Tom Pliura, MD, founder of zChart EMR, discusses six key considerations ASCs should bear in mind before deciding to implement an electronic medical record system.
1. Get a conceptual buy-in from ASC owners. Dr. Pliura says getting a "conceptual" buy-in from physician-owners and governing bodies is absolutely essential to ensuring successful implementation of an EMR. Given the resources and capital needed to deploy a system, as well as the reality of the initial impact on productivity, it's important to have your ASC's leadership commit to and understand the undertaking.
"The nurses and technicians and other staff members can desire to implement an EMR until the cows come home, but if the physicians who use the facility don't buy into the concept that an EMR would make the whole facility more efficient, you're going to have an uphill battle in implementing one," he says.
Dr. Pliura suggests showing the decision makers and leaders specific ways an EMR can improve operational efficiency or financial outcomes. One way ASCs can get a buy-in from physician-owners and other decision makers is by showing that an EMR would allow nurses to have more "face time" with patients because it will cut out extra time spent filling out forms multiple times throughout a day.
2. Understand your EMR will need constant maintenance. Although the concept of an EMR has been around for many years, it did not truly emerge as a health IT solution for improved clinical and financial outcomes until recently, when President Obama passed the HITECH portion of the American Recovery and Reinvestment Act in 2009. Even though advancements in technology for EMRs are rapidly increasing, Dr. Pliura says the EMR market is merely in its "baby stage." If your ASC plans on deploying an EMR system, be mindful that the system will also require maintenance, ongoing trouble-shooting and changing software, solutions and applications as technology evolves.
"If anyone thinks there is a perfect EMR right now, they're sorely mistaken. Even since we started developing our own EMR, the ability and storage capacity or even wireless cards to allow users walk around untethered has increased exponentially," Dr. Pliura says. "Each year, the technology gets better. Computer reliability gets better, so every year ASCs have to improve right along with the times."
In addition to ongoing maintenance, Dr. Pliura says ASCs must keep in mind the training that will be necessary to ensure physicians and staff are using the EMR optimally. Proper training in the initial stages will help curb some of the impact on physician productivity in the long run. "If an ASC thinks that it can just pick [an EMR] up and start using it without rudimentary training, they're going to get frustrated and disappointed. They need to know that it's going to take some training and time, just like when you're learning how to ride a bike or any other learning process," he says.
3. Designate a staff member who knows the system thoroughly. Another key to successful EMR deployment is appointing an in-house staff member who knows the system inside and out, Dr. Pliura says. This "super user" should have in-depth training and possess incredible technological proficiency, so if another staff member experiences a trouble-shooting problem, that EMR technician will know how to address the issue immediately.
"For example, if a nurse needs help putting an EKG into the EMR, she would go straight to the 'super user' so that later, when anesthesia providers want to see the EKG in the patient's record, the anesthesiologist can see that EKG right away without calling a vendor and waiting to get a hold of them," he says. "Otherwise, you have a patient waiting on an operating table when an issue with his or her EMR suddenly arises and there is no in-house person to address it."
4. Review security rules for HIPAA compliance. The HIPAA interim final rule calls for increasingly stringent security practices, and the penalties for not complying with HIPAA can be financially devastating and ruin an ASC's reputation. There are security rules that apply to EMRs specifically, so it is incumbent upon ASCs to review and completely understand the security rules and regulations. This is especially important now that more healthcare providers are turning to online storage databases — as opposed to external hard drives — as a means of storing sensitive personal health information, which can be breached easily if an ASC is not careful.
"The HIPAA rules pertaining to EMRs aren't complicated or difficult, but ASCs need to be aware of simple things like password security and have some type of procedure set in place to prevent unauthorized access to its EMR system," he says.
Dr. Pliura also emphasizes the need for safe web-surfing practices. With so many viruses possessing the ability to cripple your computer and EMR systems, ASCs should seriously consider downloading anti-virus software or enforcing strict web-surfing practices to ensure the system does not get attacked by a virus.
5. Optimize your EMR for increased improvements. Virtually all EMR systems are customizable to an ASC's liking. Everything from the look of the actual EMR to the design of various medical forms can be changed to individual physicians' preferences. ASCs should take advantage of this functionality, as it could lead to stronger decision-maker buy-in and more returns on investment on the back end. Dr. Pliura says tailoring an EMR system to a physician's preferences may take some time in the initial stages, but the ASC could reap enormous savings in time and money in the long run.
"Dr. Smith's orders for colonoscopies and Dr. Jones's order for the same type of colonoscopy can be totally different, and they each can have pre-operative and post-operative orders already filled out so all they have to do is click a button," Dr. Pliura says. "So unless you invest the time to learn how to fully maximize the system, you're not going to capitalize on the biggest benefit to surgery centers, which is improved efficiencies."
6. Critically assess your ASC's use of its EMR. Whether a critical assessment of EMR user habits are done by a third party or internally, an ASC should actively seek ways to improve its EMR usability. "You need to routinely perform a self-critique or analysis on your user habits. By assessing your user habits and critiquing them, you can investigate possible ways to be even more efficient with your EMR," Dr. Pliura says.
Learn more about zChart.
1. Get a conceptual buy-in from ASC owners. Dr. Pliura says getting a "conceptual" buy-in from physician-owners and governing bodies is absolutely essential to ensuring successful implementation of an EMR. Given the resources and capital needed to deploy a system, as well as the reality of the initial impact on productivity, it's important to have your ASC's leadership commit to and understand the undertaking.
"The nurses and technicians and other staff members can desire to implement an EMR until the cows come home, but if the physicians who use the facility don't buy into the concept that an EMR would make the whole facility more efficient, you're going to have an uphill battle in implementing one," he says.
Dr. Pliura suggests showing the decision makers and leaders specific ways an EMR can improve operational efficiency or financial outcomes. One way ASCs can get a buy-in from physician-owners and other decision makers is by showing that an EMR would allow nurses to have more "face time" with patients because it will cut out extra time spent filling out forms multiple times throughout a day.
2. Understand your EMR will need constant maintenance. Although the concept of an EMR has been around for many years, it did not truly emerge as a health IT solution for improved clinical and financial outcomes until recently, when President Obama passed the HITECH portion of the American Recovery and Reinvestment Act in 2009. Even though advancements in technology for EMRs are rapidly increasing, Dr. Pliura says the EMR market is merely in its "baby stage." If your ASC plans on deploying an EMR system, be mindful that the system will also require maintenance, ongoing trouble-shooting and changing software, solutions and applications as technology evolves.
"If anyone thinks there is a perfect EMR right now, they're sorely mistaken. Even since we started developing our own EMR, the ability and storage capacity or even wireless cards to allow users walk around untethered has increased exponentially," Dr. Pliura says. "Each year, the technology gets better. Computer reliability gets better, so every year ASCs have to improve right along with the times."
In addition to ongoing maintenance, Dr. Pliura says ASCs must keep in mind the training that will be necessary to ensure physicians and staff are using the EMR optimally. Proper training in the initial stages will help curb some of the impact on physician productivity in the long run. "If an ASC thinks that it can just pick [an EMR] up and start using it without rudimentary training, they're going to get frustrated and disappointed. They need to know that it's going to take some training and time, just like when you're learning how to ride a bike or any other learning process," he says.
3. Designate a staff member who knows the system thoroughly. Another key to successful EMR deployment is appointing an in-house staff member who knows the system inside and out, Dr. Pliura says. This "super user" should have in-depth training and possess incredible technological proficiency, so if another staff member experiences a trouble-shooting problem, that EMR technician will know how to address the issue immediately.
"For example, if a nurse needs help putting an EKG into the EMR, she would go straight to the 'super user' so that later, when anesthesia providers want to see the EKG in the patient's record, the anesthesiologist can see that EKG right away without calling a vendor and waiting to get a hold of them," he says. "Otherwise, you have a patient waiting on an operating table when an issue with his or her EMR suddenly arises and there is no in-house person to address it."
4. Review security rules for HIPAA compliance. The HIPAA interim final rule calls for increasingly stringent security practices, and the penalties for not complying with HIPAA can be financially devastating and ruin an ASC's reputation. There are security rules that apply to EMRs specifically, so it is incumbent upon ASCs to review and completely understand the security rules and regulations. This is especially important now that more healthcare providers are turning to online storage databases — as opposed to external hard drives — as a means of storing sensitive personal health information, which can be breached easily if an ASC is not careful.
"The HIPAA rules pertaining to EMRs aren't complicated or difficult, but ASCs need to be aware of simple things like password security and have some type of procedure set in place to prevent unauthorized access to its EMR system," he says.
Dr. Pliura also emphasizes the need for safe web-surfing practices. With so many viruses possessing the ability to cripple your computer and EMR systems, ASCs should seriously consider downloading anti-virus software or enforcing strict web-surfing practices to ensure the system does not get attacked by a virus.
5. Optimize your EMR for increased improvements. Virtually all EMR systems are customizable to an ASC's liking. Everything from the look of the actual EMR to the design of various medical forms can be changed to individual physicians' preferences. ASCs should take advantage of this functionality, as it could lead to stronger decision-maker buy-in and more returns on investment on the back end. Dr. Pliura says tailoring an EMR system to a physician's preferences may take some time in the initial stages, but the ASC could reap enormous savings in time and money in the long run.
"Dr. Smith's orders for colonoscopies and Dr. Jones's order for the same type of colonoscopy can be totally different, and they each can have pre-operative and post-operative orders already filled out so all they have to do is click a button," Dr. Pliura says. "So unless you invest the time to learn how to fully maximize the system, you're not going to capitalize on the biggest benefit to surgery centers, which is improved efficiencies."
6. Critically assess your ASC's use of its EMR. Whether a critical assessment of EMR user habits are done by a third party or internally, an ASC should actively seek ways to improve its EMR usability. "You need to routinely perform a self-critique or analysis on your user habits. By assessing your user habits and critiquing them, you can investigate possible ways to be even more efficient with your EMR," Dr. Pliura says.
Learn more about zChart.