Planning Your Electronic Medical Records Implementation

We’ve all heard the proverb, “He who fails to plan, plans to fail.”

This is certainly the case in the majority of failed electronic medical records (EMR) implementations, and usually the physicians/ administrators/ owners (circle your choice) bear the responsibility. Since this may well be the most difficult (and expensive) project your medical practice will undertake, it literally pays to have a good plan in place.

Implementation of an EMR system is truly a formidable task and the logistics can be overwhelming. We realized that we would need an integrated plan that would tie together both the technical side of the project with training in order to maximize efficiency, making the best time and use of our staff and contracted help.

So we worked with a project manager to break our EMR implementation project down into major processes and then into successively smaller processes. Key employees from administration, clinical services, IT, and business/front desk met with a facilitator in project management to create a WBS (work breakdown structure) for the project.

First they identified the major processes as:

1. Purchasing and setting up hardware
2. Setting up software
3. Building out the network infrastructure
4. Configuring the EMR system
5. Testing
6. Creating the training plan
7. Reviewing the process
8. Planning the roll-out

Each major process was then further broken down into smaller steps which were then delegated to someone who would “own” that particular sub-process. The major process of configuration the EMR program is divided into sub-processes such as configuration of templates, which is then further sub-divided into specific tasks: which standard templates to use, which templates to create, who creates them, who will review them, how will they be tested, etc.

For example, for the major process of configuring the EMR, we formed a workgroup comprised of IT personnel and physicians tasked with analyzing the existing workflow in the clinics and breaking this down into smaller processes. This allowed the workgroup to make changes to the EMR templates to adapt to our style of seeing patients, rather than trying to change the way we work in the clinic to suit the EMR program. Although this requires more of a time investment up front, it results in less of an impact on the physicians and staff once the practice goes live with the EMR.

Of course, once we do go live, changes in the current workflow will undoubtedly occur as overlooked processes are found. For instance, because of the hierarchical, drop-down format of many EMR systems, physicians who use scribes for data input may need to make slight changes in their syntax - such as clinical finding first, descriptive modifier second (lesion, temporal) instead of vice versa. This may sound trivial but it can have a significant effect on efficiency.

On the other hand, it may be hard for doctors to change old habits. Everybody needs to realize that this is a work in progress and cooler heads should definitely be in charge of the project to avoid any ‘meltdowns’  by less tech-savvy doctors or staff.

Mind-mapping software such as MindManager are invaluable tools for creating a work breakdown structure and are fairly intuitive to use. The alternative is to hire a certified project manager like we did to get you going in the right direction.