EMR/EHR: Challenges and Forces Driving Adoption of Health Information Technology and Electronic Healthcare Records

In this third of many segments on Electronic Healthcare records, being sponsored by Physicians Office Resource, we will look at the challenges and forces that are impacting Physicians today. As you begin to enter the technology market place of an Electronic Healthcare Record (EHR) there will be many things that you will want to consider. Some of your choices will have very positive impacts and benefits and some of your choices can and will impact your future negatively if not thought out carefully. In this issue, as well as issues to come, we will give you the tools to make your EHR choice a positive improvement to your practice.

B. Testing phase:

Software/Hardware Testing:

Test software extensively before implementation. Never assume that the software functions in the way you think it should. Set up a test database for software testing and for staff training. Thoroughly and completely test all areas of the software and utilize the end-users to test their specific functions.

Perform Volume testing, if possible. Take a typical day and do a dry run in a test database. This step is often overlooked but can provide important information regarding the time it takes to enter data with typical volume or increased volume.

Ask for a list of known bugs from the vendor for the version you are about to install. If bugs exist, ask the vendor to create work-around and identify dates for patch fixes. You do not want to identify a major system flaw or bug during the go-live phase when this could be prevented.

C. Training Phase:

Not enough time is allocated for training. This is a very common error made by most practices. Keep in mind that not only is staff required to learn the EHR but also new workflow and procedures. Training sessions are best if kept short and scheduled in increments. Small groups are more beneficial for more personalized training. Allow staff to practice what they have learned using a hands-on approach before introducing new information. Utilize the vendorÕs experience with training time, but be willing to alter for your individual practice.

Training should be performed outside of clinical work sessions. Practice administrators, in their concern to not adversely affect productivity, will attempt to train staff as they try to perform their clinical duties. This leads to poor understanding of the software and frustration. Train users correctly the first time. There are several methods that practices can utilize to effectively train staff such as reducing or blocking schedules, hiring temporary employees, training outside of clinical time. Staff should also be paid if they are being trained outside of their usual work schedule.

Set up a training room for staff to practice. Giving staff time and a quiet location to practice can lead to a comfort level with the software and can lessen the apprehension of go-live.

Appoint Super Users. Designate certain users to be ÒSuper UsersÓ. Their role is to provide immediate first line response to staff with questions and issues during go-live. Designate a super user for each type of clinical role (MA, nurse, receptionist, provider). Super Users should have a more extensive knowledge of the software and workflows. Being able to provide immediate support to staff during a go-live situation will more likely ensure that productivity is not interrupted.

Miscommunication risk with Train-the-Trainer method. One concern with Train-the-Trainer methods is the potential miscommunication and/or misunderstanding of information from one person to another. Trainers supplied by the vendor usually train large groups of users simultaneously and are more experienced with training on the software. Train-the-trainer methods can provide a cost savings to the practice, however.

Evaluate staffsÕ readiness for go-live. Assess staff knowledge of the software and workflows. Create mock live situations and walk-through the workflows considering all possible scenarios. Be prepared to delay go-live if the staff is not sufficiently prepared.

D. Go-Live Phase:

Schedule the go-live in close proximity to the end of the training sessions. Try to avoid a long delay between the training sessions and the go-live. No more than a week should be allowed between the end of training and the go-live. This will ensure better retention of the information.

Reduce provider schedules: Reduce the number of patients a provider is required to see during the go-live phase. Learning an EHR can be a difficult process, especially for providers. Reducing schedules for some period of time can reduce the pressure significantly. Many practices reduce schedules by 50% for one to two weeks after the go-live and then 25% for several additional weeks. Another method that has been used is to add 15 minutes on to comprehensive examinations and 5 minutes on to follow-up visits. Note: this method may involve some planning ahead to accommodate the scheduling templates.

Provide Adequate Resources. Be certain to supply the staff with well trained individuals such as vendor trainers, Super Users, in-house project manager, etc. during the go-live phase. Create a Help Desk Hotline in case trained personnel are not immediately available. Communicate the chain of support method to all users before go-live. Put a sticky label on each PC with the Help Desk Hotline phone number. Have systems in place if bugs or issues are discovered.

In the next issue we will discuss, post-go-live and best practices.