Q. 3 tips for overcoming the
challenges of EMR implementation
A. See if this scenario sounds familiar. Your ED physician group will soon begin to utilize an EMR for medical record documentation. The EMR will replace your current template system and/or dictation that you have grown accustomed to utilizing proficiently. The hospital chose the EMR with little or no input from your group as the EMR was the best fit with their I.T. system. The EMR sales people insist the change will be simple, will result in better documentation and thus higher collections, and you will become more efficient in the ED. To borrow a phrase from college football analyst Lee Corso, “not so fast my friend”.
First, understand that training on how to “best” utilize the system is critical. Mandate that all providers attend multiple training sessions. I recommend that you test provider proficiency before going live. Further, ask the EMR training staff about macros and “hot keys” as they are short-cuts that tend to expedite documentation. Macros are often developed to expedite documentation of ROS, PE, etc. via establishment of normal values such you only document abnormal values and/or systems not reviewed rather than addressing each system individually. The EMR staff usually requests physicians build their own macros; however, the task is a very time consuming and is often omitted by physicians due to time constraints. I would ask to see samples from other locations that were implemented at least two years ago so that you don’t recreate the wheel.
Second, ask about the process for addendums after the record is closed. Most EMR’s force you to free text type addendums rather than allowing you to go back into the main record for the addendum. This is very cumbersome and can be avoided as entries into the EMR should be time and date stamped electronically. Instead of free text, evaluate if dictation feeds directly into the EMR as this is faster than free text and easy to track than paper notes.
Lastly, work on the timing of when a record is closed. Many hospitals want the record closed within 24 hours. This is often not enough time for ED physicians to complete records. Try to push the closing time back to 72 hours to allow for completion. Remember that it is much easier to complete the record prior to closing as addendums are cumbersome.
All of these challenges must be overcome to avoid decreasing reimbursement and/or slowing of payments. EMR’s will take more time for charting; however, they are here to stay. Attention to detail and training are the keys to success.
President of Comprehensive Medical Billing Solutions.