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Best practices for multi-physician ambulatory EHR implementation

The head of an award-winning electronic health records installation offers advice to her peers about managing the transition from paper medical records to ambulatory EHR.

Successfully rolling out an ambulatory electronic health record (EHR) system for a medium-sized facility takes a team of trained specialists deploying it department by department, Dr. Kathryn Stout said in a presentation at the HIMSS10 annual conference -- that, plus hanging on to paper backups for a few years just for the doctors’ peace of mind, whether you need them or not.

Stout led the transition from paper to an integrated ambulatory EHR system at Virginia Women’s Center (VWC), a rural obstetrical-gynecological provider headquartered in Richmond, whose 26 physicians and 12 nurse practitioners serve 65,000 women at five hospitals. Her team won a 2009 HIMSS Davies Award for the process, which took seven years of evaluation, starting in 1996, and an additional 14 months of implementation in 2003 and 2004.

The project took so long, Stout said, partly because VWC waited to green-light the implementation until the physicians unanimously approved the vendor, and partly because it took software developers that long to create obstetrics-specific systems.

Stout shared nine tips from the experience with conference attendees planning their own transitions from paper to ambulatory EHR systems:

• Get your own IT staff. It might seem cost-effective to engage an application service provider or consultant, but dedicating an in-house staff to tending to IT needs -- EHRs included -- leads to a more effective implementation and to better physician buy-in, because they’re more invested in positive outcomes.

• Do not assign the job of medical champion to the doctor who happens to be a technophile. Instead, get an experienced IT manager, but also get a doctor involved who knows about EHR systems and has experience with them.

• Set up implementation teams. Devote IT resources and other trainers to go-live teams that will spend an allotted amount of time during an ambulatory EHR rollout. In VWC’s case, teams went from department to department, spending two weeks getting each staff up and running and adjusting the training process as they went along so that at the end of the process, staff benefited from lessons they learned along the way.

• Throttle back appointments. Give physicians time to get used to using the system. VWC physicians’ appointment schedules were reduced by 50% at first. Most made up for the shortfall later, in increased productivity.

• Consider hardware carefully. Stout said her facility settled on smartphones and tablet PCs -- smartphones to allow doctors to check in from their kids’ soccer games and adjust a patient’s treatment on the go as needed; and tablet PCs because VWC did not want physicians to ever have to turn their back on a patient during a visit. (Individual needs may be different, but think out the hardware early on in the process, she said.)

• Give physicians alternatives to data entry. Some VWC doctors tried using scribes following them around to enter data into the ambulatory EHR system; others tried speech recognition software, which has a steeper learning curve than most wanted to take on. In the end, physicians ended up learning the EHR system and entering the data themselves.

Like everybody else, if you ask the question, ‘Would you go back to paper?’ the answer is a resounding ‘No!’

Dr. Kathryn Stout, Virginia Women’s Center

• Maximize efficiency through online services: Make it possible for patients to request prescription refills online, make payments and schedule appointments -- actual automated bookings, not just Web requests for a callback, which many providers offer.

• Improving patient care, enriching safety and cutting costs are probably the top objectives for your organization, but building employees’ enthusiasm for a transition to ambulatory EHR involves proving two things to them: One, they won’t be spending more time at the office learning the system and keying in data. Two, it’s not going to cost them anything -- it might in the case of VWC, a physician-owned company, but the dividends in cost savings and expanded patient throughput eventually will be greater than the amount of money coming out of their pockets.

Above all, understand that the EHR implementation process never ends. Once a health care provider is up and running with ambulatory EHR, it’s time to review, revise and improve workflows -- and of course, to run down the glitches that invariably pop up.

“Meetings are still ongoing at all levels -- provider, staff and physicians -- so the cycle of teach, listen and share continues,” Stout said. “Now it’s definitely more Web-based communication. Like everybody else, if you ask the question, ‘Would you go back to paper?’ the answer is a resounding ‘No!’”

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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