An EHR system may take time to implement, but the benefits are well worth the investment for healthcare facilities.
- Electronic health record (EHR) systems are essential to provide the highest quality care while maximizing profits.
- The implementation process can take time, but the benefits of electronic medical records (EMR) over paper records far outweigh the costs.
- Including your staff in the decision-making process can help your organization adopt an EHR system quickly and efficiently.
- This article is for healthcare administrators who want to know each step of the EHR implementation process.
The healthcare industry's transition from paper records to electronic medical records (EMR) has been a rocky, winding road. While electronic health records (EHR) systems have been the bane of some healthcare providers' existence, their implementation is essential to maximizing profits and delivering a modern standard of care to your patients.
Fewer stages of the EMR adoption journey are more arduous than the implementation phase. This phase is where the most problems occur and where shortcuts could lead to catastrophic issues later on. A botched EHR implementation can damage your revenue cycle for months, reduce patient confidence and harm your relationships with other healthcare providers. Moreover, a failing implementation might cause you to incur penalties from the federal government if your interim recordkeeping doesn't meet regulatory standards.
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What is EMR implementation?
EMR implementation refers to the integration of software into a healthcare organization's workflow. Steps in this process include selecting and preparing the EMR software, ensuring compliance with privacy and security, training the care team, and troubleshooting any issues that arise. Taking the time to implement EMR thoughtfully will help smooth the transition and benefit your practice, your patients and your staff.
While some providers may be concerned about the costs and time associated with EMR systems, their implementation is vital to improving both patient care and efficiency within a practice. EMRs have been shown to increase quality of care, patient outcomes and safety, as well as enhance communication between patients and providers. EMR systems also streamline scheduling and patient data management processes, thus freeing valuable time for healthcare providers.
Key takeaway: Preparing and implementing EMR software takes time and money, but it can vastly improve an organization's efficiency and patient care outcomes.
How long is the implementation process?
The EMR implementation timeline will vary based on several factors, including the complexity of the system, the size of your organization or practice, and the location of the server (cloud-based versus on-site). As a general estimate, a healthcare organization can set up a novel EMR system within a year. EMR implementation for smaller practices (or modifications of an existing system) may take six to nine months, and cloud-based systems may take weeks rather than months.
Key takeaway: The size of your organization and the complexity of your existing system are two primary indicators of the time commitment required to implement an EMR solution. Generally speaking, most facilities will be up and running in six to nine months.
Steps of implementation
1. Plan your implementation EMR road map.
The first step of implementing an EMR system is creating a checklist of all the steps you anticipate will need to be completed. Consider carefully who will need to complete which task, such as your healthcare providers, managers, IT staff and patients.
Critical tasks include stakeholder recruitment, budget planning, scheduling implementation, transferring data, providing training and live testing, and establishing go-live activities and metrics for success. Collaborative project management software, such as Google Sheets and Trello, can be an especially helpful tool in developing a road map.
2. Define your budget.
The exact cost of EMR implementation will depend on both the software's features and the size of your organization. Hardware and network upgrades, vendor training and consultant fees, data backups and storage, and cost per employee can all affect your costs.
You also should consider the initial loss in productivity that comes in the early stages of EMR implementation. Providers and staff will need dedicated time for training, which may come out of their patient care hours, and they may require time additional time beyond that to adjust to the new system. Once the system is fully implemented, however, your organization can benefit from a more streamlined workflow and overall increased productivity.
3. Configure the EMR system.
The first step in setting up a new EHR is doing a system configuration, which is essential to accurately represent the details of your medical practice and your patients' information within the software. That means programming in the location(s) of your practice and the providers who will be using the system. You also need to design your practice's clinical workflow, which includes the creation of clinical templates. Templates are required to meet Meaningful Use and Physician Quality Reporting System standards outlined by federal regulations. Following those rules is critical to ensure your practice does not incur Medicare payment penalties.
During the system-configuration phase, your EHR will be integrated with your practice management (PM) system if it is not already. Also, any data stored within your old system will be migrated to the new one in this phase.
"An important component of putting a complete PM and EHR system in place is conducting a data import from the legacy system to the new system," Adam Siegel, an EHR consultant, told Business News Daily in an earlier interview. "A new software system will not automatically convert patients from one system to another. This is a complex process that must be facilitated by technical experts."
4. Begin enrollment and credentialing.
Enrollment and credentialing, which details how you are paid, depends to some extent on the responsiveness of the payers. At best, changing payer enrollment from one PM system to another will take a couple of weeks, and at worst, the process can drag on for a few months. It's imperative that you include enough time in the implementation process in case the enrollment and credentialing step takes longer than expected.
"Enrollment and credentialing is critical for accurate and consistent payment from insurance companies," Siegel said. "The process can be drawn out depending on payer responsiveness and if the practice is represented as a group or individual providers."
Getting this step right is crucial to ensuring smooth operations for your future revenue-cycle management, including the receipt of accurate, consistent and timely payments from insurance companies. Still, you won't want it pushing back your "go live" date, which would hinder your medical practice's operations.
5. Optimize the workflow.
Outline each step of your organization's current workflow, then ask the following questions:
- Is it necessary?
- Does it add value for the patient?
- Is it being done in the right order and by the right person?
For certain processes that are done by a physician, ask the following questions:
- Does this require a physician's skills or training?
- If not, can someone else complete this task?
By optimizing your workflows before EMR implementation, you can increase the likelihood of a smooth rollout and minimize any inefficiencies in the use of EMR.
6. Train your team.
Even the best software on the market is useless if staff isn't trained on how to properly use it. Training will vary based on your practice's specific workflow, the different roles of your staff members and their preferences on how to engage with the new system. There are several different ways to bring staff members up to speed, but the key is to begin training a short time before the new EHR goes online so staff members retain as much of the information as possible.
"Training is best done within a couple weeks of the go live date," Siegel said. "This ensures that new workflow and process will be fresh in the minds of the staff. … Staff interact with their [practice management] and EHR systems constantly, and it's important that they adopt the new system and look for ways to use it as efficiently as possible."
Training options range from self-paced distance learning, which is the most affordable and simplest, to on-site, instructor-led training, which is a comprehensive, in-person program. Self-paced distance learning involves reading user guides and watching instructional videos. Of course, on-site training costs more, since a professional integrator must travel to your practice to train your staff, but in-person training can provide your staff with one-on-one time with an experienced instructor who knows the ins and outs of the new system. Siegel recommended choosing less-robust training methods for practices with a smaller staff and going with on-site training for large practices or hospitals.
7. Troubleshoot the system and mitigate risk.
EHR software is complex and far-reaching, so be prepared to engage in troubleshooting and risk mitigation. As Siegel puts it, "The implementation process as a core principle involves stopping revenue through one channel and restarting it through another."
Naturally, this is a delicate and risky thing to do. Here are a few suggestions to protect yourself against some of the potential issues surrounding implementation:
- Choose a system with a friendly user interface. Any EHR system can either streamline or hinder operations in your medical practice. To ensure the new system has the desired effect, make sure the user interface of the system you choose is intuitive and simple to learn. This will help make the transition easier for your staff and increase the effectiveness of your system, all without depressing productivity.
- Include your staff in the decision-making process. The best way to determine how prepared your staff is to adapt to the new system is by including them in the decision-making process. Do they find certain interfaces friendlier than others? What does their preferred workflow look like? What kind of training would they find most helpful? These questions can help you choose a system with your staff in mind and make adoption of the new system much easier for them in the end. Involving each of the different departments in your practice during the decision-making process provides invaluable insight when making a final choice.
- Integrate all software with your new PM/EHR system. "Many practices use additional software products to provide the full spectrum of solutions needed to run an efficient modern medical practice," Siegel said. "This starts with integrating any additional systems with the new PM and EHR software. Products like appointment-reminder systems and interfaces with lab and imaging systems are critical to practice efficiency and shouldn't be overlooked during the conversion process."
- Honestly assess your practice before implementation begins. Providing an honest and accurate assessment of your medical practice's current finances, workflow and capabilities is a major part of devising a successful implementation. Through this assessment, and during the development of clearly stated future goals, a practice's administration can more effectively set and track metrics of success for the new system.
"A practice should have a clear understanding of how their complete practice will operate on the new system by the time they sign the contract and begin the implementation process," Siegel said.
The payoff of a fully implemented EHR system
At the end of the implementation process, your practice will have a fully functioning, modern EHR system that will hopefully improve both the quality of healthcare services you provide and your practice's profitability. Most practices implement new software only once or twice, and if it's done right, the rewards are exceptional.
Some of the benefits your practice should realize are:
- A more optimized day-to-day workflow and friendlier user experience
- More efficient, timely and comprehensive medical care for patients
- More complete documentation of patient visits and rendered services
- Greater patient satisfaction due to decreased wait times and simplified billing
- More efficient scheduling and increased appointments, as well as reductions in no-shows and cancellations
- Increased revenue and claims accepted by payers on the first submission, as well as a reduction in the amount of aging accounts-receivable in collections
- Improved connectivity with labs, hospitals and specialists that work with your practice
"By visualizing a modern medical practice and putting in place the right tools to manage it, a practice can put themselves in a grounded position of system optimization and excellence in performance poised for future growth," Siegel said.
Key takeaway: Although EMR implementation requires a time, energy and monetary commitment that may seem daunting, the many benefits of these systems far outweigh the costs.
Additional reporting by Sean Peek. Some source interviews were conducted for a previous version of this article.
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