Upgrading Your EHR

As strong a proponent of electronic health records as I am, I do see one major benefit to staying on paper - paper never requires an upgrade. Electronic records, on the other hand, are anything but static and require regular upgrades. This may not seem like a major issue, but having personally experienced the disruptive effects of an upgrade in my practice, I can assure you that proper planning and forethought can greatly reduce the disruption it can bring.

Don't confuse an upgrade with an update to the EHR. In general, updates are changes to drug lists, ICD-9 codes, and fixes of minor bugs - updates don't change the day-to-day operation. Upgrades, on the other hand, are bigger changes that address features of the product (much like the difference between Windows Vista and Windows 7).

Why upgrade? Why not just stay with the previous versions that are working? There are several important reasons:

• Support - EHR vendors only support a few of the most recent versions of the software, so having an old version may leave you unsupported.

• New technology - Faster computers and new technology like smart phones spur EHRs to change. This makes your product more powerful and accessible.

• Evolution of the product - No product is perfect out of the box, and any good vendor will address deficiencies in the product. This is done through upgrades. My practice's most recent upgrade was necessary so we could have access to the HITECH money offered by the government.

But for all the necessary changes addressed in new upgrades, they can also be quite disruptive. Practice work flow will need to be changed to take advantage of new features, and many of the improvements made to your EHR system can have unintended negative consequences. In truth, the upgrade process should be handled like the initial implementation - with advance planning and preparation.

Here are some guidelines to make the process as smooth as possible:

1. Find out what's different

The first step is to see what changes this upgrade will involve. Some upgrades are minor tweaks that will not affect practice work flow much, while others will make huge changes. Questions to ask yourself and the vendor include:

• How will the upgrade change the way things are done now?

• How big of a disruption will it bring to daily practice operations?
• Which staff members will be affected by this upgrade?

• Which staff members stand to gain the most benefit from the upgrade?

• Which staff members will experience the biggest disruption to their work flows?

2. Run the demo

Many of the EHR vendors will have demos of the upgrades that allow users to experience firsthand what changes have occurred. I highly recommend having people from different parts of your office run the demo to see how it affects them.

Then make a list for each role in your office, grading the effect of the change:

• Does this upgrade bring benefits that could speed up work flows?

• Does this upgrade make any tasks more difficult?

• How big of a change is it?

• How disruptive will it be?

3. Plan for the upgrade

Once you have determined the impact, planning can begin. Here are the areas for planning:

• Hardware - Will this require upgrading computers? Plan for the expense.

• Upgrade time - Will the system have to be down during the upgrade process? If so, when can it be done without hurting income?

• Support - How does the vendor work with you on upgrades? Do they do all the work, support you during the process, or are they just available if there is a problem?

• Impact and retraining - The workers with the least impact will require the least retraining, while those with the biggest impact will need the most attention. Don't spring upgrades on your staff. They need to be prepared for any changes that occur. Ideally, all of your staff should test-run a demo version of the upgraded EHR. This obviously is not necessary if the upgrade is minor.

• Change scheduling if necessary - If the upgrade is big enough, it may be wise to schedule less patients when the upgrade goes live.

4. Pick a date to go live

You can only prepare so much - ultimately, the only way to know the real effect of an upgrade to your EHR is to experience it in the heat of a busy day. Expect complaints, frustration, and surprises, which show up in proportion to the impact of the upgrade.

People don't like change, even if that change is good, so don't fret at the moaning and complaining. Users have no choice but to adjust to the changes and soon will see it as normal.

Robert Lamberts, MD, who is board-certified in internal medicine and pediatrics, practices in Augusta, Ga. His practice won the 2003 Davies Award for outstanding application of IT in a primary-care setting. Dr. Lamberts can be reached at rob.lamberts@gmail.com.