Look before you leap: small and mid-size physician practices can eradicate EMR challenges with homework and planning

Health Management Technology, May, 2005 by Richard R. Rogoski

Also, because the practice's 16 physicians, ranging in age from 32 to 78 years, have their own unique way of examining patients, "The EMR had to be flexible enough to accommodate their little quirks."

Interestingly, return on investment was not an important factor. "We started looking for an EMR in 2001 and for a new practice management system at the same time," Eddlestone says. "We realized we were going to spend money for the EMR, but its capture would not be as immediate as from the practice management system." She adds that compliance was an additional driver that overshadowed concern about the initial investment.

Standard Bearers of Adoption

Eddlestone was fortunate to have three physicians who were instrumental in getting the EMR up and running: Thomas Stern, 78, turned out to be the one doctor on staff who consistently pushed for an EMR. As new modules have been added, Stern has essentially become the practice's "beta tester." Then there's Stacy Smith. "She came to our clinic from another clinic and had no paper charts here," Eddlestone says. "She was very interested in technology and was very good at communicating with other physicians, so we made her the physician advocate."

Affiliated with the Baptist Hospital System, Stern Cardiovascular Center also was able to draw upon the advancements being undertaken on the hospital side. "Dr. Steven Gubin, a cardiologist on our staff, was very instrumental in helping Baptist Hospital set up their electronic system," Eddlestone says. As a result, some physicians at Stern Cardiovascular had grown accustomed to working with an EMR and electronic signing through the hospital's system.

Having this kind of provider support early on is crucial to the successful roll out of an EMR, says Les Wilson. "The physicians really need to be the standard bearers of adoption."

Winning Strategies

By adopting a modular strategy, Eddlestone says Stern Cardiovascular could install only those modules that the ancillary staff could learn first and that would not directly impact the way physicians did their jobs. "We wanted to do as many modules as possible behind the scenes without involving physicians. We started training our ancillary staff, and once they were trained, the doctors came on without having to be pushed," Eddlestone says.

Helping the adoption process was the fact that scanning of patient information began early on, so older patient data was already in the system for physicians to access.

Implementation began in June 2002 with the roll out of TouchWorks Dictate, which provides the functionality of a handheld digital recorder, but also incorporates features like patient list information and dictation templates. This module was interfaced with the Crescendo dictation system already in place; this "allows physicians to dictate the same way they always did, so it was seamless if they wanted it to be," Eddlestone says.

Installing the note module, however, was more challenging. Although it provides Web-based physician tools that support clinical note creation, inbound transcription, structured data entry, clinical correspondence and real-time access to clinical documents, some docs were initially slow to adopt.