QUILLEN ETSU PHYSICIANS EHR TEAM

Implementing Your Investment

Once you’ve purchased your product, it’s time for your team to begin building your system.  The amount of building that will be required depends upon a variety of factors: the software that you’ve purchased, the size of your organization, and the number of specialties within your group.

Building Your System.  Before you begin building, it is important to have a clear understanding of your organizational structure and each individual’s role within the group.  Each user will need to have specific securities and work views assigned, based upon their role in the clinic.  Front desk users, obviously, will need to have access to different parts of the system than the physicians. 

Assigning security sounds easy, right? After all, don’t all front desk employees do the same thing? Not in our experience.  Each office has a different workflow; a medical records employee in one office may also cover the front desk at times, or you may have one employee who does nursing and phlebotomy. The tasks that each individual performs on a daily basis will determine what their needs are within the electronic health record, and these will need to be clearly outlined before the build is begun. 

One of the most challenging elements of each ‘Go Live’ that we have experienced to date involves workflows. Every office has its own unique workflow, to which they are often quite attached (not surprisingly).  EHRs tend to throw a monkey wrench in even the most organized and well-planned office workflows.  Having one tech-savvy person in the office who understands the paper workflow, and is able to evaluate the necessary changes which will occur with the switch to EHR, can save everyone a lot of grief during Go Live. 

Evaluating your nursing workflow is one of the most important workflow decisions to make. Some of our practices have adopted team nursing rather than individual nursing.  Either nursing workflow can work effectively, but getting the offices to decide several months BEFORE Go Live makes the transition easier, as the office staff isn’t trying to adjust to new workflows at the same time as the new EHR.

The flow of messages, tasks, and lab results through the EHR changes the game plan, and if the EHR team knows the new electronic workflow in advance, they can build it into the system before Go Live.  Waiting until after Go Live and making last-minute changes causes chaos and confusion among office staff and the EHR team, and should be avoided at all costs.

Preparing for Go Live.  Long before the build is complete, you will want to begin making decisions regarding scanning and preloading.  Scanning the charts sounds like a simple thing, right? Believe it or not, there are a lot of decisions to make regarding scanning.

• Will the charts be separated into their various components and scanned into separate folders (i.e., notes, labs, procedures, etc.)?  Or will the entire chart just be scanned into one large archive folder?
• When do you start scanning? What is your time frame for getting all of your charts scanned?
• What will you do with the chart after it has been scanned? Keep it? For how long?
• What if the chart has already been scanned prior to Go Live, and the patient returns for an appointment? Or calls the office with a message?
• How many scanners will you need? How many additional employees?
• Would outsourcing be a more economical option?

Typically, people underestimate the time needed to scan all of the office’s charts, so speak to similar sites that have already transitioned to an EHR, to help you develop an appropriate plan of action for your practice. 

Preloading the patient’s charts is another critical element in most EHR systems. Preloading means taking all of the patient’s historical information (past medical history, active problems, family/social/surgical histories, as well as their current medications, allergies, and immunizations) and loading them into the EHR. This differs from scanning in that these items will now appear in the bulleted list format, which most EHRs require for linking problems with orders.

In all honesty, not getting data preloaded into the charts prior to Go Live has probably been our biggest Achilles’ heel for the first few sites that we implemented. Subsequent sites, which have had the luxury of time (and a nagging EHR team that wouldn’t shut up about the importance of preloading) have had a much smoother rollout, as the doctors didn’t have to load all of these items in during the patient’s first visit post implementation.

It may seem, once you have chosen your EHR system, that the decision-making process can stop, but in many ways, it is actually just beginning. Knowing your organizational structure, your workflows, and taking the time to scan and preload will go a long way toward ensuring a smooth implementation to your EHR.

The Quillen ETSU Physicians EHR Team consists of Monaco Briggs, Jennifer Logan, and Tracy Jones. Quillen ETSU Physicians is the multispecialty group teaching practice for Quillen College of Medicine at East Tennessee State University in Johnson City, Tenn.