Jerome H Carter

1. Disclosure of Financial Relationships Jerome H Carter Has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

2. Successful EHR Implementation in a Small Office II - Best Practices Jerome H Carter, MD,FACP CEO, NTM Informatics, Inc Atlanta, GA

3. Guiding Principles • EHR implementation ALWAYS results in change • Once initiated, change is continual • Change may be planned or unplanned • Lack of planning causes misery and possibly a failed implementation • The most problematic types of change are alterations in workflow and standardization of care across ALL providers. • You can’t necessarily have it your way.

4. Planning is Essential • Create structure • Administrative and clinical leadership should be formalized. Too much democracy is counter-productive. • Select a method for making difficult decisions and stick with it. • A team-based approach is best.

5. Accept Change as a Way of Life • Prior to EHR implementation begin to standardize common activities • New patient intake • Disease-based preventive care • Lab results review • Consultation requests • Rx refills • Look for differences between providers and determine how significant those differences are.

6. Workflow is the Key • Smooth transition to an EHR requires that the features and functions of the EHR match the way you do things. • The EHR will FORCE changes in the way you do things • Workflow analysis - the steps required to get any particular task done - requires a lot of time and being picky. • If properly done, workflow analysis will make the job of selecting the right EHR product much simpler.

7. Workflows Come in Two Flavors • Group – across individuals. Ex. patient visit • Personal – individual ways of accomplishing tasks. Ex. - review of abnormal labs • Both types of workflow are disrupted by an EHR • There is no easy way to change workflows. It takes time, planning, and sweat.

8. Don’t Rush Things • Start planning early; at least 6 months in advance • Devote time to practice analysis, workflow analysis and product evaluation prior to deciding on a specific EHR product. • Actual EHR implementation should be scheduled to occur over a three to six-month period – (for practices of five or fewer providers) • Allow for a honeymoon - the use of the more advanced features of the EHR and activities such as quality improvement will come later.

9. Technology issues • Interfaces usually take time. Make sure they are working properly before you go live with the EHR. • Buy a faster server that you think you’ll need. • Wireless networks should be tested for security issues. The test results should be written down as part of your practice security policy.

10. Disaster Recovery and Business Continuity • This means more than just the ability to backup your files. • If your server dies it should not require more than 2 hours to get back on-line and ready to do business • Best approach is to encrypt data and store it off-site • Use fault-tolerant servers • At a minimum servers with mirrored drives • Buy special insurance for hardware and business interuption

11. Security • The HIPAA Security Rule applies to your system • If your EHR is to be a legal record you MUST adhere to the HIPAA Security rule • Insurance policies rarely cover data loss or breaches • Minimum requirements • Virus software, firewall • Written security policies • Staff training for security issues • Staff rules for data access • Measures taken for rule violations • Disaster recovery plan

12. Chart migration • Decide on the chart migration method that you’re going to use. • Big Bang – every patient goes in on day one. • Phased • Patients entered by medical record number • Patients entered by next appointment • Patients entered by provider • Decide what information will be moved from the old chart • Dictate chart summary and load into EHR • Scan key, labs, x-rays etc. –NOT EVERYTHING! • Whatever method of migration you select make sure that it is consistent across all providers.

13. Vendor Issues • Vendors should provide • Training ( at least 2 cycles) • Local “superuser” • Workflow analysis assistance • Advice/planning for chart migration • Choose vendor • More than 3 years in business • At least a good regional presence (6-10 states) • Growing revenues • True R&D budget

14. Quality Improvement • Quality improvement takes time • It requires data in an analyzable form • This requires entering data into the system in specific ways. • Ask the vendor to clarify how various data entry options affect the later usability of the data

15. Get help • Workflow analysis, process improvement, and EHR technology are highly technical areas that few physicians are familiar with. • Don’t waste time and money- get help from those who know. • Doctor's Office Quality - Information Technology (DOQ-IT) is available through many state medical care foundations and is free. • DOQ-IT offers assistance with EHR selection, for those who want to tackle this on their own there are plenty of books and resources available • www.acponline.org/EHR