The Path to Paperless

The Big EMR Test: "Going Live"

Being well-prepared ensures a good start.

By Peter J. Polack, M.D., F.A.C.S.

Switching a medical practice from paper charts to electronic medical records is a huge undertaking, no matter what the size of the practice. Some practices have made the decision to go paperless in one fell swoop, while others have decided to take baby steps.

However you decide to do it, it is important to have a good handle on the size of your particular project. Do you have a smaller practice? Are you in one location? Then you can be like Sweden, which switched from driving on the left to driving on the right virtually overnight. You might be able to pick a hard deadline for changing to EMR, do so on every patient, practice-wide, and live to tell the tale.

Gradual Rollouts Work Best

But for most large and busy practices, this would be a shock to the system. A much better option is to plan your rollout with gradual milestones using certain pre-defined subsets of patients: for example, start with new patients only or start with follow-up pressure checks only. And as each milestone is successfully completed and any bugs ironed out, only then should you ramp up to the next level; for example, adding more complex patients such as consults.

Prior to the actual "go-live day," you should have reviewed the postmortem from your "simulation day," as described in my January 2009 column. This will help you to address major issues that were identified during the simulation and fix those that are critical for your go-live launch: for example, insufficient bandwidth at one of the offices, faulty network equipment, serious training issues or a template that just won't cut it in your normal clinic workflow.

It's Time to "Go Live"

As the big day approaches, make sure that you have information technology (IT) staff on hand and ready when the switch is turned on. If you don't have your own IT person, use contracted help, either someone recommended by the EMR software vendor or a local provider. This should be someone who has been involved in your EMR project, not brought in the day before you go live.

Key clinical and front office staff members should be told not to take vacation that day and, ideally, the physicians should be there as well. Last-minute training issues should also be addressed. Our IT staff came up with some great mnemonics — "You must hover to discover," "You must select it to affect it" and "When in doubt, right-click to check it out" — to help employees remember key points when working in the EMR system. Despite thorough training, the stress of dealing with real patients can make even the most confident computer user forget the simplest actions.

We launched the EMR system with new patients requiring complete eye exams — no existing patients were initially entered — in order to have a gradual rollout. As these new patients return, they will continue in paperless charts.

In the end, the most exciting thing that happened on our go-live day was… nothing. No explosions, no meltdowns, no waiting-room riots. Were there any problems? Yes, but nothing major. The tweaking will continue to be an evolving process. But we are satisfied that our many months of planning and training paid off in the form of a relatively smooth EMR launch. OM

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