The Administrator’s Desk: Selecting an EMR

The physicians in your practice are ready to explore the new frontier of electronic medical records. And you, they assume, are just the person to take them there.

Makes perfect sense. What with your business background, limited grasp of IT capabilities, and utter lack of time to devote to another project, who better to analyze the more than 400 different EMR software products available and ferret out which ones will best serve the needs of your clinical and administrative staff?

“Choosing an EMR vendor is a career-defining decision,” says Sue Hertlein, senior consultant for The Coker Group, an Atlanta-based healthcare consulting firm. “Let’s face it, whether you are an administrator or a physician, your job is to provide quality service to patients. You may not have any experience in healthcare IT at all. It can be very daunting, even for an expert.”

Oh, and no added pressure, but choosing the wrong EMR can drive your practice into a financial - and administrative - tailspin. More than 30 percent of The Coker Group’s consulting business is devoted to helping physician practices dismantle recently purchased EMRs they were unable to implement on their own - because of improper selection, insufficient staff training, or an unwillingness to change.

Don’t go it alone

As the most likely “designated project manager” for your practice’s EMR transition, you play the most pivotal role in helping to ensure that your business selects an appropriate system and implements it successfully. That requires input from others throughout the process, says technology consultant Rosemarie Nelson. “You can’t be the one to choose,” she says. “But you do want to make sure the group makes a good decision.”

Practice administrators who select and implement EMRs without soliciting feedback from their higher-ups often get pushback from clinical staff after implementation. “They’ll say, ‘Well, you picked this one, not us,’ and then you have a big problem,” says Nelson. So appoint a responsible medical assistant, nurse, or lab technician - anyone who can give you inside knowledge of how the clinical team interacts on a daily basis - to help you. “You may not have clinical expertise, and that makes it harder to anticipate the potential of what some of these EMR systems can do for a practice,” says Nelson.

Do your homework

Of course, you’ll want to research the pros and cons of each product you are considering and then coordinate demonstrations from the vendors of your top choices. “Read as much as possible from unbiased sources,” suggests Hertlein. “Talk to your peers who have already implemented an EMR. … Ask them what they learned, what they did that was right, and what part has been an absolute nightmare.” Once you’ve narrowed your field of potential vendors even more, visit several practices within your specialty that are already using those products, and ask them how it’s going. “Talk to the people actually using the software, not just the physicians,” suggests Hertlein. “Ask them if they were able to stay on deadline and on budget.”

And don’t forget that part of your role is also to steer doctors away from systems that simply do not meet the needs of your specialty, size, or goals. “Practice managers should have a big enough view of the practice [to determine its EMR needs] and also understand what the issues are with some of the vendors,” says Nelson. “Doctors may get excited about the bells and whistles from one vendor, but they need to be directed so they don’t pick a solution that’s not going to work for them.”

Between the software selection process, staff training, and the inevitable IT hiccups that will arise, implementing an EMR can drag on for months, even under the best-case scenarios. To minimize any subsequent revenue loss, maintain a detailed schedule that takes into account each step of the process, including research time, vendor demonstrations, site visits, physician input and feedback meetings, product selection, software (and often hardware) implementation, staff training, and follow-up meetings.

The deadlines for training should especially be clearly communicated and adhered to. “A good vendor is going to put together an implementation timeline, and there are going to be assignments,” says Hertlein. “[The plan] will state that they are responsible for doing certain things by a certain date, and the practice is responsible for doing their part by the deadline. This is a dual responsibility.”

Be the cheerleader

Throughout the EMR buying and implementation process, don’t forget to keep a close eye on office morale. Both clinical and clerical staff often resist change. Some fear they may lose their jobs. Others may be anxious about having little experience with computers. “When nurses start grousing about the project, you really need to champion that process by being the cheerleader and making sure there are not any bumps in the road,” says Nelson.

Hertlein agrees: “The key to success is educating your staff and getting them psyched. In some areas, after an EMR is implemented, the roles of employees change significantly.” Address fears by explaining to staff their new roles before implementation, and explicitly tell them how they fit into the grand scheme of what will likely be a new office dynamic.

Automating your office’s workflow with an EMR can deliver enormous benefits, eliminating repetitive tasks, streamlining billing, and freeing more physician time to focus on patient-centered care. But it’s also a major undertaking for which practices - and the administrator in charge - must prepare with research, staff involvement, and a strong commitment to making it work.

Shelly K. Schwartz is a freelance writer in Maplewood, N.J., who has covered personal finance, technology, and healthcare for 12 years. She can be reached via editor@physicianspractice.com.

This article originally appeared in the March 2008 issue of Physicians Practice.