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8 Mistakes for ASCs to Avoid During EMR Implementation

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Here are eight common mistakes for ASCs to avoid during electronic medical record implementation. Preventing these mistakes will make the implementation process smoother and allow the surgery center to optimize benefits from the new system.

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1. Lack of a strategic plan. Beginning EMR implementation without a strategic plan will result in several difficulties throughout the process. Most organizations have a business plan, workflow plan and information technology plan, but they overlook the EMR strategic plan.

Marshall Busko on EMR implementation"I rarely see them coordinate developing an EMR plan that would integrate with the other plans," says Marshall Busko, Senior Director of Executive Solutions of Amerinet. "One of the things we preach is if you don't have a plan, you are just chasing stimulus dollars. There are significant clinical outcomes and efficiencies surgery centers could achieve using EMR, and that all has to dove tail with the IT plan and business plan."

Surgery centers that have a strong strategic plan can set up goals to measure success and stay in control of the process.

"The biggest challenge that we find in implementation is that some facilities haven't formulated a clear strategic plan for their EMR. While the information you capture on paper is the same as what you would want to capture in digitalJoe Macies on EMR implementation format, there are a number of differences, such as capturing patient diagnostic information, that result in a big variance in workflow. It is important that this be thought through upfront,"
says Joe Macies, Director, President and CEO of AmkaiSolutions.

2. Waiting until the end to bring everyone onboard.
All stakeholders should be part of the initial meetings about EMR and participate throughout the implementation process. If this isn't possible, at least bring in representatives from staff members, physicians, nurses and any other stakeholders to discuss how EMR will impact them and to help make decisions going forward.

"Get everyone engaged and brought in," says Mr. Busko. "Organizations often have a directive that is too narrow in scope. If you get everyone engaged and brought in before rolling out the EMR, you can have a cohesive plan and communicate constantly throughout the process."

Physicians will have a different perspective than the office staff and nurses, and even among the physicians specialists and anesthesiologists will differ. Also include your EMR vendor because they often have a timeline and objectives, so they should be on the same page as all other stakeholders. However, this doesn't mean that you must launch implementation with everyone at the same time.

"Different facilities take different approaches. In many cases, sequencing is an effective way to go. For example a facility would start with the nurses first and then the physicians and anesthesiologists so they can get more support and help from the nursing staff," says Mr. Macies. "Sequencing is sometimes a good way to go. However you decide to handle the implementation, you will want to make sure everyone is prepared and ready in order to make the implementation process as smooth and successful as possible."

Finally, don't forget about how the EMR will impact patients and primary care physicians going forward.

"When someone implements an EMR and primary care physicians because there are new systems and patients have to enter new information," says Mr. Busko. "The ASC loses some productivity as well. Surgery centers need to explain to the patients that EMRs will help make a better experience for everyone in the long run."

3. Ignoring infrastructure constraints.
Another area where EMR implementation fails is in lack of infrastructure. Administrators must consider whether they have enough space and bandwidth to support their system and understand whether the EMR will be able to interact with local hospitals and health systems.

"Everything is going mobile, so make sure you have a wireless infrastructure that will bring more applications online," says Mr. Busko. "Have a solid backbone to connect with others in the community. You need the bandwidth to do that, so make sure it's there before system implementation."

Many times surgery centers will decide to use old or inexpensive equipment, but an upgrade usually doesn't cost that much more and can make a big difference in how well the system works.

"Ask other surgery center administrators about their mistakes and figure out what worked and what didn't for their infrastructure," says Mr. Busko. "Invest in portable devices and larger monitors. Infrastructure is critical because without that, nothing else works."

4. Fitting the EMR within old processes and procedures.
The beginning of EMR implementation is the perfect time to revise old processes and procedures for collecting and reporting patient data. The EMR won't fit within the old processes, and revising them will make the processes easier going forward.

"See if you can eliminate unnecessary steps and take waste out of the system," says Mr. Busko. "You can customize things within the EMR to fit within your system, but you should also look for ways to improve internal policies for more efficiency."

It's important to standardize your processes, data entry and nomenclature so people throughout the organization will be able to communicate about EMR.

"If you have a large office or multiple office locations, have the information updated so when you start doing business intelligence or data mining, there is a standard nomenclature in output," says Mr. Busko. "This also makes sense for outcomes analysis and profiling."

Most procedures are short in ASCs, so you want surgeons to enter the information right away in real time. "You need to think differently about how you are going to use the technology to help you with your work," says Mr. Macies. "Surgeons shouldn't just jot down notes or reminders to do the documentation later. We've designed the system so it can be used in real time. Take a look at your workflow and make sure it fits within the EMR's design."

5. Insufficient employee and physician training.
Training is very important for everyone in the surgery center to make EMR implementation as smooth as possible. "A lot of nurses that are being introduced to EMRs have never worked with an EMR system," says Mr. Macies. "In some cases, they are a little bit phobic about computers and aren't comfortable using them. Training and understanding the system becomes very important."

Most organizations train super users — one person who will be a resource for everyone else — and then offer basic training to all others.

"There should be a super user in every facet of the organization who can explain to the other staff members how to use the EMR appropriately," says Mr. Busko. "Physicians also need to be trained well. As systems have more evolved graphical and intuitive programs, you need to back up those resources with training and make sure it's continuously provided to everyone."

One of the best training resources is a "test environment" that allows people to interface with the system before it's actually ready. People can go in and test different functions to make sure they understand the different screens and process flow. If they make a mistake, they can practice fixing it.

"As successful as our initial training often is, we find that going back in six to eight weeks after implementation and reinforcing a few functions is very helpful," says Mr. Macies. "We find that going back and doing additional training, and showing additional features, helps organizations kick in to gear and accept the system."

6. Focusing on regulations instead of benefits.
When surgery centers take the approach of "the government is making us do this" instead of "this system will be very helpful for us in the future," employees and physicians are less likely to have a positive attitude about implementation. They should understand the benefits of EMR implementation and feel office function improvements are driving it forward.

"Years ago when physician offices went from tech board accounting to billing systems, there was a lot of resistance, but they came to realize those billing systems were instrumental in recovering cash for them," says Mr. Busko. "When EMRs evolved, the ones that made sense were making improvements to the billing system. They can capture better documentation and coding information."

Most types of EMR allow providers to capture all clinical information and drop it cleanly through the billing system with supporting documentation so when a claim is generated, it won't bounce back from the insurance company for lack of information.

"You can save a lot of work for coders if you catch mistakes upfront," says Mr. Busko. "Train people appropriately to make sure you are capturing everything necessary upfront."

7. Getting too comfortable with old system reports.
Providers that have been around for several years are comfortable with the depth of old systems reports and solutions they could provide; even though EMR can provide deeper analysis and better tools, they refuse to generate them. This can be a problem for EMR implementation and strategic planning initiatives.

"As you progress, EMR reports can provide invaluable information and help you achieve performance objectives in real time," says Mr. Busko. "These reports and their capabilities are often overlooked because surgery centers have other formats they're familiar with. However, the whole organization can benefit from more granular information."

Most EMRs can provide person- or function-specific data to help administrators fully understand each surgeon's impact on the center. Without generating this information administrators won't be able to compete in new markets where other providers examine and leverage that data to lower costs and improve quality reports.

8. Omitting performance guarantees in contracts.
One of the most important points to include in the vendor contract for EMRs is performance guarantees. Vendors must provide the level of service they promise and surgery centers should faithfully implement the system to optimize results.

"Because so many EMRs are being implemented right now, suppliers are stretched thin, and they bring in new people who may not be familiar with the devices," says Mr. Busko. "These new people may not have the expertise they should and the process takes longer. If you have performance guarantees in there, you are covering yourself so the vendor makes good if they don't hit the guarantees."

Run the contract by an attorney to safeguard their interests and make sure all parties will incur penalties if they don't hold up their end of the bargain. The vendor should provide annual support for product use, and if they don't the performance guarantees can defray some of the expenses associated with slow or no implementation.

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