How to Tell Whether Your Implementation Was Successful
Shah, Shahid, Medical Economics
Many initial implementations of EHRs cause at least minor or in some cases major productivity declines, and most cause physicians to be able to see fewer patients after the install than they could before the installation. That sounds counterintuitive, especially because technology always is supposed to make things faster and easier. The "old" technology of paper records is infinitely flexible, however, and allows variations in workflow, procedures, training, and other conveniences that computer software still can't manage.
So, reviewing productivity carefully after an EHR installation is key to ensuring no loss of clinical effectiveness and that problems in billing and receivables don't linger.
In the post-2009 era of "meaningful use" (MU), it seems everyone is thinking that if you meet MU requirements and get your incentive check, you've achieved EHR success. Because incentive payments currently are paid based on the honor system and you won't be tested for compliance, you should be wary of thinking of success in MU terms.
If MU payments don't determine success, what does? Most practices that started their implementations without pre-install metrics in place and expectations set appropriately find that they don't know when they're done. Consider putting some productivity metrics in place before you implement your EHR and then measure the same ones afterwards. For example:
* how long it takes to pull up a patient chart;
* where you can pull up a patient chart (in office only, from home, via mobile phone/tablet);
* how long it takes to update common data elements in a chart (medications, problems, etc.),
* how long an appointment takes to schedule;
* how many patients are seen on a dally basis;
* how much data are being captured per patient visit;
* how long the patient check-in and check-out processes take;
* how much time is spent on non-essential phone calls (better handled by EHR messaging);
* how much time a physician spends on non-clinical activities,
* how much paper is completely eliminated versus simply moved to archives;
* how many faxes are sent and received; and
* many other metrics that are specific to your practice.
Keep a close eye on chart access time. You will want to know how patient charts are indexed, found, and stored on paper compared with your EHR. The time from knowing a patient ID or name to getting into his or her chart should be less than 10 to 15 seconds (based on typing speed).
Once you have identified some simple workflow metrics, focus on questions related to disruption-generating tasks:
* How long will it take to install hardware such as computers, printers, and scanners? With a good information technology team, it shouldn't take more than a day or two to install an entire network Otherwise, productivity will be affected.
* How long will it take to install and maintain Interfaces with other systems, such as practice management systems, external lab systems, and electronic prescribing? …