So after months of searching, you've purchased and installed your new EMR. Congratulations: if all goes as it should, your practice will soon be saving time and money while improving the level of care you provide patients. Your staff, physicians, and patients will be happier once you're up to speed, and you're now in a much better position to demonstrate your clinical excellence and patient satisfaction in negotiating payer contracts and navigating the world of "pay for performance."

But selecting and installing an EMR is just the first step in a major process that will transform the workflow within your office. You can't just flip a switch and expect the transition to take care of itself. Taking the time to visualize all the essential implementation steps will lead to a smooth, successful conversion.

The first essential step is gaining physician support. If some, or even one, of your physicians remains firmly resistant to change, it could seriously damage your ability to move the rest of the practice onto the system efficiently.

"Present this to your doctors as a quality project," says Joel Diamond, a family practice physician in Pittsburgh. "Don't focus on the technology; focus on the ways [an] EMR helps us practice better medicine. For example, it helps us identify people who need smoking cessation counseling or pneumonia vaccinations, and this information will become increasingly significant in a pay-for-performance world."

Next, consider the varying personality traits and technical abilities of the physicians in your group. Some physicians can't type; for them, alternative ways to enter information into the computer, such as voice recognition software, will be extremely important.

Some physicians prefer standardized templates for common health conditions, so they can enter data for a typical patient with just a few clicks. Others prefer to work with a trained assistant who sits at the computer and enters data during the patient encounter. "The larger your group, the more diversity there is among your physicians, and that increases your need for flexible, customizable software," says Rodney P. Lusk, MD, director of the Ear, Nose & Throat Institute at Boys Town National Research Hospital, in Omaha, Neb.

Be reasonable

Have realistic expectations for the implementation process. It's not as straightforward as buying Microsoft Word and installing it on your computer, says Ronald B. Kuppersmith, an otolaryngologist in private practice at Texas ENT and Allergy, in College Station. A couple of years ago Kuppersmith's practice was working with separate vendors for a practice management system and an EMR. "They gave us conflicting advice about the hardware we needed. In the end, it came down to a judgment call," he says. "Someone from the practice has to be thoroughly involved in the process. All our vendors were really helpful, but you can't let them take over."
Once you've chosen your vendor, software, and hardware, budget time and energy for an intensive period of preparation. eClinical Works, of Westborough, Mass., a well-known supplier of EMR and practice management software, sends its clients a 12-week timeline listing all the essential steps between signing the formal contract and the "go-live" date.

During this preparatory phase, all physicians and employees should have a chance to become familiar with the software. Many vendors supply audiovisual training materials, so employees and physicians can start learning various features of the software even before it's been installed.

In addition, expect to work with the software vendor to customize the system and develop templates that match the forms you currently use. Build upon your current style of practice, instead of forcing doctors and other clinicians to adapt to the new software.

Some practices have sought to mollify technology holdouts by maintaining a separate paper-records system, just for them, even after installing an EMR for everyone else's use. That, says Lusk, is a recipe for disaster. "You double your costs, and you're never sure which system has the most accurate information."

Get your team in place

To successfully implement an EMR, you need several key people in place.

For starters, you should have a physician champion who can sell the other physicians on the value of having an EMR in the first place. Your champion should be a physician, because no one else in the practice has as much credibility with the other doctors, or is able to speak to them on their level.

"That means someone who does this as a labor of love, who lives it and breathes it, who can demonstrate the benefits to his peers," Diamond says. The ideal person may not be the most computer-savvy person in the office. Instead, seek out a physician with a strong commitment to quality of care.