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What can an EMR do for a primary health care practice? Before implementing an EMR system, you must consider whether its benefits justify the cost in computer hardware, software, and staff training.
Potential benefits of using an electronic system to maintain patient records include:
1. Improved quality of care by increasing the quality and quantity of information, reducing clinical errors, improving clinical practices and facilitating a consistent approach to managing clinical problems.
2. Reduced costs by helping prevent redundant tests, automatically generating reports and claims, enhancing office productivity, reducing patient risk, reducing legal exposure, and improving the security and availability of information.
3. Improved communication by improving the ability to share data with other health professionals and providing faster access to information.
4. Improved analysis of health data including simplifying the observation of trends in the health of individual patients and patient populations, enhancing the ability to analyze data to support management decision making, and enabling the demonstration of clinical competence for revalidation and certification purposes.
This section provides tools to help develop a "business case" or "value proposition" to determine whether you need an EMR. It also provides tools and information to assist with budget development, assessing practice needs, developing goals, and determining readiness to embark on an EMR implementation project.
It also provides a few ideas for "easing into" the concept of a technology assisted practice: practical online tools and resources that provide clinical value, and introduce users to the benefits of information technology in a primary health care practice setting.
We will save time, money and most importantly selecting the best program for practice/clinic/facility. Free inital consultation!
Choosing the right EMR system for a primary health care practice requires careful consideration. Important steps to consider as part of the selection process are to:
1. Assess the practice's needs: consider software functionality, data standards, system interoperability, infrastructure requirements, and legislative and policy standards. Develop a detailed requirements list to help define the "Scope of Work" for the project.
2. Research available EMR systems and vendors: determine if your jurisdiction has a "pre-approved" vendor list; develop checklists & questionnaires to assist with product comparison; and, prepare a Request for Proposals (RFP).
3. Create a list of vendor selection criteria, and evaluate the vendors and software: review responses to the RFP; schedule demonstrations; check references; and, use proven tools/templates for assessing and consistently comparing vendors.
4. Develop contracts with the chosen vendors: include or use the "Scope of Work" document; establish responsibilities and timelines; include initial and ongoing training and support requirements; identify data (chart) conversion requirements; and, finalize acceptance criteria.
Installing a new system may require profound changes to the way the practice operates, so making a smooth transition is dependent on careful planning. Before implementing these changes, you should:
1. Assign clinical and administrative project leads who will be in charge of coordinating the EMR project - including planning, implementation, and training. The planning team should comprise representatives from each clinical and administrative group in the practice (e.g., physicians, multi-disciplinary providers, and administrative and managerial staff).
2. Develop a detailed plan. Decide who in the practice is to be responsible for which tasks, such as project management, defining and building consensus on priorities for EMR requirements, data entry, report generation, etc.
3. Build the "team". Foster ownership of the EMR project with all members of the practice setting - each member should "own the change" and understand why and how the EMR initiative will be an improvement.
4. Training on the EMR software was scheduled to occur in small groups (3 physicians per group), over a 3 day period for each group. Day 1: morning training, afternoon office visits using the software for each physician; Day 2/3: IT/training support on site, physicians using the software while seeing patients. Most “Day 3” on site IT support was not required.
5. Identify and understand workflow impacts associated with the EMR - how will it change job roles and responsibilities for clinical and administrative staff. For patients?How can the EMR help to streamline workflow?
6. Accommodate the time and expense of training staff in the use of the EMR system. This may include some staff acquiring basic computer skills.
7. Familiarize yourself with any requirements for policies and procedures related to the EMR implementation. Identify any legal ramifications of using an electronic records system. Discard old policies where appropriate, and develop new ones. Consider privacy, security and system management implications (e.g., software and hardware maintenance, disaster recovery planning, and record archiving requirements).
Implementation & Maintenance
The Implementation & Maintenance phase acts on the components of the EMR project plan (developed while "Preparing for Implementation") that address implementation: installing your EMR, converting data from existing paper and electronic systems, completing user training as defined in the training plan, testing the EMR and new procedures and policies in the practice, and "signing off" based on the acceptance criteria established with your vendor. Implementing and beginning to use and maintain the EMR involves:
1. Installing any necessary hardware and software. This may include renovations to your offices to install network cables etc.
...three EMR products were tried and discarded before the current product's implementation. This led to significant practice disruption, cost, and staff turnovers, but has resulted in the implementation of an EMR which meets the clinic's needs.
2. Completing user training to ensure all clinical and administrative users have the necessary skills to start managing patient charts electronically.
3. Converting existing patient chart data (as little as necessary) to the new system's format, and establishing a timeline for all staff to have completed their conversions.
4. Acceptance Testing to "sign off" on the installation - to be sure all aspects of the EMR software, hardware and network meet the requirements outlined in the Scope of Work (in the vendor contract).
5. Obtaining and maintaining all hardware and software documentation (electronically or on paper), and ensuring there is a means to keep the documentation current.
6. Establishing software/hardware support procedures for obtaining assistance with the system, i.e., do you have an "in-house" expert available and at what point do you contact the vendor for help?
7. Establishing best practices for data coding and data entry, for consistent, high quality data to support clinical decision making. Practical analysis (data-mining) of the data in the EMR can improve the derived value of the EMR, by improving patient care processes (which can lead to better patient safety and health outcomes) and practice efficiency.
8. Establishing and testing procedures for system backup, data recovery, and system maintenance.
Realizing and maintaining the optimal benefits of an EMR requires measuring how the system has changed the practice and regular re-evaluation of the system.
1. Regular practice assessments (e.g., post-implementation reviews and reassessments of the practice's needs) help to determine: the impact of the EMR; whether it's meeting the practice's requirements; opportunities for improvement; and ways to measure the impact of new changes within the practice.
“EMRs open the door to trying other changes in our practice. For instance, we’ve implemented ‘advanced access’ scheduling, and could not have tracked “3rd next available appointments” without the EMR.” - Dr. Paul Murray
2. System-to-system interoperability (e.g., for electronic receipt of lab results, e-Prescribing, and exchanging patient data between EMRs) is the "next generation" of value for primary health care providers with EMRs. Without good interoperability, scanning and manual data entry costs and the lack of consistently structured data formats between systems undermine the value of an EMR - it limits a health care provider's ability to intelligently mine the data for clinical decision support and proactive care planning.
3. A practical quality improvement approach can help practices to identify short and long term goals, and to test ways to use the EMR to meet them.
Feel free to contact Matthew Keough for a free inital consultation, 302.397.9812 and/or email: mwk@eMedicalSource.com
