1. Evaluate the products on the market. Ms. Kelly started the process of EHR implementation in 2009, when the government announced they would require healthcare facilities to keep electronic medical records. She knew that ASCs would not face the same requirement as hospitals, but she thought EHR investment would give the ASC a competitive edge and improve patient safety as the initiative moved forward. She started going to national conferences to evaluate EHR products for her ASC. “We’re a busy multi-specialty facility, and I knew I needed something with a lot of different modules,” she said. “When I looked at products, they often had everything but an anesthesia module, or everything but a pain management module.”
She eventually chose a SourceMedical product developed by Cyramed called Source Plus EHR. “We used a SourceMedical product for our scheduling, and I wanted something that would integrate with and speak to that product,” she says. Ms. Kelly says the time she spent evaluating products gave her board of director’s confidence in the decision: “They knew I’d spend about two years looking at products,” she says.
2. Present an ROI to your board of directors. As with any capital purchase, you should present a return on investment on your EHR to your board of directors before making the final decision, Ms. Kelly says. Ms. Kelly admits that the EHR was a large expense, both in terms of software and hardware. But she took the time to add up the soft costs per case incurred in the ASC without the EHR, such as staffing costs for employees pulling records, performing quality audits and printing and stickering files, as well as the hard costs, like paper and printer cartridges. She determined that an EHR would reduce the workload of her business office by about one third and was able to decrease the business office staff by three full-time employees, either moving them into other positions or by attrition. “We eliminated over $70,000 a year in staff salary and benefits, as well as the money we saved on printing charts, stickering and postage for physician referral letters.”
She compared the savings the ASC would achieve with the costs incurred by the EHR. She added the cost of the hardware to the cost of the software and related maintenance, as well as the cost of an IT support technician to troubleshoot any problems. She determined the return on investment would be about 27 months after implementation, which was sooner than she expected. “You expect to have a 3-5 year period for return on investment for a significant capital expense,” she says. She says the EHR has incurred some additional costs, such as the addition of another server, but those costs are one-time expenses that she can handle as they come up.
3. Put together a committee with staff members from each department. Once she selected the EHR for her ASC, Ms. Kelly put together a committee of staff members from each department. The committee met with the company and learned how to customize the product to fit the surgery center’s needs. “We took our original charts and started building from there,” she says. “The process took about six months, and we went through five or six revisions before they got what they wanted.” She says the EHR was customized to look like the ASC’s paper charts, with ample checkboxes to make it easier to use. She says each department in the ASC is connected through the EHR; if a pre-op nurse enters allergy information on the patient, that information carries over to every other department to eliminate human error and make the surgical process safer.
She says creating this committee raised the level of satisfaction with the EHR among employees because they could see their input in the final product. Having worked as a hospital nurse prior to joining the ASC, Ms. Kelly says she has seen organizations that installed an EHR without consulting the employees. “Corporate would decide what document to use and kind of dump it into the system, and it wasn’t user-friendly and didn’t work,” she says. She says she recently spoke to her nurses and asked if there was anything they would change about the product, and they had very few complaints.
4. Develop super users for each department. Before you train your entire staff, choose a few staff members to be “super users” for the EHR system, Ms. Kelly says. She brought in a trainer to conduct a full day of training for super users before the other employees started, then asked those super users to assist their colleagues during the training and go-live process. “They would walk around and help people through the training, and every department had a person to go to,” she says. Those super users continue to help employees when they have questions with the system.
5. Hold training for staff members a week prior to go-live. Ms. Kelly wanted to make a seamless transition to a paperless ASC, using the EHR for 100 percent of patient visits starting on day one of go-live. To do this, she brought staff together for a week before go-live and hired a single trainer to teach them the product. The trainer set up meetings for staff that lasted two to four hours, during which time they watched a PowerPoint presentation on the system and then walked through test patients in the EHR.
She says the product was actually so intuitive and user-friendly that the staff needed less training than she planned for. She hired two trainers for the day of go-live to help with any problems and assist staff members as they balanced learning the EHR with conducting normal patient care.
6. Assist physicians with implementation during go-live. Ms. Kelly says she knew her physicians would be resistant to long hours of training prior to go-live, so instead, she trained her staff and asked them to help physicians learn the system as they implemented it. She made sure they understood when the go-live would occur by talking to each physician one-on-one and posting signs throughout the facility with the go-live date.
“We just walked them through the product as they did each of their patients each day,” she says. “Physicians will be fine as long as they know they’re not going to be just turned loose and handed the product.” She says while there was some initial resistance from older physicians, they now love the EHR and can’t imagine returning to paper records.
7. Explain your situation to patients during the initial weeks. Don’t be afraid to talk to patients about the EHR implementation process as you learn the system, Ms. Kelly says. “We told our patients right off the bat, ‘This is our first day using an electronic system,'” she says. “Patients didn’t have many concerns.” She says it helped that Madison, Ala., is a high-tech community due to an influx of technology companies. “Those employees are our clientele, so they’re comfortable with it,” she says.
8. Invest in IT support staff to handle problems with the system. Ms. Kelly says she ended up contracting with an IT company for a support technician to come in and troubleshoot the system as needed and verify daily backups were done. Most surgery centers don’t staff full-time IT personnel like a hospital might, so she recommends working with the EHR vendor or an outside IT company to find someone who can provide tech support when necessary.
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