ELECTRONIC HEALTH RECORDS:Tips for Successful Implementation of EHRs

Dawniela Hightower

Implementing an electronic health record (EHR) can be either a mildly painful process or a nearly excruciating one. The dividing line--according to Bre Jackson of the California Health Information Partnership & Services Organization--is between physicians who heed the advice of experts and make important choices in the earliest stages of their implementation and those who don’t. “That is a sweeping statement,” she says, “but it bears a lot of truth.” As chief information officer of CalHIPSO, the country’s largest regional extension center, Jackson is responsible for ensuring that over 6,000 California physicians have successful EHR installations.

Dr. Steven Vargas would likely agree with Jackson’s assessment. A family physician at a small private practice in Healdsburg, Vargas describes his conversion from paper to EHR as a smooth process. That’s not to say the transition didn’t impact his practice or that it didn’t cause a slowdown in patient volume--because it did. But the anticipation of those outcomes motivated Vargas to set a course that had his practice functioning at pre-installation volumes more quickly than most.

Vargas attributes this achievement primarily to staff preparedness and says that the single biggest secret to success was getting staff to buy in fully and early. He included his entire team in the discussion over which EHR to implement, and kept them informed of the progress every step of the way. Realizing that implementation was going to be disruptive to the daily work of his support staff, Vargas knew that that his best chance of success and peace of mind was to have every staff member on board and in support of the change. A successful EHR adoption can’t be imposed upon staff--adoption must be made through teamwork.

When asked what drove him toward an EHR, Vargas notes, “I decided to implement once I found the right product,” and adds that he waited on the sidelines of the industry for several years, observing and learning from the actions of his peers. He kept close watch on the products that were entering and leaving the market, wanting to ensure that his EHR company would be around for the long haul. “I asked for references,” he recalls, “and called current customers of each product I was considering.” Vargas warns that if the company can’t provide current customer references, its system is likely not worth considering. He made his final selection after discussing the products with colleagues, narrowing down his lists to just a few, and downloading their online demos.

Vargas’s experience is one that CalHIPSO would like to replicate in medical practices around the state, both in terms of outcome and timeline. With that goal in mind, Jackson shares the following set of EHR adoption tips when she makes presentations to physicians.

Do your homework. It’s important that you enter into the vendor selection process with a clearly defined set of needs. Ask yourself which EHR functions support quality patient care while simultaneously meeting the needs of your business. Determine which features are required to meet the “meaningful use” measures or other quality reporting incentives. Then make a priority list, understanding that the entire list might not fit into the budget. Reading neutral third-party reports can help balance the sometimes partial opinions of colleagues.

Understand the costs. Adopting an EHR could require significant outlays of funds, including supplemental investments in hardware, software, training and future maintenance fees. A handful of products on the market have reduced the financial barrier to entry by offering low initial investments. Some of these products, however, impose a long list of additional fees for upgrades, new service modules, data protection and ongoing training. With other products, cost savings can result in loss of control over patient data. Paying close attention to contract terms is extremely important, says Jackson. “Work with your regional extension center,” she suggests. “We’ve spent hundreds of hours negotiating favorable vendor contract terms with EHR vendors, and we make these contracts available to any provider who enrolls with us.”

Physicians are not required to sign CalHIPSO’s EHR vendor contracts to take advantage of the regional extension services. Vargas, for example, joined CalHIPSO after selecting his EHR. Even though he chose a product outside CalHIPSO’s contract program, he was still able to receive subsidized technical services from CalHIPSO throughout his implementation. He received these services through the Redwood Community Health Network (RCHN), one of CalHIPSO’s 10 local extension centers throughout the state. RCHN contracted with a product specialist of Vargas’s choice to come into his office and assist with implementation.

Have an onsite champion. An onsite champion is a staff member, not a physician, who is enthusiastic and supportive of the project and willing to take a leadership role in getting the rest of the staff on board. Physicians can spur the development of an onsite champion by mirroring Vargas’s technique of involving staff in the entire selection and adoption process. “Staff involvement is critical,” observes Jackson. “The practice manager plays an instrumental role in developing workflows to increase technology adoption, direct patient awareness and reduce the feeling that an EHR is disruptive. A motivated and informed practice manager will keep the wheels on the project moving positively forward.”

Invest in training. It’s easy for some physicians to write off additional training as an unnecessary expense, especially considering that time spent training is time spent not seeing patients. But the omission of training will cost more in the long run, both in time and money. Patient volumes will never reach capacity while staff members are trying to fumble their way through a new EHR. “A solid EHR training plan will help clinicians make the transition from paper to electronic health records,” says Jackson. “Providing staff just-in-time training will reduce bottlenecks and increase morale. While training provided by the EHR vendor is important, it is unlikely to be sufficient.”

Solve workflow solutions as a team. Involving the staff in all workflow changes goes back to Vargas’s suggestion that a successful adoption requires teamwork. The team approach recognizes each staff member’s role in delivering care. The approach demonstrates that all roles, both large and small, affect the office function, and that adopting an EHR requires a complete functional shift. While workflow outcomes will be unique to each office, the process of developing a new workflow should allow for the contribution of every player.

Plan, prepare, and expect the unexpected. One important piece of advice that Vargas offers is to have flexibility around the go-live date. This flexibility was especially critical for Vargas’s practice because he opted to go live with all patients, all at once. To accomplish this feat, he assembled a practice lab with computer stations in his back office. “I would shut down my office for two hours a day, and not see any patients,” he recalls. Vargas’s team spent one or two days a week running real-life scenarios through the EHR practice lab. As the go-live date came near, the team didn’t feel ready yet, so they returned to the practice lab to run more scenarios.

Vargas also hired temporary help to enter patient demographics. He considers this to be one of the best and least expensive investments of the project. “I didn’t want to burn out my staff with hours of data entry,“ he says. Instead, he hired college students with strong typing skills to enter non-medical data. This low-cost solution helped keep his team fresh and motivated.

Notify your patients. Notifying patients is an often overlooked step in the EHR implementation process. Patients who aren’t notified can be left wondering if their physician’s level of service is declining. Jackson says that once patients know their provider is transitioning to EHRs, they are more often than not pleased and accept the temporary reduction in patient volume.

Electronic health records are tools to help physicians succeed at their mission of providing quality patient care. Implementing an EHR will prompt discussions about best practices, practice performance and management of clinical data. As a result, the EHR adoption roadmap should reflect known wins that will affect every aspect of the practice, far beyond the technology itself. A strategic approach to EHR adoption can turn those changes into opportunities for improvement, while helping physicians assuage the apprehension that always accompanies change.

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Ms. Hightower is the marketing and communications manager for CalHIPSO.

Email: dawniela@calhipso.org

For more information on CalHIPSO, visit www.calhipso.org.