Successful Implementation of an Electronic Medical System

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Successful Implementation of an Electronic
Medical System

• Daniel Griffin, MD

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Vision Statement (Always Evolving)

• Improve the efficiency of the medical practice
• Bring patient care to a higher level
• Achieve an acceptable return on investment
• Take advantage of performance monitoring programs

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Goals and Objectives

• Pick the appropriate program or programs
• Prepare for the rollout
• Start using the system
• Successfully continue to use the system

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Todays Situation (It was worse)

• No consumer reports for selecting programs
• Most medical practices have yet to computerized
  their offices
• Of note is that computers are faster and programs
  are improving

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How do we choose the product or products?

• Designate champions and get people invested
• Involve the people who will be using the systems
• Give these people the time and needed financial
  support
• Define and evaluate your workflow needs

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Defining Workflow Needs

• Talk to your staff and have them make a list of
  all they do
• Walk through the processes with them and see how
  they currently do their work

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First Contact or Return Business

• Patient calls to schedule an appointment
• What is important to front office to doing this
  efficiently

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Patient Arrives at Clinic

• Do you have a waiting room or is it an entrance
  room?
• Do you update demographics now or at checkout?
• Confirm Insurance and alert clinic to arrival.

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Bringing the Patient Back

• Who brings them back?
• How do they know the patient arrived?
• What do they do when the patient gets brought
  back?
• Can someone else jump in?

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Nursing Needs

• Entering Vitals
• Updating Medication List
• Tests done before provider comes in
• Getting them dressed for the occasion
• Standardized or Individualized

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What type of Flow Model do your providers fall
into?

• Why we use single piece flow instead of parallel
  flow
• What type of flow occurs in your office and
  should you change this before you bring in the
  system

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Getting Ready to Go In

• You cant chart flip in the hall if the chart is
  in the room (defining what you need to know
  before you go in)
• Making sure the information you need is available

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The Provider Process

• Define exactly what we need or want to accomplish
  in the room
• Can a system allow us to complete our work while
  seeing the patient

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What does the providers want to accomplish in the
room?

• Getting the story and relevant information
• Examining the patient
• Prescribing meds
• Ordering tests/Procedures
• Charting the visit
• Setting up return
• Bill for your services

15
After the Provider Leaves (What still needs to
happen)

• How do labs and tests actually get ordered?
• How do you get results and track this?
• What happens with prescriptions

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After the Provider Leaves (There is still more)

• What about follow-up?
• What about getting patients to consultants?
• What about actually getting paid (submitting
  bills and collecting co-pays)

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Defining the Other Office Processes

• Managing medication refills
• Managing patient calls
• The list goes on so dont think the providers are
  the only ones with needs

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Time to go Shopping

• So far this has been hard work, but now comes the
  fun stuff

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Narrowing the number of choices

• Talk to actual users and not just the sales reps
• Actually go and see the products working in an
  actual clinic
• Get behind the wheel, dont just watch a demo or
  a profession demo the products

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What Products to Consider?

• See helpful websites at presentation end
• Talk to colleagues
• When talking to big organizations with
  alternative motives keep your needs in mind and
  your ability to control these.

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Youve picked the product what now?

• Scheduling the dry run
• Perform every process
• Let everyone try everything that includes the
  providers
• Set the date to go live after you know the system
  is ready

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What Challenge to Expect

• It is always worse before it gets better
• Efficiency goes down before it goes up
• You wont believe this until it is too late
• Lighten your schedule first or do this after your
  first patient when you realize you too are mortal
• Plan to stay late and work through lunch

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Misconceptions to avoid

• This is just like paper only better (it is
  nothing like paper and it is better)
• Dont try to scan the entire paper chart (it
  wont fit into the scanner for one)

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More Misconceptions

• Dictation is my friend
• We wont change, the computer software will
  change
• We wont need to work with the current system
  because the next upgrade will fix everything and
  perhaps cure cancer (the salesman told me this in
  confidence)

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Initial Usage

• Have back up systems in place
• Schedule light
• Consider a Friday to go live
• Walk up front and fix any glitches with your pen
• Have support ready to help you
• Expect to work that weekend

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Succeeding with your transition

• Be realistic and keep things simple
• Make the time to meet weekly and be ready to
  listen hourly
• If you stop listening people will stop talking
• Dont let paperless stand in the way of
  efficiency

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Reflections on our experience

• It is an ongoing challenge
• There is always something that could work better
• Physicians and staff can have high expectations

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Successful continued usage

• Get comfortable with the basics first
• Keep everyone on board, watch out for those that
  try to move backwards
• Know your risk tolerance before you apply
  upgrades
• Keep lists of helpful improvements (these may
  already be available)

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Helpful Web sites

• www.healthcomputing.com (KLAS)
• www.acgroup.org (The AC Group)
• www.cchit.org (Certificate Commission for
  Healthcare Information Technology)
• www.qualitynet.org (The Medicare Quality/Pay for
  Performance Program)