By: Ron Sterling

A successful EHR project starts with substantial practice support and thorough preparations.  In too many cases, practices undertake an EHR effort for a lot of good reasons, but with minimal support and inadequate resources.

 

In order to succeed with an EHR, you need to insure that the practice has attained a certain level of EHR awareness, and readiness. Start by asking yourself the following questions:

Does your EHR effort have physician support?

Small practices lack the resources to support parallel paper and EHR based systems for different providers. Just as importantly,  mixing paper and EHR strategies can lead to confusion and inefficiencies as well as a wide range of medical professional  liability issues.  If the doctors cannot agree to implement an EHR, then you should wait until there is a strong consensus to undertake this transformational effort.

For the small practice of three or fewer physicians, it is important that all of the doctors support the EHR initiative. The doctors do not have to back the initiative for the same reason, but all doctors need to be ready to engage in the project and support the transition effort. 

For the larger practice, the majority of physicians should be supportive of the effort, and those opposed to the effort have to agree to assist the EHR project.  This agreement should be solidified upfront.  Disagreements over product, strategy and process can inhibit progress and sap resources your practice will need to implement the EHR.

Are you prepared to address ongoing problems?

    
EHR efforts will require dramatic changes to operations, and the reality is that you will run into problems.  The key issue is to assure that you have a management mandate to correct the problem and proceed with the effort.  A number of EHR efforts have been abandoned due to a lack of effective solutions to implementation and deployment challenges. 

In small practices, governance and management should be used to empower the key people responsible for EHR success.  In many cases, one or more doctors may be responsible for clinical decisions, but staff may be responsible for operational and workflow decisions. 

Is your budget practical?

    
EHR implementations cost money.  You may have to pay staff overtime for training or transitioning the paper chart to the EHR.  You may have to buy additional training time, or more equipment than you have now.  A practical budget with contingency allocations should be included in the EHR planning documents.  For example, you may need to allocate contingency money to replace workstations that may not work with the EHR.

Does your EHR support your current workflow and operations?
 

Your EHR transition effort will not succeed if it doesn't support your basic practice processes and activities. Every aspect of clinical and administrative operations  should be inventoried and documented to insure that the EHR product and effort addresses the various functions of the practice.  For example, surgery scheduling staff typically maintains a shadow medical record with surgery tracking forms outside of the standard paper chart.  Similarly, outgoing referral staff frequently maintains their own tickler strategies to track patient care.  If either of those approaches is not addressed by the EHR product or implementation then you will have critical patient information and activities outside of your EHR.

Will your existing computer Infrastructure support an EHR?

Many practice management systems are based on older technology  that will not support an EHR.  In some cases, practices have to upgrade every piece of equipment since the current system was not designed to handle the additional workload, users, and usage necessitated by full EHR use. 

You should take an inventory of the current infrastructure to determine the additional accommodations.  For example, a slow communication line to a remote office will not be able to handle scanning and display of images needed to maintain a complete patient record in the EHR.  Similarly, shared workstations among clinical staff should be replaced with a separate device for each active clinical staff person.

Have you gotten your paper records ready?
 
Interestingly, the condition of your paper charts is also a measure of your practice’s readiness.  You'll need to make judicious changes to your paper chart to prepare for future transition to an EHR.  Reorganizing the chart, maintaining a reliable face sheet, and general chart cleanup are worthwhile activities to start early on in the EHR project.

Initially, you should carefully review the current status of several patient charts.  The current chart conditions should be analyzed and a general chart EHR transition defined.  Then you should determine what activities could be undertaken now to support the future EHR implementation.  For example, a patient face sheet could be introduced into the patient chart to collect information you will need to initially enter for a patient. 

EHR implementation is very demanding and will consume a lot of staff and physician time.  An EHR project also must overcome a wide range of organizational, workflow, patient service and technical challenges.  Analyzing your EHR readiness will help you define the issues that you need to consider in selecting your EHR as well as establish the scope of your EHR challenge. I encourage you to take time and work this process through thoroughly; after all, it makes no sense to disrupt your business dramatically only to have your EHR effort fail.