A few months ago, we chronicled the 7 most deadly sins of EMR implementation. From ignoring nurses to declining help, these offenses can be hard to make right.
But, in an effort to help big and small practices alike avoid the most common EMR faux pas, we followed up with Rosemarie Nelson, principal of the MGMA Consulting Group, and asked for her opinion on the best practices for implementing an EMR system.
Here are Nelson’s six golden rules of EMR implementation:
1. Include nursing staff. When we first asked Nelson about the sins associated with implementation, the most detrimental, according to her, was forgetting about your nurses. And now, Nelson stands by that mantra and believes the EMR isn’t all about the physician. “Physicians are the owners, or the leaders, or the key decision makers, but they are not the exclusive users of the EMR,” she said. She mentioned nurses account for almost 75 percent of the use of the chart, and physicians, 25 percent. “A successful EMR implementation focuses on how the nurses can assist the physician in the integration of the EMR into clinical workflow,” she said. “Too often, an EMR committee is created in a medical practice, and there’s no nursing representative. Bring in the nurses.”
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2. Recognize the opportunity to change and improve your workflow. “Most practices have not optimized processes,” said Nelson. “And many practices have not standardized on forms and procedures.” According to her, technology “changes what is feasible,” so look to the EMR implementation as a chance to find new efficiencies in your workflow. It’s important to remember, though, the EMR shouldn’t be used as a magic bullet to fix holes and other issues in workflow. "Most people think an EMR solves problems," said Steve Waldren, MD, director for the American Academy of Family Physicians’ Center for Health IT. "But an EMR will only amplify problems that already exist in the practice.”
3. Schedule even more training. When we first spoke with Nelson, she mentioned outside influences tend to form attitudes around EMR training. "Microsoft made us think everything is plug and play; the same with a MacBook," she said. "They think 'I can do the same thing with an EMR.' The difference is, it's a complicated environment with a lot of regulation, coding, and documentation. You have to dedicate the time for training." Nelson says to schedule time outside of office hours for you and your staff to “get on the EMR and actually walk through the tasks you’ll perform when you go live.” It will cost you overtime, she says, or even lost productivity if you close office hours. “Budget for additional training costs, so that you and your staff can get the most from your investment in the EMR.”
4. Anticipate the stress and effort required over several months. The adoption of technology is an iterative process, said Nelson. “The EMRs are full of features and functions that will bring efficiency to your operations, but it is impossible to take advantage of it all in the first two weeks of your go-live.” She said typically, groups will be in the learning and adoption phase of their transition for several months. Sounds tedious? Nelson said that’s because it can be. “Be prepared for the long haul,” she added.
5. Round on users (providers and clinical support staff). Just as nurses and clinicians round on patients at the hospital, Nelson suggests rounding on everyone in the practice to gauge their EMR comfort level. “Thirty days after your go-live and again six months after your go live, visit each user for even a few minutes to observe and identify short-cuts,” said Nelson. “Or, you can offer tips on how they can use the EMR more efficiently. Learning elbow-to-elbow is quick and non-threatening.” An added bonus? Points for teamwork and collaboration, of course.
6. Personalize and recognize the differences among physicians. “Don’t try to force all physicians to do the same thing,” says Nelson. “Incorporating technology into all personal use is not one-size-fits-all.” She continued by saying people approach even the simple technologies, like email and word processing, differently. “The EMR applications provide several ways to accomplish the same task, which adds to the training complexity, so be sure to offer providers the variety to choose what will fit their practice style the best.”
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