When Angel Burnette first joined two-physician Desoto Family Medical Center as practice and financial services manager, she was surprised to find that the Southaven, Miss., practice had been paying for its EHR for years — it just hadn't been using it. That translated to about $7,000 down the drain each month in maintenance fees. "I don't think they had the supervision and the knowledge to make it work," says Burnette.
While she attributes much of the EHR barrier her practice experienced to a system that lacked user-friendliness, even with the best EHR and a smooth implementation process, your practice could experience similar problems fully optimizing its system. That's because transitioning from paper takes ongoing effort.
"I think people need to recognize that there's an enormous amount of work that goes into being on an EHR," says Tucson, Ariz.-based family physician Kenneth Adler, whose three-physician practice, part of a 124-physician medical group, implemented its system in 2004. "I think what people underestimate is that this is a never-ending learning process because typically the technology isn't static; so any good vendor is going to continually upgrade their product and there will be new features, new functions, new capabilities that ideally someone will keep up with and take advantage of." But learning to more fully utilize the system is not the only task your practice will face. Keeping staff and physicians engaged, ensuring all electronic information is secure, using the system efficiently, and retraining staff members are just a few of the tasks that should top your post-implementation agenda.
If you do these things on an ongoing basis, post implementation, the payoff is huge — just ask Burnette. In 2008, Desoto Family Medicine finally scrapped its old system and transitioned to a new EHR. This time, Burnette took extra precautions, like ensuring physicians received adequate training and helping them get their questions answered quickly. Today, Desoto has already attested to Stage 1 of meaningful use and is now preparing for Stage 2. To ensure your practice experiences similar EHR success — the first time around — we asked physicians and health IT experts to weigh in. Here's what they said every practice must do as it moves from implementation to full-fledged use.
Step 1: Identify a leadership team
You likely had a leadership team at your practice during your EHR selection and implementation process. Don't let that team dissolve after your go-live date. As the system evolves you will need to "have alignment among the leadership of the practice to ensure you are moving in the right direction," says Voorhees, N.J.-based family physician and geriatrician Mark Van Kooy, director of informatics and physician lead at health IT consulting company Aspen Advisors.
This leadership team is critical to ensure EHR-related decisions — such as what changes need to be made to the system, when and how use will be monitored and improved, who will have access to which parts of the system, which modules to add, and what ongoing training is necessary — are made quickly. "I think a small practice is an especially risky environment for casual decision making, and some of these big-ticket decisions really need to be made explicitly and with everyone in agreement, so when the issues come up, you can efficiently and effectively deal with the issue rather than starting to figure out your decision-making approach at that time," says Van Kooy.
Step 2: Foster engagement
A strong leadership team is also critical to ensure your staff and physicians are invested in learning to use the EHR as effectively and efficiently as possible. Unfortunately, fostering staff engagement is also one of the most common EHR-related struggles practices encounter, says Rhonda Morgenstern, an independent EHR consultant based in Philadelphia. For that reason, it's critical to set expectations of staff and physicians from day one. "They definitely need to set up expectations and have a strong leader that says, 'Hey, I know there are some issues, but we're really committed to utilizing this, so not utilizing it is not an option for you,'" says Morgenstern, noting that leadership also needs to make it clear that it will provide staff and physicians with as much support as necessary, as they begin using the system more fully. "A lot of practices are reluctant to set that expectation, which can cost them, big," she says.