The Path to Paperless

10 Rules for Basic EMR Implementation

This month, we present the first five “commandments.”

By Peter J. Polack, MD, FACS

Most practices breathe a sigh of relief after their new electronic medical records software is installed and running. But that's only one step in what must be realistically viewed as a long and continuous process.

The truly difficult part of EMR implementation is getting the staff and the doctors to accept and use it so that the system can produce the efficiencies and cost/time savings that you envisioned when you originally made the commitment to buy it.

Following are the first five of a list of 10 rules (or “Commandments”) for successful implementation from our practice administrator, Don Cushing, MEd, MBA, who has years of experience with EMR adoption. Next month we'll cover rules six through 10.

1. Thou Shalt Have a Plan

As Benjamin Franklin stated, “If you fail to plan, you are planning to fail.” But a plan is worthless if it doesn't have a defined goal. For most practices, this goal will be a successful EMR implementation. But that success should be defined in relevant, realistic and measurable terms. These can include such things as: physicians will have the information they need when they need it, physicians will have the support needed to adapt to the new EMR system, and EMR will not interfere with the doctor-patient relationship.

2. Thou Shalt Honor the Three Ws

1. The hardware and software have to work. There should be enough hardware, in the right places, and with just the right amount of capacity. Trying to be too cheap with your equipment can bite you in the end, but it is also very easy to go overboard, so get good advice. Regarding the EMR software, make sure you create a list of needs and wants before you go looking for a product. For many smaller practices, expenses can be significantly reduced by using Webbased EMR systems or cloud computing, but these tend to be less robust systems.

2. The process has to work. If you have inefficiencies in your workflow already, an EMR system will make them more obvious.

3. You have to work. Buying an EMR system is neither your first step nor your last. Most of your work should occur before your purchase but you are not off the hook entirely after the software has been installed. EMR implementation is a process, and it needs continual feedback and improvement to ensure success.

3. Thou Shalt Make Flow Charts

A critical way to make sure that everyone is on the same page is to map your processes out visually using flow charts. There are several inexpensive programs that make it easy for your staff to collaborate and fine tune your workflow. If you don't spell this out in detail, you are bound to have inefficiencies, and an EMR system will just compound them.

4. Thou Shalt Not Expect EMR to Fix Bad Processes

A corollary to number three is that even the best EMR system cannot fix your bad workflow processes. Many times, a failed EMR project is blamed on the software when in fact the problem usually lies elsewhere, but by then it is too late.

5. Thou Shalt See the Examination Room as the Command Center

A common bottleneck in a practice trying to become “paperless” is an unnecessary conversion from electronic to paper (and often back again). From the exam room, all necessary tests, labs and instructions should be able to flow with simple clicks emanating from the EMR system, and without the need for filling out paper requisitions or barking orders down the hallway. OM

Peter J. Polack, MD, FACS, is co-managing partner for Ocala Eye, a multisubspecialty ophthalmology practice located in Ocala, Fla. He is also founder of Emedikon, an online practice management resource for physicians and administrators.