Managing Your EMR System’s Implementation

Congratulations. You’ve purchased an EMR (Electronic Medical Records) system. You’ve taken care to pick a system that matches your needs. You’ve purchased enough hardware capacity to last your clinic three to five years into the future. You’re comfortable that your patients’ medical data will be securely protected from prying eyes. Now you can just sit back and relax. Right? Wrong.

Your adventure has just begun. You’ve now reached the critical stage: implementation. How you plan and prepare for your new EMR system’s arrival will ultimately determine its success and failure.

To prepare successfully, you must prepare both your physical facilities and the people who work for you. Disregarding either of these two aspects will make the installation process more painful than it needs to be.

Preparing Your Office

Although physical preparation can be the easiest aspect of a new EMR installation, there are several issues that clinics commonly overlook:

•You may have ordered an EMR system with 12 shiny new workstations but where will they go? Is there enough desk space available?
•What will have to be moved or relocated to make room for such things as printers, scanners, or patient label printers?
•Where will the application’s server computer go? Preferably the server should be placed in a secure, climate-controlled environment.
•Is all the necessary network cabling in place? If not, how will it be strung? Through the walls? Through the suspended ceiling?
•If you are purchasing the capability to send & receive paperless faxes, do you have an analog phone line available? Will you need a second analog phone line, so that you can run the old & new fax capability in parallel for a while until all the bugs are sorted out?

These are only a few examples. Carefully consider how your new EMR system will impinge upon the physical aspects of your office. Then plan accordingly.

Preparing Your People

Communicate, communicate, communicate! Start early. Your staff are anxious. A new EMR system will change how your people will perform their jobs.

In fact, assuming you’ve chosen well, the success and failure of your new EMR application will depend almost entirely on the people using it. If you have experienced front-line staff members, you need to ensure that they (or at least a hand full of knowledgeable representatives) are represented in the decision making process. How else can you ensure that your new EMR system has all the features you need to run your clinic’s day-to-day operations?

People are naturally resistant to change. By getting your staff involved in the decision making process and having them sit in on product demonstrations, you allow them to start thinking about how the new EMR system will change the way they work. For example:

•Who will perform the electronic healthcare billing, and how will the new EMR system’s billing process be different from your existing one? You don’t want to interrupt your clinic’s revenue stream, do you?
•If you are going to begin scanning in all of your paper correspondence (letters, lab results), who is going to perform this task? Depending upon the volume you receive, the scanning of documents can be a full time job in and of itself!

How will people perform the jobs they do now when using the new EMR system? Break big tasks into small ones. Don’t think “How will I use this EMR system?” but rather “How do I book an appointment?”, “How do I record an injection?”, and “How do I view a patient’s allergies?” Have people make lists of the tasks they commonly perform. Determine what they need to learn how to do right away and what can wait. Use these lists to help guide and prioritize the EMR training they receive.

One of the biggest stumbling blocks encountered at sites acquiring their first EMR system is the lack of basic computer skills. Do your staff know how to work a mouse, use a keyboard, create a folder, and move files between folders? If your staff members don’t have the basic computer skills necessary to operate a word processor, they won’t be able to absorb their EMR training. Make sure your staff have these basic skills beforehand.

Try to ensure the training you receive is hands-on. Also, be aware that different people have different styles are learning: some are auditory (meaning they learn by listening), some are visual (meaning they learn by seeing) and some are tactile (meaning they learn by touching and by doing). Training that involves all three styles of learning will be more effective to a wider range of people and increase long-term retention.

Focus on the future. Attitude is everything. A new EMR system is not an excuse to abdicate management responsibility. One or two people with bad attitudes can derail the entire process. If your clinic is committed to the EMR system and its benefits, be understanding but by all means be firm. It is not your EMR vendor’s job to manage your staff’s attitude and expectations - it is yours. If possible, remind your staff of past challenges and learning curves that were overcome. Age isn’t a factor. We’ve seen people in their mid-60’s do just fine with a good attitude, patience, and a willingness to ask questions. If you are aware that certain staff learn slower, are more resistant to change, or have lower levels of tolerance to stress, try to take this into account, perhaps pairing these staff members with the quick learners in your group.

Once your EMR system is “live”, allow time for on-the-job learning. Don’t double- or triple-book your doctors the first week your new system goes live! We have seen staff literally reduced to tears by the stress of learning a new system while - at the same time - still attempting to keep up with their previous workloads. The learning curve will be steep. Expect this. Although an EMR system should eventually make your clinic faster and more efficient, it is going to take longer to perform seemingly mundane tasks. Initially, even a bit of overtime may be required to keep up with the data entry. Be patient. Don’t expect to master your new EMR system in two or three days, or even in a week or two. But six months from now, if all goes well, you may be wondering how you ever managed without it.

Timely, ongoing training can make all the difference. Initial EMR training will provide a virtual avalanche of information. Your staff will be lucky if they retain even half of what they hear. However, after using the system for a period of time most people will have mastered the basics, or at least progressed far enough to know where their weaknesses lie. Follow-up training at this point can be quite valuable.

Harris Morgan, a lawyer from Greenville, Texas, underscores the importance of this point with a real-world example. Shortly after Bell Telephone was split up, Harris was invited to a company retreat as a motivational speaker. During the course of these meetings, he learned that a computer system had been installed to automate the office work of several Bell subsidiaries. Opinion was split: some of the people thought the system was a curse, while others though the new system was “the greatest thing since sliced bread”. How could there be such a divergence of opinion? By asking a lot of questions, Harris determined:

•The “we hate it” and “we love it” camp were from different subsidiaries in different U.S. states.
•The “we hate it” group’s subsidiary spent no additional funding for training beyond what was provided with the purchase of the system.
•The “we love it” group’s subsidiary budgeted additional money for training, an amount equal to 20% of the cost of the system for continuing training and support.

As Elmer Letterman once said, “Luck is what happens when preparation meets opportunity.” Make your own luck by managing your EMR system's implementation. Prepare and plan. Get your people involved, train them well, and give them time to learn.

Glen Baxter is a technical writer for Jonoke Software Development. Diane Kermode contributed to this article. Jonoke Software Development Inc. is a Canadian company, based in Edmonton, Alberta, with clients across North America. Jonoke's flagship product is MediFile©, The Paperless Medical Office Solution.

Originally printed in
Canadian Healthcare Technology
September 2003