Electronic Medical Records and Electronic Health Records (EMR / EHR) are complex beasts of software that can completely redefine the way physicians, nurses, pharmacists, and other clinicians / providers practice medicine.
This list of tips come in at many different points within your EMR / EHR adoption. Some tips are best used when you are looking to purchase an EMR, others are best post EMR deployment.
We are slowly linking additional documents on each topic. Please come back later and see the more detailed information. If you have other tips you think should be included, please be welcome to comment or submit.
These tips are broken into 5 sections: Support, Quality, Finance, Safety, Efficiency. All five areas are critical to a successful EMR deployment, with none of the 5 really being more critical over another. The 101 tips following are in no particular order.
| # | Tips & Qs | Support | More Info |
|---|---|---|---|
| 101 | Trust, but verify | Remember that vendors are trying to make a sale, and salesman, even if well intentioned, rarely have quality clinical experience in multiple areas. You will hear many things, but make certain to verify the answers to your questions in a written process. |  |
| 100 | Ask about the learning curve | Every application, no matter how simple, has a learning curve. That curve can be very large if you are adopting your first EMR, and may still be significant even if you are on your tenth (let's hope not) EMR. If the vendor says "super easy" than make sure they show it to you. | |
| 99 | Ask what platforms are supported | You don't want to adopt a brand new product that is created for yesterday's technology. Can you get the EMR on your Blackberry or iPhone? Can you get to it from the web? | |
| 98 | Look for long life and long term support | Once you have an EMR, you will want to stick with it long term. You don't want to redesign your clinical practices any more than you have to. Make certain the product you want will have a serviced life of at least 5 years and hopefully considerably more. | |
| 97 | How will your teams be educated on the EMR / EHR? | When adopting a new EMR everyone in the medical facility will need training. Nurses, registration, physicians, etc will all need to understand their aspect of the EMR. The question to ask the vendor is "how will this training be done?". Different people will learn different ways. It is best to have multiple ways to connect, i.e. hands on classes, 1-1 training, virtual sessions, webcasts, etc. | |
| 96 | Ensure audit logs are easy to get to and are comprehensive | The last thing you need is to get a court order asking for electronic discovery just because you can't get the proper usage audit logs. This is oddly a failing with many EMR manufacturers. They often have security added as a second thought. | |
| 95 | Background check the vendor's support team | Every vendor will say they have wonderful support. Ask the vendor for some references and give them a call. Also, call some folks that you were NOT given as a reference. Ask what they think of the support they received. | |
| 94 | Ask how the vendor ensures disaster recovery and business continuity | Hurricanes, earthquakes, tornadoes, fat fingering, and crazy people that like hacking things are just a few of the everyday issues that we continually run into. We need to ensure that clinical data is safe no matter the event that takes place. Make the vendor describe their process, and then prove it! | |
| 93 | TRY to use a vendor that actually has standards in their system | I say "TRY" because it is actually difficult to find sometimes. Many vendors use proprietary databases and languages to write their software. This means that getting support from the wider community is a pain. You will often be stuck with high cost consulting fees to get something changed or updated. Look for standards driven software (SQL, C#, Java, etc). Your life will be easier. | |
| 92 | Google "product name + support forum" | You want to make certain there is a community to support you. The vendor is nice, but having real world people that actually use the product is better. The vendor's core business is software development, not care delivery. You will want to find people that actually understand your business model. | |
| 91 | Google "product name + Twitter / Facebook / etc... | If the vendor isn't engaging social media, then you will want to scrutinize them closer. They may be missing engagement opportunities with the medical community, they also may still be stuck in 1984. Either way, it is not a good sign. | |
| 90 | How does the vendor prioritize issues? | Make sure the vendor can tell the difference between what is "nice to have", "necessary to fix", and "OMG HELP!!" | |
| 89 | Evaluate your overall support needs | Are you a clinic that works 7am-5pm? Do you have weekends open? Are you a hospital that needs 24x7 on site support? You will want to evaluate your complete support needs before committing to any contracts. | |
| 88 | Make sure you have solid control, and a backup plan, for user access | Nothing is more irritating than bringing in a new staff member and having them sit around for a week while you wait for someone to create an ID so they can use the EMR. Make certain you have a solid plan locally to handle new staff. Don't rely simply on calling the vendor. | |
| 87 | Have a defined Service Level Agreement | SLAs are a bit different than your standard contracts. They will define the precise expectation for support. If you want to be 99.99999% of the time, you will need to tell the vendor. Just don't be surprised at the price tag. | |
| 86 | Define a local Service Center before going live with the EMR | Most people think of the "Service Center" as the Help Desk. However, in a clinical environment, a service center is a much more robust group. They include application analysts and often informatics and clinical staff specifically for the purpose of handling EMR issues. Have this group setup and performing before going live on the EMR. This will help your adoption immensely. | |
| 85 | Test, retest, and test the network and wireless | Once you go live with an EMR or EHR, your providers will have very little patience for slow or spotty network coverage. Make sure the infrastructure is solid before building and deploying applications. | |
| 84 | Have ONE number to call | Don't try the age old "if you have an EMR problem press 1, if you have some other problem, press 2". NO! This simply doesn't work. Every single problem will be an "EMR problem". Give people one number to call and let the support staff do the triage. They can figure out whether the issue is an EMR issue or a PC issue, etc. Remember the support team's core customer are care givers, not IT folks. | |
| 83 | Remember who the support team's customers are | Many caregivers have never had to use computers in their daily practice. These are highly educated, very knowledgeable people, but they won't have much experience in EMR process or tools. You will need to take time with them and be patient. | |
| 82 | Have a communication strategy for when things go wrong | Technology inevitably breaks, or gets a virus, or needs to be rebooted, or some other nasty thing. Make sure you have a tool (NOT EMAIL) for communication and a way to make certain everyone gets notified. Also, don't be afraid to over communicate. | |
| 81 | Make all of your planning very public within your organization | If you want an environment that is easier to support, make certain your stakeholders completely buy into the process and the project. Making your planning public is a good way to keep stakeholders engaged, and is a good way to find difficulties between specialties or supporting teams. | |
| 80 | Make certain the leader of your project's support team is a physician | Simply, IT is IT, they are not caregivers. You don't need to have a physician be the Service Center manager, but you do need a physician to be the face and driver of the overall change. This will help adoption and create a bridge between your IT folks and the clinical folks. IT and clinicians speak different languages, we have to be aware of that difference and attempt to mitigate it whenever possible. | |
| 79-60 Quality Tips |
| # | Tips & Qs | Quality | More Info |
|---|---|---|---|
| 79 | Evaluate the Process FIRST! | Remember the mantra, CRAP PROCESS + TECHNOLOGY = FAST CRAP! | |
| 78 | Make certain reporting is easy and flexible. | Quality reporting is essential for so many things. You need to report everything from meaningful use, to state medicaid, to specific chronic disease guidelines. Make certain you can run your own reports without having to get the vendor on the phone all the time. You don't want to spend the time, or the money having to call them constantly. | |
| 77 | Find out which Enterprise Content Management (ECM) systems integrate to the EMR. | Let's face it. We really wish the EMR actually made us paperless, but it just isn't true. Patients have all sorts of paper, as will the clinic or hospital, even with an EMR. You will need to know which ECM systems are available to close that gap and make paper available in the EMR. | |
| 76 | Do site visits | Get some references and put some feet on the ground. You will want to look at other site's implementation of the EMR product to ensure what you THINK you know is accurate. Ask the tough questions. | |
| 75 | Find out how easy it is to do process improvement | If you are a LEAN shop you will be excited about the process improvement options an EMR can have on a practice. The problem is that most EMR systems aren't horribly flexible. You may have to work with the vendor to see how well you can manage the screens and work flows. | |
| 74 | Predictive analytics are a huge benefit | Everyone wants to know what volumes are going to like like next year. How many encounters will I have? How many admissions? If the analytics are built straight into the EMR you will have a much easier time trying to estimate the costs and resources necessary for the upcoming years. This improves your ability to do strategic planning, and should lower your costs from 3rd party applications or consultants. | |
| 73 | Automatic trending with graphing is a huge help | Clinicians have trends they need to pay attention to. Whether it is a single patient's coumadin dosages or a population of patients diabetic interactions, those trend numbers can be invaluable. Try to find a system that generates the trends instead of just dumping out data points. | |
| 72 | Evaluate process flows that come directly from the application | You have already evaluated YOUR process first (#79), but you will also need to evaluate the EMR vendor's hard coded processes. Make certain you can live with them before signing a contract. | |
| 71 | Are we integrating or interfacing | The overall smooth transition of patient information throughout your practice is a must. There are subtle differences between integration and interfacing. You will want to understand the difference and understand what it means to the clinical data. | |
| 70 | Hard coded work flows CAN be your friend | Many vendors try to add flexibility to their application by giving you many open text fields. The problem is that you can't do quality control on that type of field. Additionally, it makes reporting near impossible. Hard coded work flows can be useful, but they are even MORE useful if you can pick whether they are hard coded or not. | |
| 69 | Social Media integration - the way business is done today | Many sites haven't realized the benefits of social media yet. Many are still afraid of SM. However, this is the way of business in the 21st Century. SM integration can be a huge advantage for your organization, especially if you are in a situation where you have to be concerned about market share. | |
| 68 | Determine how the EMR vendor encourages innovation | This question may get a lot of babbling and deep breaths from the vendors. Few of them like to give access to their customers to actually change code or enhance the system. But if you intend on innovating, your application needs to be able to support you. | |
| 67 | Determine how innovation is actually put into the practice | Encouraging innovation is a little different than actually performing with it. Once the vendor explains how they encourage innovation, you will want to know how you can actually use it. Often the answer is "it will be in the next release". You will have to decide if that is good enough. | |
| 66 | Is the patient portal comprehensive | Thanks to the ARRA Meaningful Use dollars, the question of "do you have a patient portal" is going away. Now it is much more of a question of "what can the patient get to?" Just seeing labs and refilling prescriptions won't be enough in the long term. | |
| 65 | Don't forget LEAN and Six-Sigma | I have put two or three tips around these topics, but I want to call them out specifically. Efficiency and Quality go hand in hand for this tip. Don't forget to embrace LEAN and Six-Sigma and push the vendor on how they embrace it too. | |
| 64 | Remember the EMR is not the end-all, be-all of quality | The EMR is a tool. Nothing more, nothing less. And like any other tool, it is only as good as the people that use it and manage it. Make sure to continue to partner with your community and regional health leaders to ensure your EMR is put to full use. | |
| 63 | Ensure the product has expandability for other service lines | If you have no intention of ever adding services, you can ignore this item. Otherwise, make sure that new specialties or clinic programs can be handled by the product. | |
| 62 | What are the reporting skill sets necessary | Reporting can differ greatly from system to system. It may be done in a very simple front end that anyone could learn to use, or it may be done in a cryptic proprietary language that only a half dozen people on the planet can speak. If it is the second, reporting will be slower and much more expense. | |
| 61 | Don't be afraid of low cost or open source products | Quality does not = expense. Several very high quality systems are low or no upfront costs. That being said, make sure the support structure is strong. | |
| 60 | Reporting, reporting, reporting, reports | Most of the aspects of quality and quality improvement will circle your ability to easily get data out of the EMR. Reports are necessary everywhere, not only for you, but for all the agencies and public health areas that govern your practice. | |
| 101-80 Support Tips | 59-40 Financial Tips : Coming July 13, 2010 |
| # | Tip / Questions | Financial | More Info |
|---|---|---|---|
| 59 | Are the meaningful use (MU) guidelines covered by your product? | Every vendor will talk MU these days. Just remember that MU has 5 phases and each phase requires different aspects to be ready. Few vendors are actually prepared for the entire program yet, especially on CPOE and CCHIT aspects. | |
| 58 | It they aren't CCHIT certified take a really really hard look | I might even say dump them if they aren't CCHIT certified, (because if they aren't, you can't get MU dollars), BUT.... several vendors are releasing new versions of their applications that aren't certified yet. If they last few versions were certified, you should be ok. The other consideration is that the final rules aren't out yet on MU. CCHIT just may get pushed back a phase or two, thus giving you more time. | |
| 57 | What billing systems do you interface with? | Your overall finance processes will be much easier if you can interface the EMR to your billing systems. Make sure that your is on the list of previously interfaced applications. If not, negotiate better prices, or take a much closer look at adopting that specific product. | |
| 56 | How much do changes and customizations cost? | Nearly every medical facility will need changes or customizations. First you need to be sure you can make changes to the system. Second, make certain you know how much they cost AND how long it takes to deliver them. Don't let the vendor give you the 'ol switcharoo' with a charge to make a custom and then the "it will be there in the next version" | |
| 55 | Discover how easy it is to interface to the EMR. | Easy interfacing is key to expandability and keeping costs lower while still giving your clinical staff flexibility in their third-party products. If nothing else, make sure an "interface engine" is available. Given the cost to program interfaces, you will often be $100K+ ahead to use an interface engine. | |
| 54 | Make sure to understand the licensing model | Licensing can be very tricky. Often licensing in health care is done "per physician" or "per bed". However, there are often side costs for interfaces or different components of the system that will change your costs unexpectedly. Keep the same thought in your mind when asking what the annual maintenance costs will be. | |
| 53 | Does your product handle billing? | Slightly different than #57, this question asks if the EMR itself can handle the billing functions. You can lower your overall costs if you can integrate billing into the EMR rather than having a separate product for that function. | |
| 52 | How is licensing managed? | This is similar to #54, but still a different angle on licensing. Licensing is best managed if you can use a "just in time" license model. In other words, you buy licenses when you actually need them. Many EMR vendors will attempt to charge you for blocks of licenses or for what you "will have" for usage. Doing that just takes money out of your pocket ahead of time. Once in a great while it is a good idea if you can get large bulk licenses for cheap, but most of the time it just ends up costing you too much too soon. | |
| 51 | Make certain you know what upgrades for license expansions cost | If you have a growing practice that is looking at new service lines, you will want to know about the EMR vendor's expansion costs. For instance, if you are going to add a sleep clinic you will need to know how much the sleep clinic application within the EMR will cost and how it will integrate. If the expansion doesn't integrate, then your staff will spend more time developing interfaces, or typing in redundant information. This can be a very expensive mistake if you don't explore it upfront. | |
| 50 | Determine how complete the financial reporting is | Now, remember we are talking about your clinical systems. That being said, you will have different types of financial reports that you will need. Charge capture and diagnosis codes are some that immediately come to mind. Make certain to look through the standard reports that come with the system. If you don't see what you want, you will need to pay someone to build them. That cost can be considerably more than you would expect. Try to plan for reporting costs up front. | |
| 49 | Take a close look at financing your EHR vs. paying straight cash for it | This is the same discussion you will have about any piece of large medical equipment. Should we capitalize? Should we finance? The twist with an EMR is that it is software, and capitlizing and depreciating software can be a challenge. Additionally, if you are in a long partnership with the EMR vendor, you may have better leverage with them by changing your financing model. Just make sure you don't get overcharged in interest or fees. | |
| 48 | Plan for a rollout gap | What is a "rollout gap"? It is the time after the initial deployment of the product that you lose productivity. The loss of productivity is unavoidable. You are changing the way clinicians practice medicine, changing the way you bill, changing the way you register, and often changing the overall patient experience. A rollout gap is unavoidable, but you can plan for it. You can study other institutions your size and determine an estimate to the time and depth of the gap. This is an item you will certainly want to research. There are many strategies to take into account. The first you will want to look at is "big bang" vs. "tidal wave" deployment methods. | |
| 47 | Plan for staffing surges | You will have to plan for staffing surges at different points in your EMR deployment. If you go with a big bang deployment you will have a large surge at go-live and within the few weeks after wards. If you do a tidal wave go live you will have smaller but continuous surges with the training teams and clinical staff. | |
| 46 | Know where your charges flow | Knowing how charges flow in the system seems like a no-brainer, but it tends to be much harder than people realize. Make certain you know how charge codes are being captured, by whom, and where they are going. | |
| 45 | Think about ICD-10 compliance sooner than later | ICD-10 is currently scheduled to be enacted on October 1, 2013. I know this is three years away, but it isn't nearly as far as you think. Many medical systems are projecting 12-18 month transition periods to get ready. Don't underestimate the size of this project. | |
| 44 | Make sure your revenue cycle process is as clean as possible | DRO will often suffer when bringing up an EMR. You will want to evaluate your entire revenue cycle process from end to end. | |
| 43 | Don't underestimate the time necessary to be compliant with 5010 | 5010 is the same problem as ICD-10, but it shouldn't have as much of an effect on your physician groups. January 1, 2012 is the date for the 5010 legislation. | |
| 42 | Keep transcription in mind | Don't forget your HIM teams and transcription. Transcription is a considerable cost in most organizations. Your EMR should offer considerable options to lowering those costs. Speech recognition and speech to text systems should be able to be integrated into the EMR. These systems will lower your overall transcription and HIM costs if used properly. | |
| 41 | Watch your insurance claim denials | Finance folks will usually do this anyway, but it is extra important after going live with an EMR. You need to ensure that electronic claims work as expected. If you don't, you won't get paid. | |
| 40 | Do NOT let the finance department drive the EMR choice or deployment | If I were to nominate the most important tip in the Finance area, this would be it. The finance areas must be at the table when looking at new EMRs. However, they should not lead the project. The project needs to be lead by the clinical teams. If finance drives, you will miss process enhancements and create strife and inefficiency for the clinical staff. | |
| 79-60 | 39-20 | ||
| # | Tips & Qs | Safety | More Info |
|---|---|---|---|
| 39 | Ensure work flow can be hard coded when necessary, and not hard coded when necessary | Having the ability to hard code fields (ensure a particular bit of information is required per field), is a major component of patient safety in the EMR. If fields are just free text, they tend to get all sorts of different data in the fields. At the same time, you will want to have specific fields that you can make into free text. Determining if your EMR can handle hard coding the work flow will take a pretty deep dive into the system. Make sure you set aside the time to do the diligence when you are evaluating a product. | |
| 38 | You can move to population based medicine | Many aspects of patient care can be enhanced by a move to population based care. Even though it is possible to manage populations in paper environments, the EMR simplifies the management and cross data comparisons massively. | |
| 37 | Safety is created by design | Patient Safety is not always inherently built into EMRs. You will often have to design safe procedures in the electronic environment. Don't take the EMR's original setup as the endpoint in safety. | |
| 36 | Medication Reconciliation should be a simple process | Medication Reconciliation is a JCAHO requirement. It is also key to the Meaningful Use dollars. Your EMR should not only embrace the process, but make it easy to perform. Electronic medication lists and the ability to compare/contrast with outside ambulatory or inpatient sources will be necessary. You will also need a simple (probably paper, hopefully a portal) way to get the information to the patient outside your organization. | |
| 35 | CPOE is important, but every EMR will have it. | How complex is CPOE to actually use? | |
| 34 | Make sure adverse drug events reporting is comprehensive | Adverse drug event reporting is extremely important. Your EMR will need to be able to manage drug to drug, drug to allergy, etc. | |
| 33 | Make certain drug interactions are easy to manage for the physician | Drug interactions need to be in the physicians face (e.g. a BIG popup that says their is an interaction), but make sure the physician can bypass the interaction checking easily when necessary. Also ensure that audits are available when a physician bypasses the interaction screens. It is always better to cover everyone's behind with audit logs, especially in a med-error case. | |
| 32 | Ensure integration to other products is possible | It is rare to find a situation where the EMR is the one and only application being used in the facility. Typically numerous third-party applications are used to augment particular aspects of the EMR. You will want to ensure you can integrate (or at least interface) these systems together. Items like demographics, labs, rads, meds, etc will be essential to share between apps. Failure to integrate will mean the chance of error between systems will go up significantly. | |
| 31 | Ensure information sharing is easy | Your safety strategies are heavily dependent on timely, easy to obtain, information. Look for an EMR that has easy to use sharing tools and options for putting your data into standard types that can be easily formatted. | |
| 30 | Remember that the EMR is only part of the safety problem | The EMR won't wash your hands. Remember that your organization's safety strategies should include the EMR as a tool, not be reliant on the EMR as a silver bullet. | |
| 29 | Errors should be easily reportable | Just like all of the other information, errors should be easy to get to and be very transparent. You shouldn't have to wait for month end, or employ an expensive IT guy just to get to medical error information. This information should be at the fingertips of all clinical leaders. | |
| 28 | Use data to show both individual and system safety metrics | Another very common problem with EMRs is their inability to segment data. Make certain you can separate data by system and individual provider. | |
| 27 | Record management in the EMR is just as important as in paper | Record management is a key to patient safety. Make sure your HIM teams can manage records in the EMR in a safe way. | |
| 26 | Evaluate decision support tools for a fit to your needs | Decision support tools come in many varieties and types. They range from self-registration with pre-diagnosis to medication dosage tools. You will want to ensure that the decision support tools used in your EMR meet the needs and goals of your org. Many EMRs use third-party decision support toolsets. You will want to do a deep dive to ensure you are getting what you the salesman told you about. | |
| 25 | Care coordination is much easier in an EMR and should be evaluated to be used | Care coordination is often difficult for patients to grasp. "You mean you are going to talk to each other when you manage my care? Aren't you doing that already?" -- I have heard that from patients already. Care coordination will be central to the future of patient centered medical homes. Your EMR needs to be able to take PCMH and specifically care coordination processes in mind. Look for Care plans and action plans within the notes or team notes. | |
| 24 | Take advantage of E-Health tools | E-Health tools come in many shapes and sizes. The one common factor is they can be great patient safety enhancers. From Web enabled scales for CHF patients to iPhone programs that can perform sleep studies, you can keep a much closer eye on patients without having to actually be right next to them. | |
| 23 | Make certain all caregivers know that logs are kept for any system overrides | Logs aren't just "to pin on someone" they tell people what happened. When something goes wrong everyone needs to know that you can go back in the system and do a root cause analysis. Many organizations want to downplay that they have logs of events, but I believe it is much better to make certain providers know they are there. That way providers can ask for traces from the system when they want to discover what happened in a given process for a given patient. Logs can often be a primary system for learning and fixing and discovering issues within the system. | |
| 22 | Give caregivers the ability to override the system when necessary | Often times EMRs are setup with certain safety checks to ensure certain actions are not taken. This is an important safety model, but it is also important that the providers be able to override those checks when necessary. The EMR program can't take every single possibility into account so it must have the capability to give providers and caregivers the final word on care, not the program. Just make sure you have logging when the provider overrides the system so that you can address the issue later. | |
| 21 | Develop a root cause analysis process for the EMR | You very likely already have a root cause analysis model for your practice. You will need to adopt that model to the EMR. If you don't, you will create a likelihood for the same errors to continually repeat. The EMR process is different than a usual root cause analysis. You will need to take into account interfaces, security roles, single sign on, and several other things beyond the "simple" human process. | |
| 20 | Data collaboration is key to patient safety | Whether it is a state Health Information Exchange, or making information move within your own organization, data collaboration is key to patient safety. Make certain that your specialty clinics are notified when patients have Urgent Care or Emergency visits, make certain that data can flow between your systems seamlessly so providers don't need to look it up in multiple systems. Simple data flow is a huge safety area. The biggest key is to make sure specialists are notified when there are changes in their patients, and to make sure all of the clinical data is available in one place. | |
| # | Tips / Questions | Efficiency | More Info |
|---|---|---|---|
| 19 | Know how customizable the clinical work flows are! | This is the key to being efficient with your EMR! Work flow within the EMR needs to be able to adapt to you, instead of you adapting to it. You have been in your clinical practice a long time, you know what works and what doesn't. Don't let your tool tell you how to do your business. | |
| 18 | How easy is it to customize the system overall? | This is very similar to the last tip, but expanded beyond clinical work flows. Your system will need to change and adapt to the future. Whether that be medical home, ICD-10, ACOs, or whatever, you need to know that your EMR can change with your practice. If it doesn't, you will be forced to look for a new application and that isn't cheap or easy. | |
| 17 | Know work flow can be hard coded to ensure compliance. | Hard coded work flow is essential to both safety and efficiency. Hard coded work flow really helps efficiency by creating a repeatable and recurring process that has less variation for the caregiver. The downside is that the caregiver can lose some flexibility. | |
| 16 | Ensure easy access to the system via multiple mediums. | No one has invented the perfect clinical device platform yet (even thought many think the iPad is close). Ensure your EMR can be available via iPhone, Droid, Web, VPN from home, and other ways to ensure that clinicians can use the system in whatever way is most convenient for them. | |
| 15 | Avoid multiple sign-ins if possible. | If your EMR has lots of sign-ins, or you need to access third-party applications (like PACS) that require its own sign on, you need to think about a Single Sign On (SSO) application. These types of applications can use your Windows logon and associate it to all of your other applications. They can often do patient lookups and other efficiency tasks when necessary. | |
| 14 | Make sure security is solid, but not prohibitive. | Security of the EMR should be paramount, but it shouldn't create a hassle to use the system. Evaluate things like "tap and go", biometric sign ons, and RFID cards. These simple sign on technologies and make your interaction with the EMR much easier while still keeping patient information secure. | |
| 13 | PDSA - Use it! | Plan - Do - Study - Act, if you want to create a smooth running EMR, than you need to continuously reevaluate the processes and flow of the system. Don't settle, always look for ways to improve. | |
| 12 | LEAN | The major component of LEAN is to identify ways to reduce waste within a system (not to treat patients like cars like some people believe). LEAN helps you to evaluate your practice and determine ways to improve. If something is wasteful, than why do it? | |
| 11 | Buy MORE printers | Yes, you read that right. Everyone thinks that getting an EMR will decrease your printing. Not so! Printing will often triple once you move to an EMR. Paper forms that you used to buy in bulk are now printed. Scripts are now printed, etc. You will be surprised by how much paper you use. My advice is to talk to your local HP rep and figure out which printers will work best for you. | |
| 10 | Build performance dashboards, not just quality dashboards | Health Care folks don't always think in the terms of dashboards, but JCAHO, Baldrige, and others have been trying to turn that thinking. Performance dashboards help to create an open and transparent environment. Not only for the clinicians, but for the support organizations as well. | |
| 9 | Flexibility with physician devices is important, but you still need to standardize | As much as you need to be flexible with devices, you will also need to standardize wherever possible. For instance, if you are going to offer Droid as a supported platform, limit the support to as few specific phones or tablets as you can. Standardization will speed deployment, support, and decrease the overall learning curve for new users. | |
| 8 | Do time studies | Actually perform time studies, don't just rub the belly and pat the head. There are many things that can make you more efficient in the EMR world, but if you don't have the data to back it up, then how do you know for certain? A perfect example is printers in the exam room. Many providers feel that printers in the exam rooms will make them more efficient, but without a time study, it is difficult to know if in your specific situation if that is true or not. You could be missing out on a huge physician time saver, or you may sink a lot of money into a pointless solution. Do the study and find out. | |
| 7 | Make sure IT shadows the clinicians | IT knows IT. Clinicians know medicine. Both groups need to come together to create an efficient environment. More than just having a collaborative steering committee, shadowing allows IT to actually see the work of the clinicians in the real world. | |
| 6 | Use predicative analytics | Predictive analytics are old hat in most industries. However, health care hasn't put PA in a real forefront of the clinical practice. If you want your physicians (especially in a ED / UC) to be able to prepare for trends due to environment or time, make sure to have PA built into your EMR and easily available for all providers. | |
| 5 | Automatic trending helps all over the place | Whether it is an INR result of a growth chart, make sure your EMR is able to auto graph and build graphs easily when providers want to use new or different views. | |
| 4 | Keep training over and over | Training should not be an entrance to the EMR and disappear until the next upgrade. Training should be ongoing and comprehensive to include new learnings and advanced procedures. As providers get comfortable with the system, they will learn new and faster ways to work through the EMR. Make sure your providers have a connection to each other so they can share their experiences and a way to teach their personal advancements to their peers. | |
| 3 | Infrastructure is key to performance | Infrastructure is not shiny, it is not the EMR. That being said, if your infrastructure is sub-par, your EMR performance will be sub-par. Make certain that networks, servers, SANs, and end user PCs are up to speed. Any weak link in the infrastructure chain can massively slow down your overall EMR. | |
| 2 | Quit pulling charts as soon as possible | One of the few places that a physician will actually feel a savings in time from the EMR is through patient histories. Patient histories should be in the EMR so that providers don't have to bring them up from HIM/HIS archives. A quick click and a search will be much more effective for the physician or provider. | |
| 1 | Crap process + Technology = Fast Crap | Build the process first, and the EMR second. | |
| Have some other tips in mind or other information to link up? Submit your Tips! |
