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EMR Implementation Road Map
Checklist for preparing EMR Implementation
- Do you have a clinical lead and an administrative lead for the project?
- Have you appointed a project manager? Does one of the "leads" have the time and skills to do this or do you need to hire a consultant?
- Have you worked with your team to create a project plan, with tasks, timelines and a named individual responsible for each task? Is everyone in agreement with this plan, including the vendor?
- Have you worked with your team to complete a process map for your practice and identify areas for improvement, e.g. Where the EMR software will change how you work, where staff have different roles, where information and data flow differently?
- Have you determined the training requirements for each member of your practice? Do some need to acquire basic computer skills as well as training in the EMR software?
- Have you identified potential "super users" in the clinical and administrative areas who can help other users become familiar with the software and troubleshoot issues?
- Have you scheduled dedicated training time and lighter workloads for staff during training and implementation?
- Have you developed privacy and security policies for your practice? Do all staff understand the policies? Are patients aware of the policies?
Implementing an EMR - Introduction
The implementation phase is possibly the most important topic in EMR SOFTWARE, while many vendors’ products are alike, the processes used for product implementation can vary greatly from vendor to vendor. Some offer remote training & installation services while others offer onsite services, and some even give you the option of both. Selecting an installation method that’s right for your office and your budget is crucial.
From an Information Technology point of view, there are seven stages in the implementation road map:
- Stage 1: Assessment
- Stage 2: Planning
- Stage 3: Selection
- Stage 4: Implementation
- Stage 5: Evaluation
- Stage 6: Staff Training
- Stage 7: What new policies & procedures do you need to consider?
Let us examine each stage and develop the framework of a road map.
Implementation & Maintenance
Checklist for Implementation & Maintenance
- Have all users received training per the training plan?
- Is the EMR installed per the Scope of Work requirements?
- Is the electronic-to-electronic data conversion and migration complete?
- Is paper-to-electronic data conversion underway? Have a strategy and timelines been developed and have all members of the practice team agreed to them?
- Have the acceptance criteria, as defined in the contract with the vendor (based on the Scope of Work), been met, signed off, and have you moved to an operational support agreement with your vendor?
- Have you verified that your backup processes are working correctly and verified the data?
- Have you been following your system management plan to ensure all desktops, servers, and related peripherals (e.g., printers) are up to date with their operating systems, security patches, anti-virus and application software?
- Are you aware of planned upgrades to your EMR software? Have you agreed with your team on criteria for deciding whether to and when to implement them?
- EMR SYSTEM INSTALLATION & TRAINING
Installation of hardware and network equipment is the most disruptive component of an EMR implementation. Initial training for all clinical and administrative users is normally undertaken as soon as installation is complete. - DATA CONVERSION
Data from the existing practice environment may need to be moved to the new EMR. These include:- Patient demographics.
- Allergies.
- Medications.
- Active problems.
- Recent significant diagnostic and lab results.
- Significant personal and family histories.
- Paper to Electronic
- Electronic-to-Electronic
- ACCEPTANCE TESTING
Acceptance testing is about ensuring the system functions in the practice setting as defined in the Scope of Work. For instance, test components such as the following (this is a sample list which would be developed in more detail in your actual Test Criteria):- Logging in, changing passwords, locking workstations, adding and removing new users from the system.
- All aspects of EMR functionality including prescription writing, referral letters, intra-office messaging, reporting and recall functions, etc.
- System-to-system interoperability including all agreed upon electronic data imports and exports.
- Billing for private and public payers.
- Lab results, medications, and diagnostic data from external sources.
- E-prescribing.
- Diagnostic order entry.
- Data feeds and reporting to and from other provincial and regional systems, e.g., hospital information systems, registries (immunizations, chronic disease management, cancer, etc.).
- Internet access and e-mail from every workstation and every user account.
- Printing from every workstation and every user account. Also test label printing (if relevant).
- Access to office productivity tools, e.g., word processing and spreadsheet programs, clinical reference tools, etc. for all users who need them.
- Backup and recovery. Verify that the process works as it should and that data restored from a backup is useable.
- Archiving of patient charts when a patient leaves the practice.
- Remote access. If remote access is provided to permit users to access the EMR system from off-site (e.g., at home or in another clinic location), ensure that it works as planned and that all security protocols are installed and activated.
- Wireless network security. If a wireless network is used, ensure security is properly enabled and that unauthorized devices (computers, messaging devices (e.g., Blackberry, Palm), etc.) cannot view or access the network traffic.
- SYSTEM & SOFTWARE USER GUIDES
Ensure that the vendors supply good user manuals for both the hardware and software, in either printed or electronic form (preferably both). - ACCESSING SUPPORT SERVICES
Ensure that all staff members are aware of what to do when they have technical problems. The practice should consider developing a simple policy for users on a day-to-day basis, such as the following:
If you have trouble with your EMR, follow these three steps in order:- Use the help file: examine the user guides to try to resolve the issue on your own.
- Consult the on-site "super user" or other IT support, if available.
- Contact the vendor's support desk."
- DATA ENTRY, QUALITY, & REPORTING – IMPLEMENTING BEST PRACTICES
The largest value in using an EMR is not in the data you enter, but in the information you can retrieve to help improve patient care. Effective EMR use relies on a sound understanding of a few quality principles and core concepts about data:- Data types and management - The data collected may be in either or both plain text or structured formats.
- Data mining and reports - Data collected is useful only if it can be retrieved in an efficient manner. Similarly, meaningful reports can be generated only if the data is accurate and complete.
- Data entry- Agree on a common approach to data entry and coding among all members of the practice and ensure that all members of the practice team follow this approach. Data entry best practices rely on consistency and codified data.
- MAINTAINING YOUR EMR
Staying current with user training, system maintenance, and upgrades ensures that the EMR will be more likely to continue to meet your needs. These items should be addressed as part of your service level agreements with vendors.
