How to Ensure a Successful EHR Implementation at Your Medical Practice

It took about six months to train the physicians and staff for EHR implementation at ophthalmologist Peter Polack's practice in Ocala, Fla. It also took about a year of planning and preparation prior to training. "A lot of people were asking why it was taking us so long," says Polack, who was writing about the process in an ophthalmology magazine at the time. "It's because that was our intention."

In total, all 11 physicians and 50 clinical staff members at the five-site practice learned to master the EHR. The success, he says, is due to the fact that they took their time with the process and formed a solid training plan. "If you don't have the right plan in place, if you don't have everybody involved, if you don't have buy-in from the stakeholders in the project, then you're going to fail," says Polack. "It's not like any other thing that you're going to do, so don't treat it that way."

Practices like Polack's that successfully implement EHRs know that adequate preparation and proper training is key. Here's how to launch a successful EHR transition at your practice.

Get a head start

Proper preparation for EHR training begins as soon as you identify which system you will be using at your practice, says orthopedic surgeon Eric Fishman, president and CEO of speech recognition software distributor 1450, Inc., and managing member of EHR Scope, LLC, which provides health IT consulting services to physicians. Immediately tell all staff members what system you will be using and when you plan to implement it, says Fishman, who is based in Palm Beach Gardens, Fla. Then, direct them to the EHR vendor's website to watch available videos and demos and learn more about the system. "There's a lot to be learned and it's impossible to learn all of it in a short period of time for most employees," he says. "Getting a head start is beneficial."

It's also a good idea at the start of the process to identify which staff members will play key roles in the planning and training process, says Polack. One is a "physician champion" who will motivate the other physicians. "If all the other doctors are supportive of this one doctor, then that creates a trickle-down effect as far as the attitude of the whole practice," he says.

Also, identify a staff member on the clinical side to "oversee" the training process. This individual should "work in concert with someone on the technical side of things - unless you have someone on the clinical side that has very good technical skills," says Polack.

Form a strategy

You also must determine what type of training to provide your physicians and staff. Depending on your vendor and your practice's budget, there will be various options available - from intensive one-on-one training with a vendor trainer to training that is solely Web-based. Of course, the more one-on-one vendor training your practice uses, the pricier the process gets.

Adina Friedman, medical marketing director for CTS Medical Software Selection Guides, a Rockville, Md.-based company that provides advice, reviews, and ratings of software, including EHRs, suggests looking for a mix between in-person training and Web-based training.

A smart option is to identify one staff member (or a few staff members if your practice is larger or if it is a multi-site practice) to receive vendor training, says Polack. Once this staff member - often known as the "super user" - is trained, he can assist with training the rest of the staff, and he can answer any simple questions that arise.

Prior to training staff members, it's crucial that the super user has a firm understanding of the EHR, says Fishman. As the super user learns to use it, he may realize that the system needs to be modified to fit your practice's needs. The super user can then arrange for the necessary modifications to be made early on in the process. That way, staff members "only have to learn [the EHR] once, in the way that it will actually be implemented," says Fishman.

The super user doesn't necessarily need to be a physician or administrator, but he should be a motivated tech-savvy employee who has some management experience, says Friedman.

Assess needs

Prior to training employees on the EHR, you must test their basic computer skills, says Polack, noting that abilities tend to vary widely among staff. At his practice, for instance, some of the older employees were unfamiliar with using a mouse and drop-down menus. "These are things that a lot of us that use computers know - and almost feel like we know intuitively - but you can't take those things for granted," he says.

Some of the "crucial" skills to measure are an employee's comfort level with using Windows, using a mouse, printing, scanning, and logging on and off a computer, says Suzanne Houck, president and CEO of Houck & Associates, a healthcare consulting firm in Boulder, Colo. If employees need a skills boost, the super user or another tech-savvy employee should conduct basic training, she says. "It becomes very expensive if you're trying to get people up to speed and blend that in with your EHR training."

Before training on the system begins, also assess the current high-volume work flow areas at your practice, says Houck. She suggests putting a flip chart in a staff area and writing down key work flow items, such as making referrals, ordering labs, and rooming patients. Then, ask staff to write down their responsibilities related to each item. Next, decide how, when, and who will complete these tasks in the EHR. "Planning upfront is really crucial in terms of mapping processes and deciding if you want to change them and optimize them," says Houck. Of course, a work flow assessment will also help you decide which staff members will be trained on what tasks.

Learn and explore

The actual training method you use will vary, of course, depending on the technique and type of trainer your practice has chosen. Regardless, staff members need to be trained on each of the modules of the EHR that match up to their responsibilities, says Houck. They also need some time to play and test the system on their own, then return to the module to reinforce what they are learning. At Polack's practice, for instance, he placed computers in a spare room so that staff could be trained there, and later during downtime, explore the system on their own.

Even if an employee will not be frequently using the EHR, there are some core things everyone needs to learn, says Houck, such as how to log on and log off the system. They also need to understand where the EHR and the practice-management system interface with each other, says Friedman. "Everyone has to have the big picture view and then it has to split off into function."

The duration of the training process will vary depending on your EHR and your practice, says Houck. "There are some really easy systems that people can learn in a day, and then there's some that take weeks, literally." When determining how much time to allocate to training, Houck recommends asking a practice similar to yours that has already implemented an EHR.

Test and assess

Just prior to your go-live date, the super user, or whoever has trained each employee, should assess trained employees' new skills, says Polack. That way you know who is ready for implementation and who needs a training refresher.

Then, top off training with a full-staff practice session as close to the go-live date as possible. At Polack's practice, all employees came into work the weekend before the system went live for a "simulation Saturday." Those who would not be frequently using the EHR posed as new and established patients, while those who would be using it more heavily moved the "patients" through mock visits using the system. It's a great way to "identify any problems with work flow and any technical glitches," says Polack. "You're always going to uncover something and that's the time to discover it - not on your go-live date."

Aubrey Westgate is an associate editor of Physicians Practice. She can be reached at aubrey.westgate@ubm.com.

This article originally appeared in the July/August 2012 issue of Physicians Practice.