Thursday, December 6, 2018 | Jacob Turmell
One of the biggest changes I’ve witnessed in my 20 years in healthcare is the impact of the electronic medical record (EMR) on how we deliver care. You can call it good, you can call it bad, you could even call it ugly, but EMRs are here to stay, and it’s we healthcare providers who must figure out how to adjust to using them.
At our fall meeting, I spent time talking with several cardiology administrators who are at various stages of implementing Epic. Some are in the planning phase, some are new to the platform, and some have been using it for several months or years. The mix of experiences created a rich conversation about the best practices and strategies members have used with success. Many aligned with what I have learned implementing several EMRs, and I thought summarizing them into these six success factors would be useful.
1. Form teams to evaluate workflows.
Many groups and organizations still focus on the EMR as a documentation repository into which you put clinical data. In reality, the EMR has a big impact on workflow. It’s essential to have a team map out the current state workflows the EMR will impact, and work with EMR trainers to determine the future state of these processes. Since there are many unknowns before go-live, ask the EMR vendor to give you a test environment so the team can run future state scenarios, and follow a visit from start to finish. This will help identify gaps and problems before you go live.
If you skipped this step prior to go-live, and workflows need improvement, you can still use this concept. Go to the gemba, as they say in Lean process improvement. Walk around and listen to ideas from staff. Document what’s working, and not working, and come up with a solution that makes sense for everyone.
2. Have a plan for moving data from old system to new.
It doesn’t matter if you are moving from paper to new EMR, or old EMR to new EMR. Patient care cannot be impacted during the transition. Abstracting patient history, labs, test results, and other documentation from the old system into the new one must be completed prior to the patient’s visit. Failing to plan for the time required to do this will cause front desk bottlenecks and angry clinicians.
First, figure out which data must be pulled from the previous system. Ask a group of physicians, advanced practice providers (APPs), nurses, and medical assistants for input and aim for a reasonable number of elements.
Second, decide on the data format. Typically the choice is either a PDF or discrete data. My recommendation is to pull as much discrete data as you can into the new system so you create a more complete EMR record.
Third, determine who will actually do the work of abstracting. “We’ll just have the staff do it” is not always a solution. They will be overwhelmed learning the new system, and abstracting will be added to their existing workload which is not always ideal. You can look at hiring temporary employees or outsourcing to a third party to complete this work. If this isn’t an option, modify staff workloads to accommodate the additional work. Otherwise you risk not having records ready in time for patient visits.
3. Make thoughtful, not hasty, course corrections after go-live.
It’s to be expected that not all workflows will function as you had hoped. The key is to let the dust settle for a few weeks or a month and get input from multiple users before you make any changes. Don’t let one person’s frustration or rant result in a knee jerk change that doesn’t work for the group. Talk to clinical, administrative, and IT staff to get the full picture, map the new workflow, and test it before you make the change.
While working for a hospital, I was on a team for implementing computerized physician order entry (CPOE). A cardiologist, IT analyst, nurse and I provided feedback to IT to about improving order sets and other things that didn’t work after go-live. The team was effective because we considered feedback from multiple people before offering a solution.
4. Prepare for a productivity hit after go-live.
Productivity loss is unavoidable given people’s learning curve. Just accept this and have a plan that balances it with the practice’s tolerance for slowed productivity. For instance, maybe you expand office visit slots from 20 to 30 minutes for the first two weeks after go live, to accomodate slower entry times. Or, block out every other visit slot, so that the physician and clinical team have time to document and learn the system.
5. Don’t let bad habits get hardwired.
Factor in an optimization phase no sooner than three, but no longer than six, months after go-live. This is the sweet spot when users have moved past “How do I login and search a patient?” and now have in-depth questions and frustrations about functionality and user experience, such as, “This task requires six clicks. - Is there a better way?” Ask in-house IT trainers to sit with staff and shadow providers, collecting feedback and providing tips and tricks. If your group is smaller, this can be done by super users.
An optimization phase can really make the EMR work better for everyone, so put it in the overall product plan. If you don’t, people’s workarounds and bad habits get hardwired and changing them becomes very difficult.
6. Document new workflows.
Use tools such as Visio to document new processes so that everyone knows what is expected. This goes beyond the IT department’s “point-and-click” tip sheets for using the software. The workflow documents provide a visual map of the process flow for essential workflows like check-in, patient rooming, medication reconciliation, physician review and sign-off, etc., aligning the EMR functions with process tasks.
Converting from one EMR to another, or from paper to EMR, is never easy. With the right planning you can alleviate a lot of frustration and chaos. Plan for the fact that everyone has a learning curve. Think about productivity. Spend as much time as you can planning for workflow change and data abstraction in advance. It will pay big dividend after go-live. Also, remember that your front line people are the key to successful implementation. Listen to their feedback and use it to continually improve.
MedAxiom’s blog post is published every Thursday at www.medaxiom.com/blog
Jacob Turmell, DNP, RN, NP-C, ACNS-BC, CCRN-CMC, Vice President, MedAxiom Consulting, is a certified Nurse Practitioner with a strong clinical background combined with years of medical industry experience. While earning his Doctor of Nursing Practice degree, Jacob’s focus on systems leadership gave him expertise in organizational assessment, outcome-driven change management, population health, and public policy. At MedAxiom Consulting, Jacob is focused on care processes redesign and provider team optimization. You may reach him at firstname.lastname@example.org.
MedAxiom Consulting is the nation’s leading cardiovascular-specific consulting group, working with a range of private practices, hospitals and health systems across the country to improve the delivery of CV health care. Learn more about our team.
Illustration: Lee Sauer
Jacob Turmell, DNP, RN, NP-C, ACNS-BC, CCRN-CMC, Vice President, MedAxiom Consulting, is a certified Nurse Practitioner with a strong clinical background combined with years of medical industry experience. While earning his Doctor of Nursing Practice degree, Jacob?s focus on systems leadership gave him expertise in organizational assessment, outcome-driven change management, population health, and public policy. At MedAxiom Consulting, Jacob is focused on care processes redesign and provider team optimization.
To contact, email: email@example.com