Over the years I have spoken with many physicians, practice managers and change management consultants about the process of EMR implementation. What makes for a successful implementation? How can a practice improve their chances of success?
Through all of those conversations, there are certain discussions that always come up. One is about defining a clear set of requirements for the practice and ensuring that all the necessary requirements are met as implementation proceeds. Some of these requirements relate to deficiencies and readiness to adopt the EMR e.g. ensuring that all members of the practice have foundational computer skills, can type and use the internet, email and a word processor. Other requirements are operational in nature such as ensuring there is an individual who has been designated to be the practice champion or lead and understands the level of commitment that will be required through the implementation.
One of the requirements that does not get enough attention is the understanding and adjustment of personal expectations prior to implementing the EMR. There is obviously certain system functionality that needs to be present e.g. the EMR allows the physician to generate prescriptions electronically or record notes using free text fields, drop down menus and templates.
The unspoken expectations (and some of the most important to consider) relate to personal changes that individuals may have to make after the EMR is implemented. For example, a physician may expect that they will be able to continue charting patient notes in the same way they did in the paper record - in narrative format. In order to create dependable and accurate patient records that allow information to be extracted for patient recall or analysis, some rules regarding data entry may have to be applied. Certain data may have to be recorded through coded templates, other data through drop-down lists. If the physician in question expects not to have to change some of his/her practices regarding note taking, the result for the practice can be extremely negative. I am aware of instances in which a physician has refused to use the EMR post implementation to record clinical notes because it does not match their style of practice.
It is not difficult to see that if unresolved, this can create a significant problem for the clinic and for other team members.
When setting expectations, think very carefully about what you expect to remain the same post EMR implementation and what you do not wish to change. Then make sure you discuss and validate these expectations with colleagues, the EMR vendor and other team members before proceeding. It is best to be forewarned and aware of what you may have to change once your practice has move to an EMR.
Share your experiences: If you have implemented an EMR, did you deal well or poorly with physician and practice expectations? Is there anything you would differently if you had a chance to do it again?
Click on the 'Comments' link below to add your thoughts.
I found this article very interesting and insightful.
I am the Project Lead tasked with the EMR Adoption Project for the over 75 Community Health Centres, satellites and sites that provide health care to communities across Ontario. Drawing from the lessons we have learned thus far in this project three things stand out:
1. EMR Adoption is about Change Management project, and like any other change it must have sponsors who are committed to the change, champions who are driven to change and deep communication channels throughout the organization that will foster inform the change. On one end of the spectrum some people tend to associate change with a loss in employment while others with an increase of responsibility. In each case people can feel alienated and this can lead to negative rumor mongering. Two way communication can prevent this from happening.
2. EMR Adoption is about skills; it does not so much require learning how to use a new piece of software as much as it is the acquisition of a new skill set. Whenever change is implemented between one process and another the intention is that there will be significant efficiencies gained. The change from a paper or mixed clinical environment to a fully electronic environment is such a change.
3. EMR Adoption is about managing expectations. From process mapping the existing paper process to plotting the new work flow it is important that everyone is aware of what is going to affect their role. I find that the best method of ensuring this is to have "those affected involved" in this process. This helps people to contribute and in many cases take ownership of the change as they do not approach it feeling it will solve ALL their problems at once.
Posted by: Brian Sankarsingh | February 02, 2010 at 10:47 AM