How to Ease the Pain of Launching an EHR

A new booklet from NORCAL Mutual Insurance Company provides invaluable tips for any practice about to make the daunting transition from paper charts to an electronic health record (EHR) system. “Your Electronic Health Record System: How to Purchase, Implement and Optimize” is now available either electronically or in hard copy to NORCAL policyholders.  For physicians not insured by NORCAL Mutual, here are some of the most important suggestions.

Before purchasing an EHR system there are some things you will need to consider. An EHR system is a big investment, and you should take your time to ensure that you not only choose the right system for your practice but are also ready to implement it. Careful deliberation may prevent you from making a hasty decision that can result in the need to purchase a modification, interface, or entirely new system a few years from now. Selecting the correct EHR for your practice the first time around will save time, money, productivity and lots of aggravation!

We recommend that your practice undertake a needs assessment, a readiness assessment and a workflow analysis as the first three steps in your EHR selection process (there are samples of each of these tools in the booklet). Completing these steps first has been shown to provide for a more successful and stress-free selection and implementation of an EHR system.

You will also need to consider the various EHR systems on the market and their capabilities; the vendors; your budget; HIPAA/security issues; and, in the event you want to qualify for one of CMS’s EHR incentive programs, whether the system you are considering can meet Meaningful Use requirements.    

The Contract

Once you’ve selected your EHR system, you need to negotiate a contract. This may be the most important part of the overall process of acquiring and implementing an EHR system. Both you and the vendor will be bound by the terms of the contract, so you need to be sure it provides for all your needs. It is recommended that you consult with your organization’s business attorney to assist you with reviewing the contract.

When contracting to buy an EHR you need to establish business terms; examine key contract issues; review all terms and conditions; negotiate to resolve any contract issues; and control any risk the contract/EHR presents to your practice.

The Launch

Now that you’ve selected an EHR system for your practice and signed the contract, you are ready to implement it. The many steps in a successful EHR implementation take from 12 to 24 months or longer to complete. Having a positive experience with the EHR early in the implementation phase (an “early win”) can help staff see the benefit of the EHR and boost employee morale, as well as help staff members, reluctant to use the EHR, get onboard with its use.

The ultimate success of your EHR implementation depends on the workflows you create and the communication and training you give to your staff, not on what system you have chosen. You should try to accommodate the system to your practice’s workflow, rather than making your workflow adapt to the system. Try to not let the system’s capabilities and templates dictate your workflow or what tools you use. At the same time, realize that your paper-based workflows will need to change under the EHR. Your goal should be to create new workflows that accommodate both the practice and the EHR.

The timeline, checklists and steps for each practice’s implementation phase will vary, but your focus should never stray from ensuring that the quality and integrity of the health record remains intact during the transition to an EHR.

There are many parts of an implementation that you will need to address, including:

• Implementation team.

• Implementation approach.

• Beginning implementation.

• Preparation and communication.

• Workflow analysis.

• Transitioning from paper to EHR.

• Testing.

• Preparing for and “Going Live.”

• The time period after implementation.

Tuning Up the System

After the time-intensive process of purchasing and implementing an EHR system in your practice, you may be tempted to take a break from thinking about it, but your work isn’t done. Now that the system is up and running you will need to evaluate how well it is working. You will need to make any necessary adjustments to workflow, templates or other systems issues, as well as conduct additional training for those staff members who aren’t using the EHR to its full capacity.  

You should anticipate that after the excitement of implementation has worn off, staff may enter a period of disillusionment as they use the EHR full time. After all, the period after implementation is when problems may surface, and staff may try to find workarounds to solve them. Be on the lookout for staff who may have missed or forgotten portions of training, or others who just don’t want to use the EHR to its full capacity and are finding other ways to get their work done.

These issues need to be caught and addressed as quickly as possible — having staff that aren’t using the EHR correctly or are not entering the required information into the EHR can compromise patient safety and cause liability exposure to your practice.

Kirsten Padgett is the Business Development Manager for NORCAL Mutual Insurance Company. NORCAL Mutual policyholders can request a copy of “Your Electronic Health Record System: How to Purchase, Implement and Optimize” by calling the NORCAL Mutual Policyholder Services Department at 877-443-7232.  An online version of the document, as well as other EHR resources, can be found on the EHR Tools page under the Risk Solutions tab of MyNORCAL, the policyholder-only section of www.norcalmutual.com.