Timeline for the Transition to an EMR: During Integration (Part 2 of 3)

This is the second in a three-part series on the different stages an ambulatory surgery center goes through when switching to an electronic medical records system. Part one appeared in the October issue of Becker’s ASC Review and on www.beckersasc.com.

More ASCs are making the switch to electronic medical records to take advantage of the myriad benefits an electronic system provides to patients, physicians and staff. But making the switch requires more than just a flip of a switch: it requires buy-in from leadership and staff, careful planning and ongoing collaboration between the ASC and its EMR vendor.

There are three stages inherent in the transition to an EMR: before, during and after integration. In this part of the series, we will discuss the second stage, or the series of events that take place from the beginning to the completion of the system’s implementation. There are 10 steps your ASC will need to take during this stage to ensure a smooth implementation that will have your facility immediately reaping the rewards of the EMR system.

1. Kick off the project. The beginning of implementation establishes a plan for the entire implementation process. The project kickoff begins with your EMR vendor meeting with the project leaders — those staff members who will work closely with the vendor during implementation. This may include a staff member designated as a project manager, or may include the clinical director, administrator, a few nurses, a physician and a representative from anesthesia. These leaders are not necessarily all of the “super users” discussed in part one of this series, but there may be some overlap.

Working with these project leaders, the EMR vendor will review any previously gathered information on your operations for accuracy, and may request additional details. Then the leaders will work with the vendor to target a feasible golive date. This is accomplished by determining your “go-live requirements.”

Go-live requirements focus on who you want using the system at go-live, which is typically a combination of nurses, surgeons and/or anesthesiologists. You will also determine what parts of the system your ASC intends to use immediately after the system goes live and those features you plan to use later. An EMR system has many components, and most ASCs choose to use only some of them at the beginning and then slowly incorporate others.

You will then choose a go-live target date. There are two types of go-live dates: a “hard date” and a “soft date.” If your ASC is a new facility under development and will open on July 1, for example, it would make sense to set a hard date of July 1 for the EMR’s go-live so the day your doors open, your EMR is operational. If your ASC is already operational, a soft, flexible date is more practical as it allows for adjusting the date. It is better to delay your go-live than rush to meet an unrealistic date.

Once this date is chosen, you will work with the vendor to plan the project backwards, identifying significant target dates during implementation, developing realistic expectations for the implementation process and holding an orientation to discuss the different phases of implementation. This orientation will likely touch on many of the steps we will discuss in the rest of the column. It is important to note that these steps — the phases of implementation — are frequently concurrent.

Note: In addition to working with your EMR vendor during implementation, you will need to involve the vendor supplying and setting up new computer hardware. The date your hardware is ready will often affect the go-live date, as a number of the steps described below require use of the hardware.

2. Install software. Working with your ASC’s IT staff/vendor, the EMR vendor’s technical team will discuss your ASC’s server capabilities and then install its software and databases to your server. This is typically a short process.

3. Perform facility assessment. Your EMR vendor will work with your staff to review information on facility workflow and personnel roles. The vendor will discuss how the system and supporting hardware will impact your operations. An EMR will improve your efficiency and reduce the time needed to perform many tasks, so you should use this discussion to start considering changes to make to your ASC’s workflow and staff responsibilities to maximize the system’s benefits.

4. Gather and review business and clinical documentation. If the EMR system you choose incorporates your ASC’s documentation into the software’s database, you will need gather all your business and clinical documentation and provide it to your vendor. These documents will likely include your ASC’s consents, pre-op phone call questions, patient instructions, anesthesia records, physician orders, discharge instructions and medication formularies.

Before you provide these documents to the vendor, analyze them and determine whether these documents can be improved. If you want to change a document, this is the optimal time to make a revision so the improved document and process becomes the new standard in your EMR system.

5. Build database. Once your ASC provides the business and clinical documentation to your vendor, the documents are built into the EMR’s database. The vendor will then take your ASC through the software and show how your documentation is accessed and populated in the system. During this step, your ASC may still have the opportunity to make electronic revisions to the documentation and activate some of the EMR’s features to further improve your documents.

Your EMR vendor will also teach you how to add documents to the database so you understand how to maintain your database going forward.

6. Undergo training. Once the database build process is far enough along (it doesn’t need to be complete), your EMR vendor will work with a team from your ASC to simulate a real case moving through the system. This team, sometimes referred to as an advisory committee, will involve individuals from throughout your ASC who can complete the documentation during each part of a case.

It is during this mock case — and perhaps throughout your training — that a staff member previously assigned to completing a task involving a paper record is no longer the most appropriate person to complete the same task using the electronic record. This is another opportunity to analyze your workflow and staff responsibilities to identify areas for improvement.

After the mock case simulation is completed, your EMR vendor will train other staff members on use of the system. This will include simulated experiences based upon the specific responsibilities of staff members and training on different EMR applications. Your vendor will work with your ASC’s administration to schedule the most appropriate times to train different members of your team to limit the impact of taking staff away from other responsibilities.

7. Create charting policy. After the database build is complete and you learn more about those EMR applications that you designated for immediate use, you will create a policy that assigns completion of the different components of the patient chart and use of these applications to specific staff. While many responsibilities will not change, you may reassign some tasks to further improve workflow, and you will identify who will use new applications. For example, if you start to use a pre-admission questionnaire included in the EMR, you need to determine who will perform this new task.

8. Fix issues. Until you start to test and train on the system, it is not unusual to encounter some issues in areas like hardware, workflow gaps and improper device implementation and placement. Throughout the implementation process, you and your EMR vendor will assess your progress and identify any problems to fix or changes to further improve your operations.

Prepare your staff members for the possibility that not everything will go exactly according to plan, but if they maintain a positive attitude and assist with fixing issues that do arise, those obstacles will not hinder the implementation process.

9. Go live. The approach ASCs take to their go-live is different for each facility. It will be up to you, discussing options with your vendor, for how to proceed on the first day using your EMR for real cases. For example, you can use your EMR for all of a day’s cases or a single case. You can select individual staff members who are comfortable with the technology to use the system or have all of your staff on the system. If you have multiple operating rooms, you can choose all of them to use the system or have a phased-in approach where just those you identify as having the strongest users go live on the first day.

Once these decisions are made and the go-live date arrives, you and your EMR vendor will perform a final onsite walkthrough, and the vendor will shadow users within each department to help ensure a smooth transition to the live system.

10. Celebrate! When you make the switch to an EMR, you are investing in a resource that will significantly improve your operations and the experience of your team and patients. Since the preparation for and the implementation of the EMR system requires significant time and energy from all of your staff members, celebrate their effort, and recognize the commitment of those team members who led the way to making your surgery center an even better, safer and more efficient place to work and receive care.

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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