Respondents also cried out for products that really, truly provide for continuity of care from hospital to practice to the ED — products that are intuitive and user-friendly yet easy to customize.
Most products don’t seem to meet these needs, at least in our readers’ eyes. But it’s worth noting that it’s not impossible.
David Willis, a family physician, told us how he and others are making the future real down in Ocala, Fla. Willis is with Ocala West Family Medicine as well as medical director for Healthy Ocala, a health information trust. He describes Healthy Ocala as a “grassroots effort to establish a health records exchange.”
Basically, the idea is to provide one portal that lets physicians in the community tap into a patient record no matter where they are in the system. “As patients transition from inpatient to outpatient or home health or [skilled nursing facility], everything will be aggregated. If the patient has given permission, the physician can go in and see everything that has happened with that patient. We’ve seen estimates that more than 60 percent of a physician’s time is spent collecting data. This should save us a tremendous amount of time.”
Private practices can join in using any EMR. “Seeing what people go through, we know there is not a one-size-fits-all solution. We’re trying to create a model that will allow adoption at whatever rate,” says Willis.
And who pays for all of this? Well, the hospital is providing some technology, but patients and major employers will be paying too, making the model self-sustaining. An unusual model, but it points to what may be a better future for technology — one that physicians find more user-friendly and affordable.
EMR Implementation: Getting it Right
Deploying any major technology system can be perilous, frustrating, and costly if you don’t plan properly. Follow these tips to maximize your success.
Get the hardware set up ahead of time. Internist Ronald Hirsch was frustrated when his EMR trainer had to take time out to get his scanners running and to patch holes in the office’s wireless coverage. Also, have a couple of extra laptops around for backup.
Train — a lot. “Whatever training is recommended, ask for double,” Hirsch advises. He also set some ground rules for physicians training on the new system. “Physicians love to learn, but hate to be taught,” he says. So his peers had to be on time and had to observe a don’t-interrupt-the-trainer-with-obscure-questions-to-show-how-smart-you-are policy.
Stage the rollout. More than 60 percent of survey respondents expect their implementations to take more than six months — and that’s not bad. David McAnulty’s practice took its time, and he’s glad. “If we did it all at once, it would have been very frustrating,” he says. Northwest Primary Care Group, Milwaukie, Ore., started by using just the billing and scheduling aspects of its new practice management-EMR system from Sage. Then the nurses started inputting vitals; after that, immunizations. The physicians started training to create encounter notes in November 2006. They finally stopped pulling paper charts in February 2007.
Prepare the charts. McAnulty’s practice also entered current diagnoses and medications before each provider visit. “It was helpful to try and prep it as much as possible. To prep while seeing patients would have been painful.”
Slow down. Les Kazmieruzak, WellGroup HealthPartners, Chicago Heights, Ill., is preparing to roll out Epic across his 100-physician, multispecialty group. All physicians adopting the technology will cut their schedules in half for two to four weeks, he says. That’s a real challenge, as physicians in the group are paid based on productivity and they’re already seeing fewer patients each week thanks to the recession. Some practices take even longer to get back up to speed.
Set a standard. To accelerate the learning process, Northwest Primary Care set a minimum charting requirement for its providers. When they started using the EMR, providers were required to do full EMR documentation for at least two patient visits in the morning and two in the afternoon. For the remaining patients, they were allowed to enter just the medication and problem list and dictate the encounter note later on. People gradually started transitioning on their own, doing three or four visits in the morning, for example.
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Pamela L. Moore is editorial director for Physicians Practice. She can be reached at pmoore@physicianspractice.com.
This article originally appeared in the September 2008 issue of Physicians Practice.
