Most practices breathe a sigh of relief after their new EMR software is installed and running. But now comes the hard part: getting the staff and the doctors to accept and use it. The following is a list of ten “Commandments” borrowed from our practice administrator, Don Cushing M.Ed. MBA, who has years of experience with EMR adoption with multiple practices.

(1) Thou Shalt Have a Plan. As Benjamin Franklin stated, “If you fail to plan, you are planning to fail.” But a plan is worthless if it doesn’t have a defined goal. For most practices this goal will be a successful EMR implementation – a somewhat vague goal, at best. Success should be defined in relevant, realistic, and measurable terms. These can include such things as: physicians will have the information they need when they need it, physicians will have the support needed to adapt to the new EMR system, the EMR will not interfere with the doctor-patient relationship, etc.

(2) Thou Shalt Honor the Three W’s:

1. The hardware and software have to work.  There should be enough hardware, in the right places, and with just the right amount of capacity. Trying to be too cheap with your equipment can bite you in the end, but it is also very easy to go overboard, so get good advice. Regarding the EMR software, make sure you create a list of needs and wants before you go looking for a product. Most practices rush out and get the software, then figure out what they need – wrong move. For many smaller practices, expenses can be significantly reduced by using web-based EMR systems or cloud computing, but these tend to be less robust systems.
2. The process has to work. If you have inefficiencies in your workflow already, an EMR system will make them more obvious (see number 3 and 4). Now is a good time to ask why you are doing things the way they have always been done.
3. YOU have to work. Buying an EMR system is neither your first step nor your last. Most of your work should occur before your purchase but you’re not off the hook entirely after the software has been installed either. EMR implementation is a process, and it will need continual feedback and improvement to ensure its success.

(3) Thou Shalt Make Flow Charts. A critical way to make sure that everyone is on the same page is to map your processes out visually using flowcharts. There are several inexpensive programs that make it easy for your staff to collaborate and fine tune your workflow (see article on Convenience Applications). If you don’t spell this out in detail you are bound to have inefficiencies, and an EMR system will just compound them.

(4) Thou Shalt Not Expect EMR to Fix Bad Processes. A corollary to number three is that even the best EMR system cannot fix your bad workflow processes. Many times a failed EMR project is blamed on the software when in fact the problem usually lies elsewhere, but by then it is too late.

(5) Thou Shalt See the Examination Room as the Command Information Center. A common bottleneck in a practice trying to become “paperless” is an unnecessary conversion from electronic to paper (and often back again). From the exam room, all necessary tests, labs, and instructions should be able to flow with simple clicks emanating from the EMR system, and without the need for writing on a paper router, filling out paper requisitions or barking orders down the hallway.

(6) Thou Shalt Know What an EMR Is. A common cause of EMR project failure is the lack of physician buy-in, and a major reason for this is that they see it as just a digital version of a paper chart. A paper record does not have the ability to cull clinical information and transform it into actionable data, nor does it allow for enhanced communication such as sending tasks and reminders instantaneously to multiple users. On the other hand, many physicians have become accustomed to experiencing things a certain way when they use a paper chart and this does not always translate easily to an electronic one (see number 9).

(7) Thou Shalt Not Confuse Templates and Documents. Templates are the data entry forms of an EMR system and what most users see. The documents are the forms that are generated from the templates and what really constitute the official medical record. Templates are also the sexy side of the EMR and what sells the EMR to customers. And customization of the templates can make life easier, especially for less tech-savvy physicians. But customization of the templates is not as important as that of the documents, which are potentially subject to the scrutiny of an outside auditor. All to often, practices concentrate on the former to the detriment of the latter resulting in a potential liability (see number 8 and 9).

(8) Thou Shalt Consider the Inputs in Terms of the Outputs. When looking at EMR systems or customizing the one you have, it’s important to begin with the end in mind. It is easy to get bogged down in detail regarding what minutiae needs to be included in a document. Who is the reader? An associate in your group or a referring doctor? What pertinent information is needed? Long-form exam or brief clinical summary? Does it help justify the level of coding? Ensure that the critical elements are present. Everything else is probably extraneous.

(9) Thou Shalt Not Use Templates Out of the Box. In general, the easier an EMR system is to use out-of-the-box, the less flexible it will be. This may not be as critical to a new or solo practitioner who can easily adapt his or her processes to the software. But for most practices, this is like trying to fit the proverbial square peg in a round hole. Most doctors have acquired a certain gestalt when they’re looking at a paper record and much of this is lost when staring at a busy computer screen. So it’s important to approximate this is much as possible. If a prospective EMR does not have customizable templates, keep shopping. If they are customizable, then figure out a way to make them fit the way you practice medicine. Otherwise, you’re in for a lot of frustration.

(10) Thou Shalt Not Confuse Paperless With Paper-Appropriate. Some practices are so intent upon becoming paperless that they actually throw logic out the window. For example, such things as drawings and signatures are not data that need to be mined for analysis. Rather than spend a lot of money on an expensive tablet and software that allows patients to sign forms electronically, why not just have them sign a paper and scan it? The practice has what it needs and the patient keeps the paper copy – everyone’s happy.

Have you been through a successful EMR implementation (or not)? Do you have any of your own ‘commandments’ to add to the list?