In previous posts, we discussed the elements of selecting and implementing electronic medical records, or EMR. This has included the process of selecting software, hardware, and infrastructure. Once the technology part is determined, it’s time to integrate these disparate elements into the reality of a working EMR office.
At our practice, the IT team did a great job of planning key tasks from the beginning. This included the wiring of our satellite offices. Our practice’s requirements called for an integrated plan which meshed with the technical aspects of the project. The plan incorporated a training element to boost the staff to maximum productivity, while making the best use of everyone’s time.
Choice personnel from the IT, clerical, and admin departments met with Frank Polack of Eviton Consulting – our project management facilitator. Together, they created a WBS, or work-breakdown structure, for project implementation. The primary processes to address included infrastructure, and hardware selection, already accomplished at this point, followed then by EMR configuration, setup, training plan, process review, rollout, and testing.
These processes can be divided into smaller jobs to be delegated to staff who would “own” that particular sub-process. The primary process is divided into specific issues such as ‘configuration’ or ‘templates’ for example. These issues are then further sub-divided into particular tasks such as which templates to create, which templates to use, who reviews templates, and how they will be tested.
For our EMR configuration, IT staff and physicians created a workgroup which looks at the clinical template set within the EMR application. The workgroup makes changes only as needed, as determined within the workflow in use at the practice. This method lets changes happen in a way that is noticeable when documenting patient exams. This is particularly helpful for physicians who are less technically-minded, and who will naturally expect that that new digital system will out-perform the analog one currently in use at the practice.
There will be some required changes to the workflow, a necessity born from the hierarchy of the EMR design. As an example, if currently we’re making dictations which look like ‘2+ NS and PSC,’ we may have to instead write ‘lens, NS 2+ PSC 2+.’ This may seem like a small difference at first, but it could have a real effect on workflow when multiplied across hundreds of exam records daily.
The configuration workgroup must come up with a method which doctors and staff are both comfortable with. A separate ‘test’ database of the EMR system is available from home using remote desktop services. The group can conduct a final review before new changes are implemented on the working ‘production’ database.