EMR Implementation

Jacob PersilyNovember 20, 2014

EMR Implementation

• The process of a medical facility putting the usage of an electronic medical record system into place for daily use

The Steps to a Successful Implementation

1. Assess your practice/facility readiness2. Plan your approach3. Select or upgrade to a certified EHR4. Conduct training and implement EHR5. Achieve Meaningful Use6. Continue Quality Improvement

Selection

• RFP• Narrow to Top 3

– Vendor Demonstrations– References– Availability of Training and On-going

Assistance

Training

• Initial– Online– In Person– During Go-Live Week

• On-going

Implementation Models

• Parallel Approach• Phased Approach• Pilot Approach• Cutover Approach

The Go-Live Period

• Often, things don’t go as planned.– 96% of physicians cited excessive time to

implement– 89% noted disruption in practice– Only 37% said they were truly ready for the

Go-Live date

Scribes

• “A Medical Scribe is essentially a personal assistant to the physician; performing documentation in the EHR, gathering information for the patient's visit, and partnering with the physician to deliver the pinnacle of efficient patient care.” –ScribeAmerica Definition of a Medical Scribe

The Benefits of ED Scribes

• St. Peter’s University Hospital, New Brunswick, NJ

•  8.52 percent improvement in average patients per hour

• 87.2 percent improvement in down-coded charts

My Experience with Go-Live

• Scirbes are meant to be a helpful part of the EMR Go-Live process.– It really doesn’t help if the scribe has not seen

the EMR software until they are working in the ED.

– 120 hours of training in 40 hours, with no hands-on software training

TAPS EMR

• Physican Documentation System for use in the Emergency Department

• Endorsed by ScribeAmerica

Issues with TAPS

• Using a Tablet software on a Laptop• A software that relies on right/left click

does not work well with a stylus• Template Flaws

– Tonsillectomy• Spell Check

Hospital Case Study

• Dr. Eric Persily, President, General Anesthesia Services, Inc., Chief of Anesthesia, Charleston Area Medical Center

• EMR: Siemens Soarian Clinicals• “Our hospital implemented Soarian about ten years ago. 

At the time, we were promised it would never go down; of course, that hasn't proven to be true…We are literally the first hospital to use this system so they have customized it for us, but there were a lot of bugs at first. I wish our hospital had used an established system.”

Psychiatric Hospital Case Study

• Cynthia Persily, Ph.D, MSN; President and CEO, Highland Hospital Association

• EMR: Netsmart MyAvatar• “Our implementation has been less than smooth. We

have been working with the company since 2011 and thus far have spent about 500k on implementation, not counting the time and cost of my staff and loss of productivity. We just began implementing in our outpatient department in January 2014. We are intending to implement in our hospital  beginning in January 2015.”

Problems to Learn From• 1. We have had 5 project managers from the company in

the last 3 years and are staring with a new one now. Every time we get a new PM, we get a new team, and we have to start over essentially teaching them our health system and our needs. This has increased our time, costs, and frustration.

• 2. Promises made are not kept. Contracts are 40-50 pages long with multiple addendums and it is difficult to keep track of where we are (by design I believe).

• 3. Reports are difficult to access so difficult to use to analyze quality, etc using the EMR data.

A More Positive Example

• Dr. Jerry Weissman, Associate Professor, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital

• The major implementation of our current system called Quadramed was several years ago with periodic additions and modifications. Between formal classes and plentiful onsite assistance at times of major changes and an ongoing 24 hour telephone help desk the implementation has been relatively smooth effective. We are now preparing to switch to a new system called Epic with intensive input from the clinicians which ,hopefully will result in a user friendly system.

The 7 Deadly Sins of EMR Implementation

1. Not doing your homework2. Assuming the EMR is a magic bullet3. Not including nurses in the planning process4. Not participating in training5. Thinking you can implement the same processes as

paper6. Not asking for extra help7. Being shortsighted

Any Questions?

References• http://www.healthit.gov/providers-professionals/ehr-

implementation-steps• http://medicaleconomics.modernmedicine.com/medical-

economics/content/tags/ehr/ehr-best-practices-surviving-go-live-stage?page=full

• http://www.beckershospitalreview.com/capacity-management/are-medical-scribes-worth-the-investment.html

• https://www.scribeamerica.com/what_is_medical_scribe.html• http://www.healthcareitnews.com/news/7-deadly-sins-emr-

implementation?page=1• Course Textbook• Personal Interviews