The Path to Paperless

Run an EMR "Simulation Day"

Assess performance before "going live."

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

Prior to the actual "go-live" day for electronic medical records (EMR) implementation, a practice would be well-advised to do a dry run of the entire process, from patient check-in to examination to check-out. This is what is known as a simulation and it should mimic an actual half-day or day of clinic. If you also use an electronic practice management system (EPM), which most practices do, a simulation day can also test the integration of the EMR with the EPM, as well as the billing process.

We set aside a Saturday in November and, after patiently listening to the moans, groans and objections (mostly from the physicians), laid out our plan to look for possible chinks in the armor.

All Hands on Deck

With a few exceptions, all clinical staff and physicians were expected to be there. We also had employees who volunteered to be fake "patients," as well as front desk and business office personnel assisting in checking them in and out. The doctors and staff were sent to the location where they would normally be on a Monday, including the surgery center. Then we began the simulation, evaluating the EMR in the following real-world situations:

Testing different patient scenarios. Each of our fake patients was given a diagnosis and clinical history so that we could simulate different EMR entry processes: a new patient requiring surgery, a patient with an acute problem, an established patient with a follow-up issue, etc. This allowed us to see how using the various templates affected the data entry in real time.

Stressing the entire system. By having all of the satellite offices simultaneously accessing the EMR software, which is housed in a central location, we hoped to check for any possible deficiencies in our system. Could our wide-area network handle the workload? Did we have enough bandwidth? Did our workstations freeze up? Would any of our servers crash?

Workflow. Our simulated patients went through the same routine a real patient would: signing in, having a medical assistant walk them back to work-up, exam and check out. This exercise will uncover any problems with your workflow that weren't evident in the planning process. For most practices, the workflow with EMR will be different in unexpected ways and simulation day is the day to learn that—not on your go-live day.

Don't forget the ASC. Since our surgery center will also need to access patient records, it was included in our simulation as well. We checked patients in and the nurses entered pertinent medical histories on laptops mounted on mobile carts. The surgeons accessed the EMR to review patients' charts prior to choosing their intraocular lenses, then performed a "time out" in the operating room by double-checking the records on a monitor.

Post Mortem. Our administrative team met with clinical supervisors at the end of the simulation day to assess the performance of the staff as well as the system. With the exception of some minor technical glitches, the practice received a passing grade. And the physicians all agreed that those dreaded few hours spent indoors on a beautiful sunny day were well worth it, primarily from the standpoint of stress reduction leading up to the actual go-live day. OM

Next Month: Getting Ready For The Big Day