Going live with an EHR: Practical advice from DOs who lived to tell

Prior to implementing electronic health records, a practice should designate a “physician champion” to field questions from colleagues and office staff and to communicate with the vendor, said Robert L. Hunter, DO, who along with Thomas G. Zimmerman, DO, provided some tips this morning during an OMED session sponsored by the American College of Osteopathic Family Physicians.

When setting up an EHR, it is important for a practice to get everyone from the front office to the back office involved, explained Dr. Hunter, who practices with a large Ohio multispecialty group. A team of physicians, nurses and administrative staff should collaborate with the vendor during the setup phase.

Dr. Hunter advised the audience members to develop a detailed patient-history form for patients to fill out before the transition to EHRs. “Having this information before you ‘go live’ helps make the transition process smoother,” he said.

He also recommended that physicians set up as many clinical presentation templates as they can before launch. This way, drop-down menus will be available to physicians when they see patients, so they won’t have to click on as many boxes.

Post-launch

Once the EHR goes live, physicians should lighten their schedules by 30% to 50% during the first week, Dr. Hunter suggested. “On the first day, I think I saw five patients in four hours,” he recalled. “I had visited other practices and gone to training sessions. I thought I was prepared. But some of the drop-downs weren’t ready for some of the conditions I saw.”

The first days of implementing an EHR are usually very frustrating for physicians. “Be ready for anger, crying, agitation,” Dr. Hunter warned.

But the benefits of EHRs quickly outweigh the drawbacks, he stressed. “One thing I was very impressed with during the first week was that I could see each patient’s medications, lab results and everything on the same screen. Previously, I would have to ask my assistant to go get the chart, and sometimes we couldn’t find what we were looking for, ” he said.

In that first week of launching an EHR, “attempt to close all encounters by the end of the day,” Dr. Hunter advised. “The more you say, ‘I’ll do that tomorrow,’ the charts will just pile up and pile up and pile up.”

Physicians should delegate as much work as possible to staff, Dr. Hunter said. In time, because it will improve efficiency, an EHR will allow a practice to function with less staff.

Dr. Hunter encouraged those who have not yet implemented an EHR to plunge in and use a new system to the fullest extent possible from the beginning: for orders, for referrals, for electronic prescriptions. That way, through practice, physicians will become comfortable with all components of the EHR more quickly.

“If it seems complicated it is, but it’s not impossible,” said Dr. Zimmerman, the director of osteopathic medical education at South Nassau Communities Hospital in Oceanside, N.Y. “But there are many, many details that you will need to figure out, remember and execute. It you don’t keep track of them, they will snowball into big problems down the line.

“It’s a continuous learning process.”

cschierhorn@osteopathic.org