Technology

On the front lines of EMR implementation

Several lessons helped ease the transition from paper chart and pen to an electronic medical record system.

BY MARTHA C. TELLO, BA, COMT, AND STEPHANIE D. MCMILLAN, MHA, COA, PLANTATION, FL

Anticipate spending more time with each patient during EMR implementation.

Although only two authors names appear on this article, electronic medical records (EMR) implementation at the Bascom Palmer Eye Institute in Plantation, FL, has been a collaboration among staff at every level. This article shares several of the critical lessons we learned, which helped us manage the ups and downs of EMR implementation.

The innovation and challenge of EMR implementation evoked different reactions and expectations among physicians, medical staff, and registration personnel in our multispecialty ophthalmology practice. To begin the process, administration identified a team of super users. This team included senior ophthalmic technicians who were computer proficient and had advanced degrees in education, business and healthcare administration. Everyone needed guidance!

As we proceeded, we understood the transition could represent fear of change, internal challenges, and difficulty in maintaining workflow. Among some staff, it was as if EMR threatened their positions. They questioned their ability to memorize, analyze, and follow the steps for successful implementation. From this, we learned two lessons:

• We would not speak about “how challenging” a new system could be. Even if only one staff member interpreted this as fear, their single voice could impact many others negatively.

• We needed to provide the appropriate tools — such as computer training, one-on-one sessions, and immediate feedback on errors — to help change the mindset of staff who resisted change. We carefully monitored these individuals’ progress by providing quality assurance.

Prepare prior to training

Before training, it is essential to set trainee expectations. For example, EMR training is not Ophthalmology 101 — that is, if you were not aware of how to perform a test, EMR will not suddenly make you proficient. Likewise, computer illiteracy can hamper your ability to traverse an EMR system.

Through multiple classroom sessions, the instructor should train staff to create templates and/or “smart phrases” (abbreviations for commonly used diagnoses and instructions). To understand the transition from paper to EMR, augment training with sessions on abstracting patient charts.

Training must also make staff aware of the patient benefits and financial implications of EMR.

Hold a scavenger hunt

Before the go-live date, consider holding a scavenger hunt. Include both simple and more difficult items or tasks. For example, we asked clinicians how to send an order for a test, where to locate scanned images and how to send communication to outside physicians. Assign your staff mock-patients to “work-up” in the system. This dress rehearsal helps in navigating your new EMR system, preparing the staff for the transition, allowing time for potential questions, and helping identify any bugs. The rehearsal might help adjust workflows. For example, during rehearsal, we identified ways to expedite patients scheduled for special procedures by placing future orders.

The dress rehearsal also helped calm the anxieties of staff who anticipated the real event.

Don’t sweat the small stuff

One common misconception of clinicians is that EMR will be faster than paper. We often hear the complaint that EMR requires “too many mouse clicks.” The challenge is not to focus on the number of clicks or the speed of your exam. These come in time. Focus on the quality of the documentation, set goals and provide instructions for your patients. Remember, your training, templates, and abstract charts will provide you with all the tools and resources needed to perform effectively and proficiently.

Educate ancillary staff

Ophthalmic ancillary personnel can provide considerable support to the practice in the transition from paper charts. In our clinic, for example, each technician plays a vital role in making the patient’s experience as fulfilling as possible. So we hold a round-table meeting where the ancillary staff can highlight their concerns. After go-live, consider weekly meetings. Here, our technicians share a “trick” or an “FYI” that they may have discovered during the week.

Regarding staff, expect hiring practices to change. For example, scribes will need extensive ophthalmic knowledge to not only transcribe findings and instructions, but also to anticipate testing and proactively foresee any orders. A certified ophthalmic assistant (COA) is critical in this role, as he or she will also be able to perform any ancillary testing, while having the ophthalmic background as your other technicians. In this role, the COA can help increase patient volumes and prevent medical errors.

In addition, computer literacy and troubleshooting are indispensable with EMR, and our hiring choices reflect this change.

Likewise, an individual with excellent computer skills, but no ophthalmic knowledge, will require arduous ophthalmic training. Ultimately, the physician is responsible for information written, but the scribe creates important notes. Having the wrong staff combination might create a bottleneck that could block the EMR implementation flow.

Long-term gains

After eight months, we can accurately quantify improved compliance with Meaningful Use and Medicare requirements, improved patient communication, and a more efficient method to quantify surgical results. We expect to see improved technician and physician productivity. Recently, we began using EMR reporting tools to investigate our wait times and report on follow-up appointments fulfilled.

Beyond staff training and preparation, we still need to take into account patient needs and volumes. We anticipated spending more time with each patient during the first few weeks of implementation. As we navigate the system, we may spend more time ensuring the patient has all the necessary treatment and that our documentation was pristine.

In the past, turning a page in a chart and having a pen handy was part of our daily routine. We could not fathom a change! Now, we can confirm that the latest advances in technology, like EMR, are here to stay and are transforming the way we perceive change in a clinical setting. OP

	Martha C. Tello, BA, COMT, is an ophthalmic technologist and clinical research coordinator with Bascom Palmer Eye Institute in Plantation, FL. She has a Bachelor’s Degree in Leadership and Communication from University of Miami.
	Stephanie D. McMillan, MHA, COA, is the lead ophthalmic technician and a clinical and informatics trainer at Bascom Palmer Eye Institute in Plantation, FL. She is currently obtaining her COT certification.