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| Implementing an electronic medical record (EMR) is a major initiative that should be undertaken only after a thoughtful analysis of the costs and benefits involved. |
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| ADA for exchanging data processing standards to the dental services of the health care industry... |
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| Barack Obama: In his Plan for a Healthy America, Obama calls for lowering costs through investment in electronic health information technology systems, acknowledging... |
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| 1.
CHECKLIST FOR OPTIMIZING YOUR EMR |
- Have you completed the post implementation
review? What works and what don’t? Are all
users using the EMR? If not, why not?
- Now that you’ve been using the EMR for a
while, what else can it do for you? Are you
using it to its fullest?
- Is additional or refresher training required
to ensure all users are comfortable with the
system?
- Is everyone using the same data coding and
quality standards? If not, why not?
- Have you implemented any patient recall
programs or clinically indicated alerts?
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POST-IMPLEMENTATION REVIEWS
(PIR’S): EVALUATING THE EMR
Both the practice's needs and the EMR system may
change over time, so regular evaluation and re-evaluation
of the system, practice goals, and priorities
will help to ensure you continue to get the most
from the EMR.
The purpose of a post-implementation review is
to assess the degree to which the practice's goals
and requirements have been met and thus assess
the value of the EMR.
PIRs
(Post Implementation Reviews) are not
intended to be "one time" events. They provide
an opportunity to assess what works, what doesn't,
and to determine the best means to address any
outstanding issues. The first review should be
held within one month of becoming fully operational.
PIRs (Post Implementation
Reviews) can and should be conducted regularly,
e.g., 1, 3, 6, and 12 months post-implementation,
and every 6-12 months subsequently. Regular review
and reassessment of the EMR, and its fit with
the practice goals and objectives, will help you
continue to maximize the value from your investment
in the technology. Sample questions for consideration
in a PIR include: |
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- Was the EMR implemented on time?
- Was it on budget?
- Does it meet your needs, as documented in
the Scope of Work and the contract with the
vendor(s)?
- Did the Scope of Work and vendor contract(s),
as written, effectively document the clinic's
requirements?
- Does the EMR meet staff's expectations?
If not, why not?
- Are all health care providers and administrative
staff using the EMR? If not, why not?
- Are all health care providers and administrative
staff using all features of the software,
which are relevant to their jobs?
- Are all paper charts archived? If not, what
timeframe has been set to complete this work?
- Are health care providers coding problem
lists consistently? Have standards been set
for the level of detail to capture for data
entry/data coding?
- Has the EMR improved patient care? If so,
how?
- Has the EMR improved patient safety? If
so, how?
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| Does
the EMR save any time for health care providers?
If so, how: |
- Charting?
- Billing?
- Prescription writing/renewal?
- Referrals/letter writing?
- Assessing lab results? (E.g., out of range
values? trends over time?)
- Monitoring rule-based recall/guideline-based
care processes - e.g., how many diabetes patients
have had their A1C measured within the past
3-6 months?
- Identifying high-risk patient populations
(e.g., patients eligible for/requiring annual
flu vaccines)?
- Drug recall?
- Other areas?
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| Does
the EMR save any time for administrative staff?
If so, how: |
- Billing?
- Scheduling?
- Referrals?
- Patient recall?
- Other areas?
|
| Is
additional training required for any health care
providers or staff? |
| The
results from a PIR research project have been
compiled in a formal study. The results demonstrate
the increasing value of an EMR over time. |
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| 2.
DATA SHARING & INTEROPERABILITY |
To
maximize the utility of your EMR, you need to
be able to share data - with other providers participating
in the care of your patients, with other health
care facilities (e.g., labs, hospitals, pharmacies,
public health organizations), with government
agencies (e.g., billing), and with patients themselves.
Interoperability relies on the development and
implementation of standard data definitions (for
data format and content) and information exchange
infrastructure (e.g., system architecture), to
allow different systems to communicate with one
another. |
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| 3.
QUALITY IMPROVEMENT (QI) |
| Quality
improvement relies on good data. An EMR
can support improved patient care and practice
management by enabling measurement of improvement
through high-quality data. The "Assessing your
Practice: Green Book" provides guidelines to assist
practices to collect quality data and information. |
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- Set the aim.
- Establish the measures.
- Validate the measures with the team.
- Test the changes.
- Spread and sustain the changes.
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This model provides a customizable framework
to help a practice to assess its success in
meeting its goals (e.g., EMR project goals set
during the "Getting Started" phase of the EMR
project). It can help with measurement of general
practice efficiency, workflow, and improvements
in processes of care and patient health outcomes.
Regardless of whether a practice is interested
in applying a formal methodology to "measure
change", or just interested in working
together more effectively to provide the best
patient care possible, there are three general
questions to address with your practice team
to effect continuous clinical practice improvement: |
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| 4.
LOOKING AHEAD |
In
conclusion, implementing an EMR isn't just a one-time
deal - both the practice and the EMR will continue
to evolve over time. Along with that evolution
you will identify new priorities, goals, and opportunities
for each. As a part of this continuing process,
you will want to stay up to date with your vendor(s)
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EMR implementation can be a difficult and complex
multi-disciplinary effort that can stretch an
organization's skills and capacity for change.
The process is a continuous learning experience
that will be challenging, occasionally stressful,
and ultimately, offers the potential for significant
clinical and practice value. |
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