Timeline for the Transition to an ASC EMR: Before Integration (Part 1 of 3)
More and more ASCs are making the switch to an electronic medical records (EMR) system because an EMR offers a significant improvement over paper records in all areas of an ASC's operation, and the system provides numerous benefits to patients, physicians and staff. But there is a common misconception about investing in an EMR which assumes that once you purchase the software and install it, you're ready to go.
Integration of an EMR goes well beyond that, which is part of the reason it brings such significant improvements over the use of paper records. The advantages are even greater for those ASCs that put time and effort into the EMR transition process. Clients have repeatedly told us that preparation, teamwork and a facility-wide commitment to making the switch helped ensure a smooth integration and allowed them to reap even more benefits of using an electronic-based records system than they expected.
We like to make sure ASCs considering making the switch are aware of what is involved in the EMR integration process so they can ensure their facility is well prepared. It is particularly helpful to understand the three stages an ASC goes through during the EMR transition: before, during and after integration. A firm understanding of what is involved in each of the stages will make the integration of the system a seamless transition.
In this first part in a three-part series, we will discuss the first stage, which is the time leading up to installation of the EMR software and the period when the ASC prepares the facility and its staff for the technology upgrade. Here are 10 steps your ASC will want to take during this first stage to maximize the system's long-term effectiveness.
1. Create leadership buy-in. Bring together your administrator, nursing director, physician champion, OR charge nurse/OR leader and any other relevant department leaders to discuss the plan to switch to an EMR. Explain why your ASC is making the switch and how important it is for the ASC to have the complete buy-in from these leaders. As leaders, they will set the tone for their department and, together, for the facility; it is critical that they are prepared to do whatever they can to help during the transition.
2. Identify 'super users'. "Super users" are the go-to contacts for your EMR vendor and ASC staff throughout all three stages. You will likely want one super user per department. Work to identify someone to fill this responsibility from pre-op and recovery, at least one OR nurse, an anesthesiologist, a surgeon representative and a business office staff member. These super users will have several different responsibilities, including working with the vendor to configure the software, understanding how the software works and enhances your ASC's operations, addressing staff member questions about the EMR and training new staff members on the system's use.
Super users are often designated as the only staff members who can make changes to the system's dictionaries, orders, instructions and templates. The best super users are people who are computer savvy. They should have a positive attitude and patience, as they will assist staff members who encounter challenges.
3. Perform facility-wide assessments. After bringing your leadership together and identifying super users, you will work with your EMR vendor to assess the current workflow of your ASC's operations and different departments. The information gathered during these assessments will help ensure your EMR is properly configured for your ASC. These assessments will include your clinical departments, business office and equipment.
The clinical assessment will provide you with the material needed to update your administrative policies. It looks at paper documentation such as consents, questionnaires, formularies and physician orders. This information is needed to not only configure the software but also train your staff on how to perform these same clinical documentation tasks electronically. The business office assessment looks at facility fees, insurance carriers, contracts, inventory, preference cards and more. This information provides the framework for the database build to properly meet your facility's needs. The equipment assessment allows your EMR vendor to understand what equipment (computers, laptops, workstations, etc.) is already used by your ASC. This information helps your vendor visualize how staff members perform documentation, identify hardware needs and determine an efficient deployment and maintenance model for the system.
4. Review and evaluate current workflow. Together with your EMR vendor, you will use the assessments to analyze how staff members in your clinical departments and business office perform their duties and the processes they follow. You will assess and identify when and where every task that is completed and every document is filled out, and what happens after each task and documentation is completed. This will provide you and your vendor with a clear, visual understanding of how all information travels throughout your ASC, who is involved in completing all of your ASC's responsibilities and which of your staff members touches each and every document. It is during this step that you will also have the opportunity to identify areas for change in your workflow so that when the EMR is installed, it follows improved processes.
5. Determine hardware requirements. You and your EMR vendor will then determine what hardware is needed to use and maximize the benefits of the system. For example, you'll want to think of where a member of your staff performs documentation and would sign a piece of paper. Wherever documentation occurs, you will likely want a computer workstation, and where staff members sign documents, you will want an electronic signature pad.
An ASC's layout will also influence what hardware can fit in a facility. For your pre-op and post-op bays, you may have enough room for a dedicated workstation or you may need a workstation on wheels. As another example, your operating room's layout will determine if you have room for a circulating nurse's workstation on the side of the OR.
You will need to involve your ASC's IT leader or vendor, if you outsource your IT to a third party. It's important for your IT provider to ensure your network is adequate to handle the EMR and keep it fully functional at all times.
6. Decide on all-in or staged-in integration. When it's time for the actual installation and "go-live" of the EMR system, some ASCs elect to have everything installed and running at once, while others prefer a more gradual installation. Choosing which approach is right for your organization is the next step.
With an all-in integration, your EMR goes live with all of the nursing, physician and anesthesia documentation and records ready for use. A staged-in integration is a longer process that allows the nursing records to go live first. In this case, your nurses essentially become a first-line support system for your surgeons and anesthesia providers when their components of the EMR are installed at a later date.
7. Establish realistic timeframe. Now it's time to determine a realistic timeframe to install the software, train your staff, go through trial runs and then make the complete switch over to the system. The amount of time this takes will vary by facility since no EMR installation is ever the same.
Working with your EMR vendor, you will want to select a kickoff target date and schedule the events that will occur in the days that follow. When choosing this date, you should take into consideration possible interruptions in the transition process, such as vacations and holidays, and significant increases in case volume that will keep your staff busier than normal. Members of your team will need to step away from their usual responsibilities for training and working with the EMR vendor (discussed further in the next step), and you should take this into account when choosing the kickoff date.
8. Plan to allocate resources during transition. Members of your team will need to allocate time to the transition process and learning the EMR. You will need to identify upfront which staff members will help prepare the facility for the system and, as noted earlier, and if different, who are your super users. Rather than disrupt these staff members' regular working schedules, some ASCs will ask staff to work overtime and address preparation and training during off hours.
If you decide against this approach, you will need to determine how to handle the responsibilities of the team members working on the EMR transition. This may require reassigning certain tasks or bringing in PRN staff to fill in any gaps. Your ASC may need to make similar decisions for a short period once the system is up and running as staff members will need to set aside time to receive EMR training.
9. Analyze staff computer literacy. While computers are now commonplace in all ASCs, this does not necessarily mean all of your staff members know how to use them. It's important to assess your staff's computer literacy and identify any members who do not have a basic understanding of how to use the machines. If this is the case for one or more staff members, you may want to consider signing them up for a few "Computer 101" classes that cover basic computer functions prior to the switch. This small investment on their behalf will help them become comfortable with using the EMR once the transition takes place.
10. Prepare for hurdles. As with any significant change, you may encounter an occasional hurdle you will need to work to overcome. Examples could include a designated super user becoming ill around the go-live date, an ASC realizing late in the process that it forgot to pass along data stored in inventory by a third-party vendor and an occasional staff member who initially resists the change. It's important to be prepared for such hiccups and take them in stride. By working closely with your EMR vendor and securing complete buy-in from your ASC's leadership, you should have no problem navigating these obstacles and finding the switch to an EMR system goes smoothly.
Stages and two and three
After completing these steps, your ASC will now be prepared for the second stage — the time during integration of the EMR, when you move to the electronic-based system and train your staff on how to use the new system. Then comes the third and final stage, which is the time after integration when your ASC will work to maximize the benefits of your investment and ensure all staff members are properly using the system. The next two stages will be discussed in the November/December issue of Becker's ASC Review. The complete, three-part series will be available on www.BeckersASC.com.
Joe Macies is the CEO of AmkaiSolutions, software/services provider to the ASC industry and its affiliated practices and clinics. The company's AmkaiCharts EMR, together with the AmkaiOffice administrative program, provides a comprehensive, fully integrated solution designed for the specific needs of the ASC. Learn more at www.AmkaiSolutions.com.
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