By Jessica Kojima, vice president of professional services, AdvancedMD.
Medical providers often battle inefficient and piecemeal software configurations that constitute the technological lifelines of their practices. Even if current solutions aren’t integrated to meet their needs, they sometimes feel it is easier to stick with what they’ve got instead of considering the possibility of upheaval.
Staying current—or better yet, striving for innovation—often comes at a price of temporary disruption for providers and staff. But if a new electronic health record (EHR) and practice management (PM) system are implemented with proper planning and stakeholder buy-in, the practice can realize true efficiency without substantial disruption.
Here are three best practices for implementing a new EHR or PM system for medical practices to minimize disruption.
Consider the big picture
Before the EHR/PM implementation process kicks off, the practice should assess the effectiveness of its clinical and administrative workflows. A practice that wants to cram a new EHR or PM into an existing workflow that isn’t working is thinking short-term. It’s important to consider “big picture” goals and aim to improve bad processes and optimize productivity. An effective approach will realize efficiencies across an entire practice versus one function or role. By considering the importance of productivity optimization across the whole operation, a holistic and integrated approach will enable growth and improvement for both patients and staff.
Preparing for payer migration
While considering the practice’s overall goals, the practice must also perform a payer analysis. A new PM system will require new Electronic Data Interchange (EDI) agreement enrollments to electronically submit and receive claims, remittance, eligibility, and claims status, which differ from payer to payer. This is often a forgotten aspect of moving to a new practice management system, and is arguably the most critical change. The practice should have the following items ready well before implementation:
List of payer IDs as they are credentialed. This information can be found by reviewing how the practice submits and receives electronic transactions currently, or by contacting the payer directly.
The official name as credentialed.
Understand if the providers are credentialed as a group or provider.
National provider identification (NPI) number.
Many payers also require online registrations, voided checks, letters on specific letterhead—to name a few—to process an agreement. This demands timely attention by a designated individual in the practice for a seamless enrollment process. The practice should also set a “go-live” date to start submitting transactions through the new system. Preparing adequately in the weeks ahead of implementation will enable a timely kickoff of the new system.
Focus on people
Instinctively, an EHR and PM implementation might seem to be all about the software technology. Not so: it’s about the people. It’s vital that a medical practice identifies an implementation champion who will be responsible for both supporting and managing the transition. Depending on how aggressive the go-live goal is, the practice may need a practice management and a clinical champion to ensure all of the configuration and training occurs simultaneously. The champion’s role is to listen to every staff member affected by the transition and communicate openly with the team about why the switch is being made and how the leadership will support them. Ideally, everyone agrees on the approach, objectives, and expected outcomes.
The implementation of electronic health record (EHR) is not a new thing in the industry. The digital wave has completely transformed the way medical records were maintaining before and now. With increased demand for efficiency and faster solutions, more and more medical practices are embracing EHR to simplify and organize their data storage process. Initially, many providers were reluctant and hesitant to use EHR. However, with Medicare and Medicaid incentive programs, providers are encouraged to adopt EHR. As a result, since the time EHR implementation began in 2009, around 73 percent of providers have registered for the EHR incentive program.
However, still, some challenges hinder EHR adoption and slow down the process for many. The initial implementation may be easy, but the user experience was not a good one for many.
Here are some of the obstacles that medical practices, healthcare professionals and others from the healthcare industry face while leveraging EHR:
My time spent with a major EHR vendor was to educate members of the healthcare community (physicians, nurses, practice leaders, hospital administrators, etc.) and the general public (patients, consumers, people like you and me) about the benefit of electronic health records and how to navigate the EHR implementation process.
As you can figure, most of the talking points included operational efficiencies of the systems, how practices could improve their practices and save money without paper, how they could create the opportunities for bringing in more patients by using EHRs, and so on and so forth.
What is rarely talked about by the vendor community (and given my former seat at the messaging table, I think I’m qualified to make this statement) is the inherent challenges faced when implementing an electronic health record system.
That said, the following are some of the biggest hurdles practice face when they begin the EHR implementation process:
Training: You need training of your system. You need more than eight hours. You need more than 16 hours. Implementing an EHR is a major undertaking and it can take months, if not longer than a year, to truly implement. Even after that, you may need additional training.
Don’t make the mistake of contracting for the least amount of training offered by your vendor. Don’t be fooled into thinking less training means you’re saving money. The money you save on training now will be spent later when your staff fails to truly understand how to use the system. Purchase more than enough training and consider training super users who become true experts in the use of the electronic health record.
You must make sure you secure internal buy in. You need to establish an education program for your staff and create communication channels for your staff so that you can ensure the greatest level of buy in. during this process, explain the needs for the system and why the practice is moving in this direction. If this is a re-boot for your practice and you’re implementing a second or third system, discuss the reasons for the change and why it’s important to the health of the business.
Like employees, you must educate patients. The importance of this statement has never been as true as it is now especially give the move toward patient engagement through meaningful use Stage 2. Engaging patients in the EHR implementation will help create external advocates for your practice, as well as will lead you down the road toward educating them about the benefits of tools like patient portals. Education is key here. Work to create patient champions. Do not brush them off as individuals who are either not interested in the technology or as unsophisticated enough to understand the scope of your work. Doing so may lead to an epic fail of your long-term plans for a unified, smooth running, meaningful used practice.
Lack of a pre-implementation plan may kill the project from the start. An implementation plan means you’ll be able to perform a workflow analysis. Workflow analysis reveals practice inefficiencies and provide you insight into where you need to focus your efforts during implementation efforts. An implementation plan allows you to redesign processes, look for ways to create additional practice efficiency, increase patient and staff satisfaction, and align your goals with your long-term practice plans.
Lack of vendor transparency. Those who don’t seek it may find themselves owned by their vendor partners. You must ask questions, demand answers and don’t take their word for it. Vendors want long-term contracts that are sometimes as gray as possible. Review the contracts, never treat vendors as your friend (or, at least during the negotiation process) and ensure the best deal for your practice. Seek optimizations and customizations. Ask for referrals; call the referrals. Go on site visits, but make sure they’re not all hand picked by the vendor. To accomplish goal, consider reaching out on the web and aligning with practices in your area that use the system you’re thinking of purchasing. Do some independent research.
Un-needed long-term vendor contracts. Don’t sign long-term contracts unless it makes absolute sense. Some vendors require contract lengths in unreasonable lengths of time, like seven years. Granted, implementation is a major undertaking, but a seven-year contract is unnecessary and only serves the vendor. Be cautious of a deal of this magnitude. You wouldn’t sign a seven-year lease for a car, a property or anything else. Take a vendor move like this as a sign the vendor has plans to lock you for its own personal gains – to make itself attractive to potential buyers or to boost quarterly reports – not your own.
In taking a look around the HealthIT.gov site recently, I once again stumbled upon its series dedicated to offering practices insight into how to implement an EHR. A several part series, topics included cover what to look for when selecting a product, how to conduct training and, ultimately, how to reach meaningful use.
Given that nearly 50 percent of all practices currently have some sort of EHR, the process for setting up and implementing the systems are becoming more well known; however, having a clear plan and getting a little advice goes a long way.
So, without further ado, the following information is valuable and bears repeating, at least in part, even if you heard some of it before.
When starting an EHR implementation, a practice should assess its wants and needs. Keep in mind that no implementation is going to go completely smoothly (or at least as smoothly as imagined) so it helps to have a plan for what to expect and the plan should include room for error. Figure 10 to 15 percent in added time, resources and staff commitment over and above what you originally plan.
During the assessment, there will be some error and a few hurdles to jump. Don’t allow yourself to be told otherwise. If someone tries to tell you differently, that person does not have your best interest in mind.
If it’s a vendor, run. Do not purchase the product from the company because it’s only the beginning of what’s likely to be a long road of misinformation and false expectations. And no one appreciates being snowed, especially when you’re spending money on something.
Asking yourself questions
During the assessment phase, you also need to determine if you are even ready to implement a system, and if not, what more you need to accomplish. Assessments are designed to answer the “why” of implementing an EHR, and what is working and can be improved by installing one.
According to HealthIT.gov, “practice leadership and staff should consider the practice’s clinical goals, needs, financial and technical readiness as they transition.”
The site provides the following questions that practice leaders should consider during the process:
Are administrative processes organized, efficient and well documented?
Are clinical workflows efficient, clearly mapped out and understood by all staff?
Are data collection and reporting processes well established and documented?
Are staff members computer literate and comfortable with information technology?
Does the practice have access to high-speed Internet connectivity?
Does the practice have access to the financial capital required to purchase new or additional hardware?
Are there clinical priorities or needs that should be addressed?
Does the practice have specialty specific requirements?
What will the future look like?
Next up, it’s time to envision the future. Think about what you want to accomplish with an EHR, and write as part of your plan some things like: how are patients going to benefit, how can the care provided be better and how are providers’ lives going to change?
Finally, set some goals. According to HeathIT.gov, “goals and needs should be documented to help guide decision-making throughout the implementation process. And they may need to be re-assessed throughout the EHR implementation to ensure a smooth transition for the practice and all staff.”
Goals guide an EHR implementation, and are set once an assessment has been completed. As in life, goals provide an achievable end to an arduous task; the medal at the end of the race, if you will.
When developing goals for the implementation forgo conclusions like trying to determine what amount of savings will be created or how much of an increase in the number of patients or revenue will come into the practice. For now, these are intangible and often create a sense of failure if not immediately met after the EHR is “turned on.”
Keep the goals more process oriented and related to practice strategy and team building. For example, what goal do you have for the transition team? Do leaders emerge? Do advocates and coaches come to the forefront of the team that you had not expected? What practice visions are realized? Are you now more technologically savvy and able to attract better talent to the organization?
Perhaps you have business goals (other than the aforementioned money goals). Do you have a stronger business-planning process and clearer organization objectives now?