Selecting an EMR: Ready, Set…Go Compare! is a series of blogs that serves as a resource for physicians who have decided to select and implement an ambulatory electronic medical record (EMR).
The selection and implementation of an electronic medical record (EMR) in a physician practice is a complex and expensive effort. An important factor for success is the early development of EMR goals that identify what the practice wants to achieve by implementing an EMR. These EMR goals create a common vision that everyone in the practice can understand and share. Involving a broad representation of each discipline within the practice during the development of EMR goals will create a team-oriented environment and "positive energy". Such an effort will naturally involve a lot of communication between the staff and physicians. Sharing a common vision, creating a team environment and maintaining effective communications help create trust and promote buy-in for this complex endeavor. Weaknesses in any of these areas are known pitfalls that can sabotage an implementation.
EMR goals will help the practice make better decisions, keep the EMR implementation activities on track and act as a catalyst that keeps the project moving forward. When important decisions are discussed, dialogue on how well the various options align with established goals is valuable. When one person or a group of people get diverted onto rogue activities, a good project manager, with a finger on the pulse of planned project tasks and on the EMR goals, will proactively identify these and re-align efforts back to the goals. During difficult times the EMR goals can become a rallying point for the practice to hang on to until smoother days arrive.
What are the best kinds of goals to develop? In general a practice will discuss goals that relate to ways to improve patient care, become more efficient or be more productive. But it is helpful for the EMR team to focus on developing a set of EMR goals that is really meaningful to them. Every physician practice is unique and every physician practice has a different set of priorities. Goals that are meaningful to the practice are more likely to unite the physicians and staff and and remain useful throughout the EMR implementation.
Ideas for EMR goals may be developed by discussing questions such as the following:
- What are three things most important things the practice wants to achieve with an EMR?
- What three changes will be most meaningful to the practice?
- What three quality improvements do we want the EMR to help us achieve?
- What three gains in efficiency are desired with the new system?
- What changes, if any, are expected with regards to productivity?
- What financial impact is expected?
- What else is desired to be gained or lost?
- What is expected to not change significantly?
The following suggestions may be helpful for the EMR project team to consider when developing EMR goals:
- Invite participation and/or feedback from all of the physicians and staff in the office
- Goals should be challenging but also realistic—they need to be achievable
- The best goals are meaningful to the physicians and staff
- Gain insights on EMR "Best Uses" (how other practices have successfully used EMRs to improve care or gain efficiencies)
- Identify current workflows and processes that are bottlenecks or cumbersome; consider how an EMR could facilitate an improved workflow for those processes
- Consider other future workflow redesigns that your practice could benefit from based on EMR "Best Uses" insight
Instead of focusing on the technology, focus on the workflow or process
- "Implement and use an e-prescribing tool" is focused on technology
- When this goal is viewed from the process perspective it becomes, "Reduce time spent refilling prescriptions"; now it becomes more meaningful and is measurable
- Consider starting with broad goals (related to quality care, efficiency or productivity) and then refining them to more detailed, meaningful goals
- Not all broad goals can be refined— but they may still be considered important milestone goals
Broad goal examples:
- Improve revenue per patient visit
- Improve our revenue cycle
- Decrease amount of time spent on phone
- Qualify for "Meaningful Use" incentive payments
- Improve adherence to preventative care guidelines
- Perform patient satisfaction surveys
Related but more specific goals might be:
- Increase charge capture by X% (through EMR's chart documentation and intelligent charge capture)
- Decrease the number of accounts receivables days
- Reduce pharmacy call backs by using e-prescribing
- Send the identified Meaningful Use quality reports to CMS as specified
- Identify and notify diabetic patients who have not had an HgbA1C in the past year
- Improve patient satisfaction by a certain percentage
- Selecting a smaller number of specific, meaningful goals will likely be more satisfying than a large number of broad, ambiguous goals
At least some of the goals should be measurable and baseline measures known
- i.e. for the aforementioned e-prescribing goal, spend a couple of days tracking time spent refilling paper prescriptions, then repeat 6 months after EMR implemented
Other goals should be quantifiable:
- i.e. track total # of patients that were recalled for being deficient on a HgbA1C lab
- Prioritize the list of goals
- Document pre-implementation measurements
- Develop a plan and timeline to assess goals post-implementation (i.e. 2 weeks, 6 months, 1 year later….)
- Share these with everyone in your office; perhaps some can be shared with your patients
- Remember to measure the progress toward goals after the EMR implementation
EMR Selection Guide provides an outline of additional topics on the selection process
EMR Implementation Guide provides an outline of topics on the implementation process