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Keys to a successful EHR implementation: Communication, training, time

This buyer's guide has discussed four key steps in the process of selecting an electronic health record system, from

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evaluating features of EHR technology to knowing what to ask peers about EHR software. This final section covers another arduous task -- EHR implementation.

Once you have selected an EHR vendor, it's time to run a pilot. Let your employee task force test it on a small group of patients and evaluate the results. Make the vendor adjust the setup based on the feedback from the task force, and try it again.

Providers of all sizes who have gone through an electronic health record implementation say the process should focus on four elements: training and education, user authentication, communication, time, and meaningful use.

Training and education. No EHR implementation can succeed if the IT staff does not take the time to show doctors how the EHR system works. For small providers, this could be accomplished in small, even one-on-one, training sessions. Hospitals should introduce the system to one department at a time, and schedule additional sessions for those who want them. To medical personnel who are skeptical about using EHR technology, point out its global benefits, such as reporting across a broad patient population, in addition to the advertised benefits of electronic note-taking and prescribing.

User authentication. Employees use the EHR system for different reasons, and therefore should see (or not see) different parts of each patient's record. A good EHR implementation strategy will incorporate role-based authentication, which may require an add-on module that's not part of the original EHR system.

Communication. The team-based approach used to select your organization's EHR software should continue through the implementation process too. Remember that without physician buy-in, EHR implementations are doomed to fail. In addition, keep the team together once the software is installed to ensure that strategic IT decisions are made with patients and physicians in mind.

Some physicians and staffers learn more quickly than others, but many find that they ultimately are more productive with a new EHR system optimized to their workflow.

Time. Your organization's board of directors needs to know that a methodical EHR implementation is preferable to a rushed one. Some organizations, for example, have been at it for six years and are still not done. Go too fast, and productivity undoubtedly will suffer.

Meaningful use. Once the EHR implementation is finished, start collecting the reporting data you need to send to the Centers for Medicare & Medicaid Services, or CMS, to receive federal incentive payments under the Health Information Technology for Economic and Clinical Health, or HITECH Act. (To see which data to collect, read the criteria for meaningful use.) Do so by 2015 to avoid having your Medicare reimbursements reduced.

Ultimately, providers starting with a brand-new EHR system or switching EHR vendors should plan to lose at least 25% of their productivity for a while, or maybe for several weeks or even months, most experts say. Understand that this is a cost of doing business, and adjust your appointment booking to reflect it. Some physicians and staffers learn more quickly than others, but many find that eventually they are more productive with a new EHR system optimized to their workflow, so in the end they make up for lost time.

Thanks to John Moore of Chilmark Research, who assisted with this five-part series. Let us know what you think about the stories; e-mail Don Fluckinger, Features Writer.

This was first published in August 2010

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