As I See It

By Paul S. Koch, MD, Editor Emeritus

Paul S. Koch, MD is editor emeritus of Ophthalmology Management and the medical director of Koch Eye Associates in Warwick, RI. His e-mail is paulkoch@kocheye.com.

Converted Luddite comes clean about EHR

Surprisingly, the world as we knew it didn't collapse when our EHR went live.

And so, with egg on my face, I come clean on our conversion to electronic health records. I am prepared for a chorus of I-told-you-so from readers regular and not. I shall confess I was wrong.

I was a leader in the over-my-dead-body movement. Every time the subject of EHR came up in my office, I explained stubbornly that paper was the way to go. I could see everything at a glance. I could jot down notes quickly. I knew where everything was.

Then we sold the practice to a private equity firm and word came down that we would go electronic.

I do not wish to endorse a specific system here, for there are many good ones, but to forestall requests for details, let's just say we selected a very excellent program that rhymes with bed flow.

RIGOROUS TRAINING

The software company recommended a rigorous training schedule that established super-users, of whom we trained more than a dozen. In addition to the regular training we all received, these super users had an additional 80 hours each.

After they were ready to coach us, we brought in more than 100 staff for six hours of basic training. After that we took a break, and then returned for another long session, this time focusing on our unique roles in the office.

Next we set up dummy accounts and rehearsed over and over how we would document a patient who might be sitting before us. Some of us explored the system; others took their charts from that morning and practiced entering them.

CRISIS, WHAT CRISIS?

Finally it was go-live day. We had heard every rumor (which I had previously accepted as inevitable) that we would be at 25% capacity for weeks, that the office would be clogged and that, basically, the world as we knew it would collapse.

Wrong, wrong and wrong. We took one week at 50% capacity. We filled out what we could in the rooms and did the rest later in the day. By the end of week one, we were able to do almost everything during the patient encounter.

The second week we went to 75% capacity and, like the previous week, we had some stumbles, but worked things out.

Week three we were at full capacity. By this time I was completely comfortable with the system and began to wish we had converted years before.

GROW TALL, TREES!

I learned that I should have paid less attention to the naysayers and more attention to those who had already adapted. I should have learned from the successful users, and not listened to those who didn't prepare enough. I'm glad we did all the training and practice before seeing a patient and did not attempt to learn it on the fly.

So, while you may call me a Luddite, a troglodyte, a fossil or an old fart, I was wrong and I am changing. I am using electronic data instead of reams of paper. Grow tall, trees! OM