If you don't already know, it will be a challenge. But there isn't a single practice I've seen that would ever give up their EHR after a year of having it, and if you tried to take it away, you could get really hurt (I've been verbally threatened). The reality is: 2011 is not as long away as you think. If you think you're going to start your EHR selection and implementation process in 2011 you're in for a big surprise. There has to be "meaningful use" occurring on your EHR...and that takes a year anyway. Not to mention that the world just doesn't have enough implementation people to get all these implementations done! If you're really smart, you'll get started now. So here are what I see as the best ways to prepare your practice for taking advantage of the stimulus package and the incentives soon to come.
- Get buy-in...like...tomorrow. Don't put it on hold until next week. Don't save it for after spring break. Do it now. The sooner you have buy-in from everyone in your practice, the better you'll all feel about moving forward. If you don't, you'll wish you had. Identify the saboteurs and address them from the beginning. Include them in the process. Let them make decisions with the group and explain how the EHR will impact their day-to-day. I see this as the biggest hurdle a practice can face if not dealt with early on. If any physician wants to try to retire before the EHR comes, you're in trouble. Get them on board or have them pack their bags for Florida early because the last thing you want is a paper process running parallel with your electronic process.
- Narrow down the possible vendors. Did you know there are over 300 EHR/EMR vendors out there? Don't just Google "Pediatric EMR" and expect to come up with anything useful. You'll end up with a program written by a 16 year old out of the basement of his parents' house when he gets the time between Halo games on his XBOX (I didn't actually Google-research "Pediatric EMR", so I hope I didn't offend anyone). The worst thing you can do is invest in an EHR that isn't going to be around in 5 years. Or worse yet, it's around but only because it lives on your server, and there isn't a person (in this country or any) to support it. Start with your state medical society. Many times they have already narrowed down the long list to a handful. The Medical Society of the State of New York narrowed their list down to 6 vendors and they still get asked to give practices the top three. It's not easy to watch all those demos, deal with all those salespeople and expect to actually get anything out of it other than a headache. You can also look at your specialty journals for their recommendations but many times they are specialty specific EHR solutions which may sound great but aren't always the best solution. KLAS (http://healthcomputing.com/ ) has users rank software packages as well, but they don't rank everything. For instance, many products that smaller practices couldn't usually afford have been made affordable through hosted offerings, and they can be much more functional than some small practice products without any of the servers or other IT requirements.
- Work~~~~flow. This part can be hard because a lot of implementation teams don't perform any workflow assessment. They'll train you on the system, wish you luck, and head back to where they came from. Force them to look at your workflow. It may cost you some extra money, but the majority of implementations go over budget by around 50%. This isn't a place to save money, do it for your sanity and the success of the project. You can start working on workflow now and eliminating inefficient processes, but you won't really know how it'll all flow until you choose an EHR.
- You gotta have IT. Information Technology. You'll need to have things in place before you even get the IT with the EHR. If you're looking at hosted EHRs, make sure you get yourself a high-speed Internet connection. It's probably worth having a wireless router installed in your office by your local IT guy if you plan on carrying around tablets. Ask every vendor you talk to about what they've had good experiences with...if you're talking to the salespeople, they may have no clue, so have them ask some implementation folks. I've heard a lot of good feedback on Fujitsu tablets. Look for lightweight products that feel sturdy. Or maybe you want desktops in each exam room? Great! Now take a look at the furniture that exists for that type of thing. Consider mounting a monitor on a swivel on the wall so you can show the patient what you're doing on the EHR. This is something many patients LOVE. Finally they get to see what their doc is doing for them. Remember, kids will ruin every piece of technology you leave in an exam room, so be careful.
- Start planning for scanning. You can even outsource it if you want. There are a lot of companies out there that will scan all your paper records for you. But...think long and hard before you scan 20 years worth of data for your 60,000 patients. When are you really going to have to look back over a year for anything. Save yourself some time and money and put those old files in storage somewhere. There are practices out there that may have their reasons for scanning everything, and I'm no doctor, but I have a hard time buying into paying thousands of dollars in salary or scanning services to put in information you might access once.
This list could've gone on forever, but I said "5 Ways..." so I'm sticking to it.