Implementing an EHR Software
Proven technique for a successful transition
By Alex Niswander
The check has been written, your new EHR software has arrived and the hard part is over right? Well, if only plug and play meant that once installed you could stop using your paper charts the next day and begin full speed ahead with your new EHR system.
Oftentimes a doctor’s first question is, “How long will it take me to implement this EHR?” There is no cookie cutter answer for this, as everyone learns a little differently and at different paces. Some people may have a lot of experience with computers so they can forgo the extra step of just learning his/her way around their new PC or tablet. On the other hand, there are doctors who have barely touched computers, so would need a little extra time to figure them out first.
Over the past 10 years we have been fortunate enough to be part of hundreds of successful EHR software implementations. There are so many important parts from the hardware specifications to the network configuration; to completing (all) of the training, to the staff’s attitude and willingness to learn, to the doctor’s ability to put down the paper charts. All are important; however the single most important step is your implementation plan.
Without an implementation plan you would be less frustrated if you walk over to the trash and throw away your new software unopened. The most common reason EHR software is still not implemented after a year is that either there was not a realistic plan developed, or the practice didn’t stick to the plan.
Before covering the plan, I think we should clearly define what we recognize as successful implementation of EHR software. In order to be 100% successful you must utilize the EHR software for each patient visit that you provide.
There are 2 plans for implementing a new system:
- Cold Turkey- meaning we stop using the paper charts September 1 and start using the EHR.
- Gradual Approach- meaning we do so many charts in the EHR every day and progressively increase the number over time to work toward the goal.
Both plans are successful, however the gradual approach is typically less stressful for all involved. Also remember that all staff members must be on board and everyone must be accountable. If you agree that every day of week one, 5 patient visits must be done in the EHR, then are you held accountable if you do only 4 patient charts that day?
Every office is different. Some prefer cold turkey approach and know if they do not jump all in, they will have a tendency to never make the jump. If this is your practice you must recognize and get your ducks in a row before your “go live” date.
Whichever style of plan you choose will have the same basic pre-check list so to speak. There is the setup (we call this implementation as well), and training (personal one on one training is always best). Both are very important. Without proper hardware and network, your system is destined to fail causing frustration in the product and company. Without proper training on the product you have about a snowball’s chance in hell of being successful.
Implementation: Hardware, Network oh my.
It is important that you are not trying to run your new software on hardware that is outdated. Every EHR software package has what is called the ‘minimum requirements specifications’. The three most important specifications on these are the RAM, CPU speed and version of Windows that is supported. Try to think of minimum requirements as your first car. It got you to school and back but didn’t impress your friends and it sure wasn’t the car that your mom and dad drove.
Most companies will have what is called ‘recommended hardware specifications’. This is more the hardware of today that would ideal for the given software. We recommend you stick with this or better yet, call their tech department and ask what they recommend for the best performance.
A few years ago at a chamber luncheon a guest speaker was talking about networking and I remember being impressed because he took a topic that was extremely boring to me and made it into a great presentation. His main message has always stuck with me: “Without a properly setup infrastructure, you have created an opportunity for failure in the future”. My translation is: “please let the networking experts setup the office, it is money well spent to ensure no wires are crossed”.
If you setup your own office network please raise your hand. For those with your hands in the air, please strongly consider getting the network checked out. You would be amazed at how much damage an improperly designed network can cause EHR software in the future. It is worth the investment to have a solid infrastructure setup from the onset.
With IT and networking it is best to hire a company that has a good track record and handles many businesses. It is attractive to hire a single guy or your friend, however do yourself a big favor and hire a reputable company for IT work.
Training: But I already know how to run my computer, why do I need training?
Of course you are intelligent. You’re well educated, well trained and you have done more ongoing education that most people do throughout their careers. On the flip side is that you have been doing your charts the same way for a very long time. You are quite comfortable with the current method and it means any change is going to be painful. As a rule we run from pain. Because of this the more education you have on your new software, the better for your long term success.
You will need to know the ins & outs, how to customize, how to upgrade and apply patches. You likely need to know as much about the software as the person that trained you. Here is the big point: To be the most successful you need to know all of this BEFORE you begin using your EHR software.
Once your software has been installed you can and should start learning right away. Most companies will have live trainings that can be attended, in addition to some on-line recordings or CDs that can be reviewed at your convenience. There is usually a trainer assigned to your account and this person would be in charge of answering questions that may arise throughout your relationship.
Oftentimes, training sessions are broken down into small parts so that you may have some practice time before the next session. This makes the learning curve more manageable and puts the time line control into your hands. The more time you can spend practicing and the faster you complete all the scheduled training, the quicker your implementation phase will be completed.
It is important to commit to the project by devoting extra time to practice with test patients. If you skip this step during training it is very likely your implementation will be greatly prolonged or such a failure that you will be forced to start it all over again. Training sessions are great for starting, however most doctors quickly find that it is by using the software that they learn most efficiently.
Once the commitment is made the advanced computer user can have their entire system implemented in about two weeks. The average doctor may take more like two months. The less advanced could likely will take up to 6 months or longer.
Regardless of where you fall in the computer knowledge level, remember that forward progress is important and the very most important rule of implementing an EHR system is to have a plan and stick to it.
Author, Alex Niswander, is a soap notes expert with over 10 years focusing on clinical charting and proper noting procedures. He has reviewed charts in hundreds of clinics throughout the country and continually reviews new requirements by Medicare and major insurance carriers. He is also the owner of Chiro QuickCharts EHR system.
To learn more about Alex’s products, please visit the company website: