Objectively compare systems: Dr. Robbins suggests preparing for a product demonstration by creating several clinical scenarios typical for your practice.
“Wrestle control of the demo right away by telling [the sales people] that you want to run through a clinical scenario,” he says. “Use that same clinical scenario to test and compare different systems.”
Think about the kind of medical note you want to create: “A lot of systems generate too much information,” says Dr. Waytz, recalling his own receipt of an eight-page note from a referring physician, only one page of which was relevant to the hand-off. More is not always better.
“There was seven pages of garbage,” he says. “And because it was faxed to me I have seven pages of paper here that I ended up throwing away.”
Lola Butcher is a medical journalist based in Missouri.
Implementation Pearls
Give Yourself Time to Learn the System
“You have to look at this as a marathon and not a sprint,” says Dr. Blau. “It took over a year for us to become paperless.”
At first, he used the EMR for only two patients a day, refining the templates bit by bit as he gained experience with the system’s capabilities. Similarly, he started with a single template—the one for osteoarthritis—and he chose a single nurse to learn the system with him. She then trained other nurses in the practice who, in turn, trained members of the administrative staff.
Prepare to Slow Down
“You must plan for a reduction in productivity, compared to scribbling in the paper record, which is much quicker,” says Dr. Robbins. “EMRs tend to slow people down, especially when they’re first learning it, and sometimes forever.”
The improved documentation by a template that forces physicians to record their decisions and actions may lead to higher reimbursement levels. Also, for many physicians, EMRs eliminate any dictation at the end of the day.
Establish Protocols to Tailor the System to Your Practice
The EMR purchased by Dr. Waytz’ group had no rheumatology-specific templates, so the physicians built them from scratch. One physician was designated to create and change the templates to correspond to the diagnoses, treatment options, and other information applicable to their practice. For the first year or so, the doctors met every six weeks to decide on which tweaks were needed.
“There are still some things that are superfluous and some that I want to add,” he says. “You have to have the group wiling to meet to say we want these choices.”
Reconsider Workflow and Staff Responsibilities
Dr. Blakely operates his practice with only a few staff members other than himself: an office manager and a part-time assistant who handle billing; a receptionist/scheduler; two nurses—one to room patients and one to do infusions; and a laboratory technician. The lean staff, which includes no transcriptionist or medical records staffer, is possible only because of the EMR system, he says.
