As we discussed a while back, one important part of a proper implementation of an EMR (electronic medical records) system is staff involvement. This simple fact can't be over-emphasized, as no single person can accomplish this task on their own, regardless of how good they are. You must be ready when problems begin to develop, verbalizing your trust in the staff throughout the entire process.



Perhaps the most interesting observation made during the design and implementation process was noting differences in how staff from different generations learned the program. Younger staff members usually learned more quickly, most likely because they had grown up using computers. Of course, the older staff members tend to have more experience with performing the tasks of a particular job function. For this reason, you must be ready for frustrations from both sides of the generational situation.

The owner and administrators must fully understand and appreciate the legitimate concerns that staff members will have about implementing a new practice-wide system.

Staff members know that by switching to a new EPM system there will be effects on billing and scheduling; they understand the risks that are being faced, and some will feel the pressure. The right sort of employee will thrive in this work environment. It's the sort of person we like to hire on at our practice: someone with a desire to succeed who accepts responsibility for their own actions.

The EMR Committee

While making the initial transition from the older EPM system to the new one, yet before fully over to the EMR system, we sometimes faced staff resistance. People are comfortable with the existing way to do things, even when presented with a way which is more user-friendly and intuitive. The 'super-user' members of the EMR committee are the first ones to be trained on upcoming elements of the new system, and must take the lead on to the rest of the employees.

These super-users should come from within representative slices at the practice:

- Compliance & coding

- Business office

- Clinical

- Front desk check-in, check-out, & scheduling

- Administration

- Information Technology

A committee must own the project to make the transition a true success. These aren't just words. In fact, our committee created the authority to have meetings whenever the need was felt. Some individuals work on the evenings and weekends as they really took the project along from its inception; they had the power to make decisions and accept the responsibility. One side benefit from this sort of management style: confidence grows, not only individually but in each other also.

Important Players

Front desk staff - Front desk provides valuable input from the perspective of end-users; their tasks include check-in, check-out, posting charges, and scheduling. Having the time to get the bugs out of this process helped to support our initial decision to postpone the implementation of the EMR until the staff was well acclimated to the new EPM system.

Clinical staff - Their participation will be key to the success of the integration of the EMR into the practice in a few months. Nevertheless, it is important to for them to be involved in the early stages of planning; it is helpful for them to have an appreciation for what the non-clinical staff does and how the EMR will fit into the entire scheme of things.

IT specialist - This person should be involved from the very beginning, even prior to selecting the EMR software. If a practice cannot initially justify hiring a full-time IT specialist, an IT consultant should be retained. Because we knew that conversion to EMR was just part of our overall plan, we felt we could justify hiring a full-time IT specialist; in fact, due to this person's expertise in such areas as software licensing, Internet communications, and hardware networking, the changes that were incorporated into the practice eventually paid for his annual salary.

Coding/billing specialist - These employees should also have a voice in the initial software selection process. They helped to minimize the hiccups we experienced when we switched from our old EPM system to the new one. On their recommendation, we performed a trial run on the new system (soft “go-live”) prior to completely abandoning our old system. This allowed our IT specialist to verify that the posting and billing were being performed correctly. Someone technically proficient with coding and compliance issues will also be invaluable when the EMR module of our system goes live to prevent under- or over-coding and ensure HIPAA compliance.

The physicians in our practice felt it was essential to empower the EMR committee with the authority to plan and manage the EPM/EMR integration from the beginning. The managing partners meet on a regular basis with our administrator for status reports but oversight of the nuts and bolts of the entire process is handled in a laissez-faire manner. As mentioned previously, the success of this project depends in large part on the involvement of all members of the organization.