Steps for the Installation of an Electronic Medical Record
Donald Tex Bryant
A Free-Reprint Article Written by: Donald Tex Bryant
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.
Additional Article Information:
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Distribution Date and Time: 2009-08-19 11:24:00
Written By: Donald Tex Bryant
Copyright: 2009
Contact Email: mailto:wmblakel...@yahoo.com
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Steps for the Installation of an Electronic Medical Record
Copyright (c) 2009 Donald Tex Bryant
Bryants 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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Donald Bryant helps healthcare providers meet their challenges.
If you want more free tips on improving your health care site,
visit http://www.bryantsstatisticalconsulting.com/ for a free
article to help you start making improvements right away.
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