From the Chair: Implementation, Implementation, Implementation

You’ve done your homework. You and your colleagues have chosen an Ambulatory EHR that you believe to be the best for your practice with respect to price and payment model, functionality, platform, and certification status. You have already put in substantial time and effort, but you also understand that it will be several months before your practice–and revenue stream–are flowing smoothly, again. You also realize that everyone from the receptionist to the billing clerk to the clinicians has to adapt to electronic processes and new workflows. You have set an installation/implementation date and you are ready to flip the switch and go live.

Still, this is a major transition in your life and in your practice. And, like many other major transitions that you plan and prepare for, “go live” is more complicated than you may think–and fraught with a number of challenges.

One thing that can help is talking to people who have lived through this transition. Clinicians who have been through the process and those who provide help and support to those clinicians can offer some practical advice, starting with the need for thorough training before transition date. Hopefully your vendor has supplied you with a number of training modules that you and each of your staff have mastered. If not, ask for a list.

You will have spent time undergoing a full self-assessment of your practice patterns and preferences so that you can identify and prioritize those functions that are critical for patient care at the time of installation and those that you may choose to implement in the near future. As a practice, you need to have come to agreement on what will be abstracted from the paper record, how the information will be entered into the EHR, who will accomplish this time-consuming task and what the timeline for completion looks like. You will need to be facile with the use of data migration templates. Your team will have completed all of the policies and procedures necessary to input new information on a specific number of both established and new patients before go-live. You will be familiar with the building of order sets, favorite lists and coding guidelines. But, you should also keep meaningful use and quality measures in mind during the pre-go live decision-making and preparation. Don’t underestimate the importance of your entire staffs’ involvement in this pre-go live planning, decision-making and workflow redesign to the success of your EHR implementation.

You will have learned how to build and populate templates for the most common problems that you see clinically, so that these templates can be implemented and test driven before go-live. The same is true with alerts and reminders. If you have a patient portal with your EHR, you will have developed policies and procedures concerning patient consent and what information patients will be able to access and when. Likewise, you will need to work with your vendor to assure that you are appropriately set up to maintain those policies while allowing promised access of information to your patients.

Perhaps one of the most important things to consider is how your clinical and billing functions integrate. Make sure that on “go live” day that all of your payers are included in the system, that all billable care is captured and reported, and that an appropriate claim is successfully submitted to the appropriate payer.

Lastly, don’t assume that you can do everything on go-live day. Good implementations take time and further training, ongoing workflow adjustments and software updating will be needed. Problems will arise. It just happens. Make sure the most important aspects of the EHR are installed, functioning well, and understood by all members of your practice staff by the end of the “go live”, but also make sure that you have your vendor’s commitment to return several times more to help you add more functions, expand more in depth the ones you started with, or make necessary modifications as you discover what works and what doesn’t. A good vendor is a good partner throughout the entire transition period, not just on go-live day.

Karen M. Bell, MD, MMS
Chair, Certification Commission

Karen Bell, MD, MMS, is Chair of the Certification Commission for Health Information Technology (CCHIT®. Dr. Bell has wide and varied expertise in health information technology (HIT), quality assurance and clinical practice, in both the private and public sectors. Previously, she served as Senior Vice President, HIT Services, Masspro, the federally-contracted Quality Improvement Organization within Massachusetts, where she oversaw the development, implementation and distribution of products and services to support adoption of electronic health records (EHRs) within the health care system. Between 2005 and 2008, Dr. Bell was Director, Office of Health Information Technology Adoption, Office of the National Coordinator (ONC), U.S. Department of Health and Human Services (HHS), and, in 2006, served as Acting Deputy of ONC. She was ONC’s representative on CCHIT’s Board of Commissioners from 2006 to 2008.

Prior appointments held by Dr. Bell include Division Director, Quality Improvement Group/Office of Standards and Quality for the Centers for Medicare and Medicaid (CMS), and Medical Director of Blue Cross Blue Shield (BCBS) of Rhode Island and of Anthem BCBS of Maine.

She received her medical degree from Tufts University School of Medicine, Boston, and her master of medical science degree from Brown University, Providence, R.I. Dr. Bell has clinical experience as a board certified physician in internal medicine and also was an Associate Professor at the University of Rochester, and Clinical Instructor at Harvard University School of Medicine.