Private Office Deployment of Electronic Medical Records (EMR)

You’ve selected your EMR/EPM (electronic practice management) vendor — now what? First, you as the physician in charge must be a champion for implementation. You must project the belief that success is the only possible outcome. EMR/EPM implementation is likely to be one of the more difficult management tasks you, as a private practice physician, will tackle in your career, and significant investment in preparation coupled with first-class leadership will be required. Everyone, including all of your staff and even your patients, needs to be informed — a true team effort will make this experience more of a challenge than a burden.

That said, implementation will not be trivial. The physician who wishes to implement a system needs to be realistic, yet optimistic. Naysayers may be technical assistants, nurses, office personnel, or maybe even colleagues. Some will be negative due to perceived greater workloads, laziness, or fear of the unknown. Don’t forget that even today there is a significant number of people who are intimidated by computers. Readying your staff is the key ingredient for success. Don’t forget: Thousands of systems have been put into service in multiple offices around the country — with the proper attitude and planning, anyone can succeed with EMR, and you can too.

First, a site visit by your selected vendor should examine your practice patterns. The representative should interview your staff and office manager to get an idea of how the front office and back office function. Management needs to be flexible, as some office work flow will need to adapt your EPM and EMR. Fortunately, your system will very likely be versatile and adapt to many of your preferred practice and business patterns. The overall purpose of the initial site visit is to determine hardware needs and software options, and to assess your practice’s readiness for implementation. This step should be free of charge and result in a list of the hardware, software, and peripherals needed in your office.

Second, a broadband connection to the Internet needs to be established. Recommendations include cable, a symmetric DSL line supporting at least 1.5 Mbps (megabits per second) upstream and downstream, or a dedicated T1 line. Dial up is not an option.

Next, computers and hardware need to be purchased. A combined printer/fax/copier with networking capability should be purchased if not already owned. A high-speed scanner is also required to scan legacy records. Some practices will want to place workstations in each exam room and in common areas like a technician area, reception area, or business office. A physician may want to use a tablet PC to carry to each exam room. The minimal operating system requirement is typically Windows XP Pro. Please be aware that some Windows Vista operating systems are not compatible with the needs of an office network and may not be supported by current EMR/EPM software. A practice may also decide to have all incoming faxes saved as image files on one of the office computers to facilitate their integration into the medical record. Remember, a large part of the world still functions on paper.

A local area network with wireless capability and firewall should be established. Typically, a wireless router will be required and perhaps a wireless access point if the office is large. Each computer will also need to be connected to the router by wire or wireless connection. For faster speeds, desktop PCs should be hardwired to the network for speeds of 100 Mbps. Each computer that is not hardwired will need to have a wireless adapter to connect to the Internet. Wireless speeds can be a bit slower, but they are improving. Encryption and establishment of a firewall should also be assured by your vendor.

Plan to deploy EPM first to confirm that billing and scheduling will not be interrupted significantly. Arrange for training a few days before go-live. In the run-up to go-live, legacy patient demographic and insurance information from old computer systems should be ported over to the new EPM system. Training needs to occur prior to go-live so that scheduling and billing can move forward rapidly on roll out. Testing with government and private payors should pre-date practice management implementation if possible. Smoothing out billing procedures is necessary so that the inevitable reduction in revenue during the EMR implementation phase can be better withstood. On site assistance should be provided by your vendor during the initial start-up phase. Keep seeing your patients and document on paper charts during this time.

During the practice management software implementation, you should formulate plans for your legacy charts so that you have a game plan before go-live with electronic medical records. Some offices will want to scan paper charts into the electronic record before a patient arrives. Others will scan patients’ legacy records after the initial visit to facilitate data entry into the EMR. If possible, legacy laboratory data should be imported into the EMR system before deployment. Remember that increased staff time will be required to scan all records. Some will want to hire temporary or part-time workers to complete this task — a task that is easily accomplished by a high school or college student. In my experience, vendors that offer this work are prohibitively expensive. Don’t forget to calculate your shredding cost. You will be ridding your office of a sizable amount of paper.

After about three to four weeks of successful practice management implementation, the office can then move to EMR implementation. On EMR go-live day, expect minor hiccups. Schedule fewer patients. Your vendor should provide on site assistance. Prepare for stress. You will feel overwhelmed and disheartened. You will have second thoughts and start doubting yourself. Do not give up. Recall all the positive outcomes you expected when you first planned for this day. Expect to spend 60–80 hours a week during the first several weeks. Gradually, you and your staff will become familiar with your system and everyone will get accustomed to functioning digitally. Before long you will wonder why you didn’t switch to EMR sooner. The benefits are enormous, and you will be on your way to improving the care you provide to your patients.