Steps for the Installation of an Electronic Medical Record

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Article Title:

Steps for the Installation of an Electronic Medical Record

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Article Description:

Because of the funds available for electronic medical

records in the Federal Stimulus Package, many healthcare

sites will be installing them. If you follow the steps

described in this article, the choosing of a vendor, the

installation of the EMR and the initial use of the EMR will

go much more smoothly.

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Distribution Date and Time: 2009-08-19 11:24:00

Written By: Tex

Copyright: 2009

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Steps for the Installation of an Electronic Medical Record

Copyright © 2009 Tex

s Statistical Consulting

http://www.bryantsstatisticalconsulting.com/

Change can be very difficult and unpleasant for some of us;

others welcome change as opportunity for growth and new

experiences. One change that is surely coming to almost all

healthcare sites is the adoption and installation of electronic

medical records, or electronic health records. The recently

passed stimulus bill in the U.S. funds the use of electronic

medical records; those that do not adopt EMR's will suffer some

penalties; more on that later. Another impetus driving the

adoption of electronic medical records is the NCQA inclusion of

EMR's in its criteria for primary care providers being

designated a Patient Centered Medical Home.

Being that EMR's will be almost universally adopted, if you

haven't yet installed such a system I propose that you use Lean

Healthcare or Design for Six Sigma techniques to implement the

installation and incorporation of the HIT systems. Those who do

not carefully plan will probably add complications and wasted

efforts (muda) to their care processes and become very frustrated

besides. Suppose, for instance, that you do not include

physicians in planning the implementation and the physicians

using the new system do not understand it well enough to use it

effectively and become upset using it. What is likely to happen?

They will avoid it as much as they can or use it inefficiently.

This can result in poorer outcomes for patients as well as lost

billing opportunities. What could have been an opportunity to

increase the effectiveness of billing and improve income instead

becomes a financial burden and a source of contention.

Such a scenario is not necessary though. Those who plan and

choose well can reap significant benefits from the use of EMR's.

Achieving these benefits will require significant changes, such

as in the way of logging patient data. Of course the data will

now be electronically stored instead of on paper. The type of

data being captured will also change. For instance, suppose that

a physician making rounds at a hospital leaves a note for nurses

that involves the drawing of a figure on paper, such as the

position of a bedsore. For most EMR's this will not be possible.

However, there will be room for comments to be added to the

record. Hence, the physician will need to more descriptive.

Becoming adept at the new ways of entering data into the records

will improve outcomes for patients and the caregivers.

Even better results can be had if the healthcare sites use teams

to plan the implementation of the EMR. Let me suggest several

steps that you might use. First, someone should be leading the

overall effort of adopting and using the system. If your site has

a Lean Leader, this is the best candidate. Otherwise, you might

choose someone who is very familiar with quality improvement.

The leader should then form a team of representatives of those

who will be using the system. In a primary care office I would

include someone from billing, a physician, a nurse, an office

manager and others who might be using the system. You might even

want to include a patient if you intend to supply your patients

their own records upon request, as suggested in the Institute of

Medicine's Crossing the Quality Chasm. Such a team will make

better choices than a person working alone to get the system up

and running.

I suggest that the team assume several responsibilities over its

useful lifetime. First the team should choose the vendor and

software. There are several hundred different EMR's available.

Choosing the right one will be difficult, to say the least. It is

very likely that the team can choose one that fits the working

style of the healthcare staff best. Using only one person to

choose such a system, on the other hand, will probably lead to

information from others who have already installed an EMR at

their site, resulting in a choice that does not fit the needs of

your site.

After the team has chosen a EMR it should be the first to be

trained on using it. Since they are vested in it they are more

likely to be the easiest to train in its use and also probably

the most interested in making the best use of it. Once they are

trained, they can then train others at the site in its use.

Further, through the training they can decide which features of

the EMR should be utilized by the office. Generally, most EMR's

come with many features; to use them all at startup would be

overwhelming for new users.

Finally, this team can be used as the first responders to others

who are first time users and who have questions about the

software's use. Rather than have the vendor be responsible for

answering all questions, it will be much more effective if

someone who is comfortable with the software at the site tries

first as face-to-face instruction is generally more effective. If

someone on the team cannot answer the question, they can contact

the technical support of the vendor or the person with the

question can.

Now that I have briefly explained the advantages of implementing

an EMR with a team let me add a few tips about EMR's in general:

1. EMR's do not eliminate all errors. True, illegible

handwriting will not be a problem anymore. However, if the EMR is

not used effectively, it will create its own problems. Remember

the old dictum from the early days of the advent of computers in

the workplace: garbage in, garbage out.

2. EMR's are not like paper and pencil, as described in the

opening of this newsletter. I read recently in Family Practice

Management (March 2007) that one vendor described his EMR as the

best possible paper and pencil record that could be achieved. A

physician responded that is like stating we can use a very good

horse and buggy to design an automobile.

3. It is very important that your site consider interoperability

with other healthcare sites with which you do much business. For

example, a primary care site will want to use an EMR that

communicates effectively with the hospital(s) with which it

commonly interacts.

4. As stated in the opening paragraph there are bonuses for

adopting the EMR's earlier. You can receive up to $44,000 over 5

years from Medicare if you meet certain conditions. You must

adopt by 2011 or 2012 to receive this payout. Adopters in 2013

and 2014 will receive less. Adopters in 2015 receive nothing.

Physicians who treat Medicare patients in 2015 without an EMR

will receive 1% less in reimbursements; in 2016, 2% less. To

qualify for these reimbursements you must make meaningful use of

the technology; " meaningful use " is still not defined by

Medicare. One of the certain qualifications will be that the EMR

talks to other EMR's at hospitals and labs.

In conclusion, we know that electronic medical records will soon

be necessary at your healthcare site if you do not already use

them. Implementing the use of an EMR can be very disruptive if

the implementation is not well thought out and planned. The best

way to implement the use of an EMR is through a team of

representatives of those who will be using the EMR. The team will

be responsible for choosing the right EMR, for being the first to

be trained in its use so that the members can help other first

time users become familiar with the EMR, and for helping

troubleshoot problems with the use of the EMR at the site.

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