers. It also changes the way the office works, affecting the flow between clinical staff, billing staff and patients.
I’ve worked with practices for years on selecting, purchasing and installing EHRs, and I have seen a number of pitfalls that can be easily avoided. Doing your research and thinking strategically about implementing an EHR can make the difference between a successful installation with happy, efficient employees and a long period of lost productivity and frustrated physicians. Appoint an EHR owner.
One way to successfully implement and use an EHR in your practice is to appoint a single person or department to be the subject-matter expert. Consider this to be a central repository of knowledge. It is their job to not only know how everything works with the EHR, it’s also their responsibility to improve how the EHR is used by the staff. They can do this by incorporating feedback from “power users,” (someone who possesses above-average advanced knowledge of how to use the software) addressing questions from staff and adopting best practices from the vendor. An alternative is to have everyone at the practice become experts in their own discipline (billing understands billing, front desk knows front desk, clinical knows clinical, etc). One of the benefits of having an EHR is realizing efficiencies that were never possible in the paper world, and this means rethinking the workflow within the practice as a whole, not just in “siloed” areas. Training is worth every penny.
Although it is important to fit the EHR into your workflows, it’s equally important to evaluate what workflow changes the system will invite. Vendor-provided training for all affected employees is a great way to help staff familiarize themselves with the product. Some vendors will offer a “train the trainer” tactic, where just a few power users get trained; after that, it’s their responsibility to train the rest of the staff. Review this option closely to see if it will work well in your practice, because it often results in filling the gaps of training with assumptions that could vary from the recommended best practices or that might not work in your organization. It’s also important to ensure the clinicians attend and are fully engaged in the EHR training process. Remember that a few hours of lost time with patients due to training on the front end could pay off with clinicians being fully ready on your “go live” date.Don’t take the contract “as is.”
EHR purchase agreements and price quotes are made to look like they are industry standard legalese. Too many practices lose out by simply signing the agreement as it was presented by the vendor. Make sure you are protected if the relationship dissolves by stipulating what happens to the data if you separate from the company. This is especially important if the EHR is in a remote or hosted environment. Your charts are one of the most important parts of the practice; it is critical that you have continued access to them. A second part of the purchase agreement that is too often overlooked is the payment schedule. Almost all are structured to maximize the amount the vendor receives even before its implemented. These schedules, however, are often negotiable. Customize these to meet the needs of your organization.
On the surface, EHR implementation may seem simple, but it’s a time- and resource-intensive project. Be sure to research and understand how implementing an EHR will affect the practice in terms of staff time and training. Taking the right steps at the beginning of the process will go a long way toward preventing headaches down the road.
MGMA Health Care Consulting Group