You Can’t Just Flip a Switch: Preparing Your Practice for EMR

September 2007

You Can't Just Flip a Switch: Preparing Your Practice for EMR

Alice Loveys, MD, Davies Award Winner, and Leigh Burchell, Director of the Center for Community Health Leadership.

Implementing an electronic medical record (EMR) is becoming a common process in medical organizations across the country. However, the process is not as simple as just turning on a computer, and there are key steps that should be taken to improve your odds of success.

Identify a Champion

Even thinking about implementing an EMR means that your practice needs a champion—someone who has support from the highest levels of your organization and is 100% committed to the process. This person should be a leader who others respect, and not someone who will be upset by moments of unpopularity during the project's duration. It is also unrealistic to expect someone with a full-time job to be able to manage oversight of an EMR implementation in addition to their regular responsibilities, so the champion's work list should be adjusted.

The champion can be anyone with the clarity of vision and the dedicated time to oversee the initiative and does not necessarily need to be a physician. You simply need someone with an understanding of what the EMR will mean to your office and an ability to help others believe in that potential. However, in the case where the champion is not a physician, it is still necessary to identify a doctor willing to participate from a clinical perspective.

Develop a Vision

A vision statement or value proposition of why your office may want or need to implement an EMR is an essential factor for success. The well-developed vision statement truly captures your practice's personality and should affect every stage of the EMR selection, implementation, and use processes.

For example, your vision statement can strongly impact what features of an EMR you will want to prioritize and can influence your choice of hardware or office design. An interest in clinical trials, a desire to get ahead of pay-for-performance initiatives or a goal of simply streamlining practice workflow will all possibly lead you towards different systems.

Take a Hard Look Inside

Once your practice's vision is agreed upon, the champion can begin active planning. This should occur well before vendor selection, and it might be a little uncomfortable for everyone because the first step in planning is an honest office self-evaluation.

You need a realistic view of how things work in your practice, and you will need to examine your procedures from both a clinical and business perspective. With this, you can assess the impact of an EMR on those functions. Ask yourself these questions:

• What are the workflow processes in the office?
• Are processes efficient, or can an EMR improve upon them?

Additionally, EMRs come in many shapes and sizes, with different features. What features of an EMR does the office consider a priority? Are you aiming for a paperless office or do you plan to maintain paper charts, and what related functionality does the EMR require?

It is important to remember that initiating use of an EMR system is not a change that ends when your system gets turned on. Using the system will necessitate different support from your staff than before, and it is important to prepare for not only the requirements of the implementation period but also the long-term impact on the practice's business.

Embrace the Size of the Change

The champion needs an understanding of change management and how it will influence the transition to EMR. Even positive changes carry some sense of uncertainty, and it's important to be aware of who is onboard with the move among physicians and staff, and who may be resistant.

Sharing a realistic timeline can be enormously helpful in setting expectations. A steady, modular approach is often successful in building on small successes to further develop consensus. People will tolerate the pains of implementation if they know there is an end and if they experience some of the benefits along the way.

Develop a Focus on the Future

Change is not easy, and frustrated people often fall back to what they are comfortable with. EMR implementations can be undermined by staff members who insist on doing it the old way; however, having a "no turning back" attitude coupled with sufficient support can strengthen an office-wide commitment to the new processes. Be prepared to accept feedback during the time of change if a new process is more disruptive than was anticipated. Also, consider the possible need to provide incentives (or eventually disincentives) for change.

Don't Skimp on Training

Providers and staff will need enough training and support to ensure that they are never embarrassed in front of a patient by a lack of proficiency with the EMR. Everyone needs time to train, and the staff must make a commitment to participate. Fortunately, most vendors offer a variety of instructional choices that allow your office to learn the system without interrupting your business.

Make Sure You Have Back-Up

It is possible that the IT support specialist you've worked with previously may no longer have the skills to support your newly wired practice. Large offices may be able to afford their own IT specialist to assist with the transition. But smaller offices may have to invest in hiring someone to manage and troubleshoot the new system on an ongoing basis once the EMR is live.

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