Going paperless: Tips for implementing an EMR

March 1, 2006

EMR implementation success depends on solid preparation.

Most of us will make this transition without blood, sweat, and tears, but others may have horror stories to tell about the experience. The goal of this article is to help you take an organized approach to implementing an EMR into your practice. For expert guidance, I've interviewed Jeffery Daigrepont, a consultant with the Coker Group in Alpharetta, GA, and a leading authority on EMR.

Homework before going live

The most successful implementation occurs when the practice allows plenty of time to use the program before going live, Daigrepont points out. Every one of the practices where he has served as a consultant agrees that rushing the implementation was a major mistake and that more time should be relegated to training staff and learning the program before going live.

Next, Daigrepont suggests allowing the staff and physicians to voice their concerns and fears about the implementation process. For example, your office staff may worry about losing their jobs and the doctors may be concerned about a decrease in productivity during the early implementation process. You can allay such apprehension by reassuring the staff of job security and allowing the physicians ample time to become accustomed to the process.

During the first few days with an EMR in my practice, for example, I used the program only twice: with the last patient in the morning and with the last patient in the afternoon. Each of the first two patients required nearly 1 hour to complete the EMR. I told the patients that this was a new program, that they were first to experience the new technology, and that the visit would be a little longer than usual. Most of the patients were very understanding and accepted the delay in their office visit.

When I grew more comfortable with the program, I used it for every third patient, then every other patient, and, finally, for all patients. During times when I have a problem with the EMR or am delayed, I will temporarily return to paper and then complete the EMR at the end of the day.

Another suggestion for encouraging physicians to get into the comfort zone with the EMR is to begin with tasks that don't require significant changes in the process to which you are most accustomed. For example, doctors who use e-mail should quickly get the hang of the EMR messaging system. From there, they can move to automating incoming faxes, then to prescription writing and reviewing lab reports, and only then to the more complex point-of-care documentation when they are eyeball to eyeball with patients. These simple tasks build confidence among the physicians and allow them to become familiar with the EMR without significantly impacting their productivity.

Request feedback, opinions

Conduct regular meetings with physicians, the office manager, and any members of the staff who are part of the implementation process, Daigrepont recommends. It is important to allow the staff to vent their frustrations, provide suggestions, and let the group know about deficiencies that need to be communicated to your vendor or and/or its technical support staff.

Caveats on contracts

Ask the vendor for a locked-in fee for your annual service contract. Agree to a limited percentage that fees may increase (eg, 1% less than the consumer price index) within 1 year. If additional training is necessary, agree on the availability and cost of additional training.