Part V: Choosing Poorly Designed EHR Software
Here is the fifth installment of WRS Health’s 10-part series dedicated to Dr. Lawrence Gordon’s recent white paper, “10 Implementation Mistakes to Avoid: Why Practices Fail.” Each segment of the series examines one of the 10 most common implementation mistakes by medical practices when implementing electronic health record (EHR) systems.
MISTAKE #5: CHOOSING POORLY DESIGNED SOFTWARE
People, processes and tools are required to successfully carry out any business operation in order to achieve a goal. The employees must have the necessary training, experience, work ethic and background knowledge to learn the software. Poorly designed software or not understanding the process implicit in the design will lead to a less than perfect outcome.
Mid State ENT had been through the rigmarole of using several different systems over the past decade prior to finding a well designed web-based EHR system that meets all of its needs. “Ten years ago we started using a system that we got disenchanted with. We never really produced a note on it. Then we went to another system, which we used for three years. I stuck it out because I hate to waste money so I made myself do it. But I took twice as long with my notes because the voice recognition was so bad. It was an electronic note. It didn’t have billing associated with it and it didn’t code for you. The word recognition was very poor. You’d say Celebrex® and it would say, ‘sell some brex.’ It produced a fair note. It kept a database, but it was our own database; it was not web-based, so we had to have it up all the time to access it from one office to the next. It was an issue transferring between our two offices,” says Dr. DeMoville.
In an article in the American Academy of Family Physicians, entitled, “Implementing an EMR System: One Clinic’s Experience,” Paul D. Smith, M.D. sheds light on the importance of following a plan for a successful implementation. Six months prior to going live, the practice created a project team to manage and understand the implementation process. The team talked about the implementation process with the vendor’s staff. The conversations gave the team an initial point for developing the implementation plan. Before going live, the project team met each week and communicated by email to develop and refine the implementation plan, to talk about issues and update progress.
The plan the team developed involved several simultaneous implementation tasks, including work-flow analysis and redesign, facility modification, hardware installation, software configuration, developing a backup system, entering old data, dealing with paper and training.
Another key to a successful EHR implementation is having a clear definition of what you want the EHR to accomplish and making decisions throughout the process that support that goal. For evidence, look no further than Belleville Family Medical Clinic. With the goal of becoming paperless, the practice handled the following implementation tasks:
Work-flow analysis and redesign. One of the practice’s most important jobs was to analyze every function of every job to understand how tasks were accomplished with the old system. The project team spent considerable time analyzing existing work processes, looking for opportunities for improved efficiency, designing new workflows that could be accomplished with the tools available in the electronic health record and developing a transition plan. At monthly meetings during the implementation process, office and medical staff discussed and made plans for necessary changes in workflow that would make the best use of the web-based EHR system. For example, the decision was made to replace paper phone messages with electronic ones, and resident supervision documentation (a task formerly done on paper) was incorporated into the electronic progress note.
By the time the practice went live, the staff members who had to change how they did their jobs were prepared to do so and had previously given input as to how to solve problems that came up. The implementation experience offers a window on the importance of understanding the process.
In an article entitled, “Principles for a Successful Computerized Physician Order Entry Implementation,” researchers point out the importance of help “at the elbow” at the time of implementation. “In addition to the symbolic importance of supporting the users by being present while they are first using the application, intensive support at “go-live” allows the implementation team to directly experience what is and is not working well. Most successful implementations have had more post go-live support than pre-go-live training. Most sites have had 24/7 support for several weeks,” state the researchers.