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).
An enduring axiom about electronic medical record (EMR) implementations remains unchanged: “If no physician champion, then don’t implement”. The physician champion’s role in an EMR implementation is to keenly focus on strategic implementation decisions, education of colleagues on the EMR, process/work flow redesign and on the design, configuration, build and testing of the EMR.
In a June 30th Digitized Medicine blog (High Demand Persists for Chief Medical Information Officer (CMIO) and Health IT Physician Champion Roles) the evolution of the role of physician champions within health information technology (HIT) is described. In the 1970s physician IT champions typically served as clinical "subject matter experts" to ensure that clinician's needs were identified and met by IT projects. Since the 1990s the implementation of more expensive and increasingly complex clinical technologies, such as EMRs with computerized physician order entry (CPOE), has led to the need for an executive CMIO role at a majority of hospitals. As described in the blog, the CMIO role is different than the physician champion role of the 1970s. The CMIO, in fact, needs to recruit , mentor and infuse the clinical expertise of physician champions from within the organization into health IT implementations. Similarly, an office practice should identify a physician champion before selecting and implementing an EMR.
Most of the work involved in successful EMR implementations is not technical, but instead involves changes in process and work flow. The physician champion must be closely involved in the redesign of processes and work flow to ensure the changes align well with how the clinician works and thinks best. The physician champions also are the “subject matter expert” for the EMR’s clinical design, configuration and build. They work on structured documentation templates, order sets, clinical decision support tools and, most important of all, work flow redesign to optimize how the EMR design is used. The champion is a key figure for strategic decisions that need to be made during an EMR implementation. The physician champion works with colleagues to identify their unique needs. At the same time he/she educates colleagues on the value of and garners their support for standardizing their template-based documentation and orders as much as possible.
The effort needed to garner support, design the EMR and redesign processes/work flow is often underestimated. Implementations that proceed without physician champions or without enough time for the physician champion to adequately participate are more likely to encounter significant problems when the EMR “goes-live”. Examples of such problems are:
- Documentation takes too much time because there are too many required answers that the physician has to enter
- Documentation takes too much time because of work flow issues
- Inability to easily get quality reports that were expected from the EMR, because the data is entered differently or in different places by different doctors
- Pick-lists have so many choices that it frustrates the doctors
- Poor template design makes it easier for clinicians to just free text; data needed for quality reports does not get entered into discrete fields that allow it to be reported on
- Poor work flow redesign slows down patient flow in the office, productivity goes down
Decisions about what quality data needs to be entered in the EMR and standardization over where it gets entered are needed before even designing templates. Limiting the amount of “required fields” to these pre-determined data needs helps prevent documentation templates that are to elaborate to enter data quickly. This is important for the physician champion to drive because physicians generally expect to be able to capture quality data, produce quality reports and exchange information with registries or other health information exchange entities in their area once they have an EMR. These reports and registries are tools physicians expect from EMRs to help them improve population care.
Capturing and reporting on quality data will be required to qualify for “meaningful use” incentive payments for physicians using EMRs (under the ARRA/Stimulus package) most likely starting in 2013. The physician champion will have a key role helping the practice qualify for these incentive payments as “meaningful users”.
The physician champion has strategic roles and post-implementation roles as well. The physician champion will be a key participant in strategic decisions that the practice will have to make during the EMR implementation, including the go-live strategy ("big bang" vs. phased in) and what to do with the current paper charts or old EMR data. Post-implementation the physician champion helps optimize and maintain templates, order sets, decision support rules and other EMR tools. He/she should be the main point of contact with the EMR vendor and manage the timing and scope of future updates and upgrades to the EMR.
The importance of strong physician leadership is stressed in much of the EMR implementation literature. The following characteristics help this lead physician be effective:
- Well-respected as a clinician
- Strong interpersonal skills
- Ability to “makes things happen”
- Teaching mentality (a typical trait of most physicians)
- Strong negotiating skills
- Commitment to successful EHR implementation
- Ability to sell EMR benefits to other physicians and office staff
- Sets realistic expectations
It should be noted that although an interest in computers is helpful, technical skills are really not needed for this role. Much more important than technical proficiency is a willingness to learn and teach.
There is one final caveat based on personal experience that this author would like to share. Unless it is a small 1-3 doctor practice, the physician who is the designated EMR physician champion should not be the individual who develops, monitors and coordincates all of the tasks of the EMR implementation project plans. This is discussed further in "EMR Selection: Project Team, Project Manager and Decision Making". The physician champion’s role is to keenly focus strategic implementation activities, process/work flow redesign and on the design, configuration, build and testing of the EMR. Larger practices should consider compensating the champion for the time and effort required to successfully accomplish these tasks.
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