How to Survive Go-Live

Written by on August 29, 2014 in Practice tips - No comments

Practical Tips For a Successful Electronic Health Record (EHR) Implementation

Introduction:

Is it a coincidence that “go-live” rhymes with “survive”? Those of you who have completed an EHR implementation understand. As a pediatrician who has been involved with two go-lives, both as the provider and as the supporter, I have learned a lot. My own go-live was about 18 months ago, and although I have become considerably knowledgeable and efficient over that time, I continue to improve. Looking back, there were many things done very well for our implementation, but there were also quite a few things that could have been done better.  Approximately 6 months after my implementation, I was able to support another group in theirs. Because of my experience, I was able to give them valuable education, support, and tools to make theirs go a little smoother than ours. I am pleased to share with you some tips that may be helpful to those of you who are anticipating an EHR implementation or have recently begun your journey with optimizing the use of your new EHR.

Part One-Preparation:

MedicalGroupWEBStart early. Get the team familiar with the EHR far ahead of time, at least a few months. Provide structured education, tailored to their role as much as possible. But, more importantly, give them plenty of time to practice, to “play’”. In medicine, most of our learning is accomplished by doing. It is the same with using an EHR. Of course, providers often learn best when working with real encounters, but practice time before the stress of the “real-world” can be very helpful. Don’t focus too much on the details, but rather get used to navigating the tools available. Some of the education can be on one’s own, but some should also be in small groups with peer mentors, allowing providers to share their experiences and tips with each other.

Use providers and other staff “superusers” as educators and support as much as possible, especially those with real-life experience with using the EHR in similar workflows. As I was fortunate to have used the same EHR in a past practice and had an interest in educating and supporting others, I was the perfect person to support my own group as well as another. After brief initial training, I joined in the formal classes, providing real-world insight and examples. I was at their side during go-live. I was available to answer questions on a daily basis, either working directly with a provider, or by a quick phone consult when needed. If you aren’t fortunate to have a provider in your group with experience in your specific EHR, you may have providers with experience with other EHRs who are able to work with information technology (IT) to become proficient, or you may look at hiring a provider consultant to fill the role.

Try to anticipate problems that may come up. One of our providers has a sight impairment. We were able to provide him with a program to increase screen text size and readability. Other providers had little prior keyboarding skills. Tutorials were used to increase their efficiency. Of course, there are many technical issues that need to be considered, such as use of laptops versus desktops and placement of these devices, and how they may affect workflow and interaction with patients. Internet service must be optimal-no one wants to deal with downtime!

Cut back schedules if able. In urgent care, we did not have much ability to reduce our schedules, though we were able to increase staffing somewhat. The primary care group reduced their schedules by about 50% for the first two weeks, which significantly reduced stress and gave them more opportunities to learn while the full support team was present. Most groups gradually worked back to full schedules within a few weeks.  By starting a little slower, you are usually able to get back to close to full productivity faster and gain valuable tools for efficiency for the future. And, your patients will appreciate it. The first few days, each visit often took over an hour. Imagine if you had 20 or 30 patients scheduled!

Part Two-Go-live:

This is it! Go-live is most likely going to be stressful, chaotic, scary, challenging, and exciting. When you look back, it will likely be much better AND much worse than you thought it would be.

Know it is temporary: The learning curve for a new EHR is actually quite steep. We had full-time support for the first two weeks. The first day was indeed stressful, chaotic, and exhausting, but after the first chart was closed, then all of them for the day, there was much celebration! From day two to week two, miles were gained. Even though it often takes months to really feel knowledgeable and efficient, with the right preparation and tools, it doesn’t have to be painful for long.

Share and communicate with each other. As a provider supporter, I worked directly with the consulting support team. Each day, many “tips and tricks” were sent back and forth with valuable information. We learned from each other’s mistakes and successes and worked as a team for the benefit of the group. When faced with a problem we couldn’t solve, we reached out to the team for answers. In addition, each site had team “huddles” daily to discuss the successes and challenges of the day and plan for the next.

MedicalGroup2WEBAgain, use providers and other staff superusers when able. I cannot express enough how invaluable it is to have experienced and knowledgeable providers and staff working directly with their peers. While the support team had excellent technical information, providers know about the daily workflow and issues that providers face and were able to answer questions with “This is how I do it.” versus “This is how I was told to do it.”

Part Three-Post go-live:

Re-evaluate workflow. Workflows and methods that worked on paper may not work with an EHR, at least not as efficiently. An EHR affects every process involved in a patient visit, from registration, nursing, orders and medications, charges and billing, patient discharge, to provider documentation. All of these need to be re-evaluated frequently over a period of many months.

Establish an EHR provider/workflow group with regular meetings and goals. Our group invited those providers and staff who had expertise and interest in improving workflow and efficiency. Initially, we were putting out fires; building workflows, documentation tools, and templates; and problem solving. We met frequently, often weekly, for the first few months and then reduced to monthly. About one year later, we began meeting every few months to continue to work on efficiency issues, and after 18 months, we are still meeting infrequently.

Provide one-on-one support as well as group support. A combination of group meetings to share important workflow and efficiency strategies and direct one-on-one support is optimal. Some providers need much more support than others, and direct support from their peers, often at their side during office hours, can be invaluable. Some providers will have less computer skills or will even be quite resistant to the significant changes required and would most benefit from direct peer support. Eighteen months later, one provider continues to ask for my help when we are working together, and others contact me with specific concerns as they come up.

Develop templates, preference lists, and tools to personalize. Even if the training and initial support is somewhat tailored to your specialty, personalization is a huge factor in improving efficiency and satisfaction with using an EHR. Everyone has a slightly different approach to the practice of medicine, and this is also true of how they utilize an EHR. Some providers like to document with more free text, while others prefer more pre-built templates or lists to choose from. The use of dictation may be an option for some. I have developed preference lists for medications and common diagnoses, along with many ‘smart phrases’ which enter frequently used text with just a few characters entered. I share these tools with my peers and with new staff, who also find them invaluable for efficiency and thoroughness.

Final thoughts: The right EHR can be a valuable tool for your medical practice. And, for most, it is no longer optional. It can be a big factor in your financial security, both positively and negatively. There are considerable costs involved in implementing and using an EHR, and soon documentation, coding, and billing through the EHR will be tied to reimbursement and incentives as well as possible fines if not done correctly. Provider productivity, which is enhanced by EHR efficiency, is directly related to compensation for many. For these reasons as well as many others, it is of utmost importance that EHR implementation and optimization be done well. Hopefully, the tips provided will help you on your path to success. And if you haven’t already, practice your keyboarding skills!

By Laura E. Marusinec, MD
Urgent Care Pediatrician

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