The Path to Paperless

Introducing EMR Into Workflow

Larger practices will require a staged rollout.

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

The most important issue to address when it comes to planning your EMR "launch" is to make sure that it has the least amount of impact on the practice. A poorly planned rollout can potentially set you back months and possibly scuttle the entire program altogether.

There are two opposing factors to consider. One is limiting the impact on the doctor or provider. The other is limiting the impact on practice revenue. These are inversely proportional: make it easy on the doctors — "Let's cut the clinics in half until we get the hang of this" — and the revenue will take a hit. Minimize the hit on revenue — "Let's just flip the switch and run all the patients on EMR" — and things won't be pretty, leading to doubts about EMR's value.

So, what plan would have the least effect on overall clinic volume while limiting the number of EMR patients that a particular doctor has to see in a given day? To achieve this, you need to carefully select a group of patients who will be seen as EMR patients and leave the rest on paper for a time.

Possible Rollout Approaches

With a single doctor, this is a simple process. But it gets more complicated with more providers. One of our partners suggested that only one doctor should go live first. But what happens when another doctor has to see an EMR patient? You would soon end up with multiple versions of records for the same patient — a logistical as well as a potential medicolegal nightmare. You should strive from the beginning to follow the dictum: once a patient is EMR, they are always EMR.

If you have a single doctor, it is possible to roll out one office at a time, as long as the patients stay in their respective locations. But this is no help in a multi-physician practice if the doctors rotate locations; if so, we're back to the mess of the hybrid paper/electronic record.

You can also decide which specific group of patients will be seen based on their type of appointment — new patient or established patient or consult or surgical evaluation, etc. — and only that one group of patients will be seen on the EMR system. If that single group is too large, you can break it into subgroups: new patient complete examinations, new patient intermediate exams or new patient limited visits.

This is the way we went. We introduced the system into our practice in November of 2008, just for what we call ‘New Completes,’ or new patients scheduled for a complete eye exam. New complete exams need the least amount of prep work beforehand; perhaps some old records that need to be scanned but otherwise no previous visits or diagnostic tests. Once these patients are in the system, all of their visits and tests will be electronic.

The group that you pick should give every doctor at least some experience with the EMR system without slowing his or her clinic too much. Don't add more types of patients until the first group is being seen consistently and smoothly.

This might be a good time for a dry run with your staff. You can either hold a simulation or use your real live clinic as the simulation. There will always be problems at first; if not human, then technical. But if you trust your staff, your hardware and your network, then go for it. OM

Next: Major Causes of EMR Abandonment.