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The difference between an EMR system that is frustrating and one that is satisfying can be traced back to the implementation process.
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AAOS Now

Published 11/1/2011
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Richard Dell, MD; Charles Rhoades, MD; Howard Mevis

10 tips to implementing an EMR system

By Richard Dell, MD; Charles Rhoades, MD; and Howard Mevis

How you make the shift makes the difference

You’ve invested countless hours evaluating electronic medical record (EMR) programs and the companies behind these programs. You’ve selected a system, completed the purchase, and installed the new software and hardware. You’ve ensured that everyone in the office—physicians and staff—has successfully completed training on the new system and is ready for the “go live” date.

Although productivity drops initially, some additional training addresses the issues, and in less than 2 months, the office is running smoothly, just as you expected. Despite the occasional bumps in the road, you tell your colleagues, “This EMR system really works.”

Granted, not every switch has such a happy ending. In some practices, after making the move to EMRs, physicians may wonder “Where did we go wrong?” as they carry their laptops, iPads, or tablets from room to room, continually falling behind throughout the day. You can see their frustration increasing, as they say “this system isn’t working for me!”

Implementing an EMR system requires a physician champion, careful planning, a commitment to training, and strong knowledge of the office workflow. The following 10 tips can help ensure successful implementation of an EMR system at your office.

1. Choose your TPA carefully
Many EMR systems have a recommended clearinghouse solution (third-party application, or TPA), which may not be the same clearinghouse you presently use. As you evaluate your situation, determine whether or not you want to stay with your present clearinghouse and inform your EMR vendor of your decision.

If you decide to change clearinghouses, you will want to ensure that the TPA is intuitive and that your staff will receive proper training to prevent your billing from grinding to a halt. You should also pay specific attention to the enrollment process with individual payers when switching clearinghouses, because mismanaging the approval timeframes can cause an unexpected spike in your account receivables.

While you are considering alternatives, check out the AAOS Revenue Management Program powered by Gateway EDI (www.gatewayedi/aaos). This program can reduce your clearinghouse cost and is compatible with most EMR systems.

2. Ensure connectivity
Your EMR system implementation must include establishing connections to all your clinical data. This includes linking to pharmacies, labs, and imaging systems. To establish such connectivity, your vendor may have to develop a proprietary interface, which could result in additional costs. But this will give you both a sophisticated interface to external sources and a linked interface to internal resources.

3. Meet meaningful use criteria
If you want to receive the government’s $44,000 payment over 5 years to help offset the purchase cost and implementation hassles of switching to an EMR system, you must have a thorough knowledge of what you’re required to do to qualify. AAOS has a free meaningful use toolkit that can be downloaded from the online Practice Management Center (
www.aaos.org/pacman).

4. Establish workable templates
Templates are essential to help document patient care. Most EMR systems have woefully inadequate templates for orthopaedic patient documentation. Identify your needs for patient documentation templates (such as the conditions you see most frequently) and set aside time to develop the templates.

5. Get it in writing—and get fixes ASAP
Before you sign on the dotted line, negotiate the payment plan. Although the vendor may ask for money up front or in stages as the system is installed, you shouldn’t have to write a check unless you’ve actually tested the system in your office. You should stage payments based on your access to data, as well as successful demonstration of end of month/year report generation.

You might be able to negotiate payments based on the staged implementation by staff in various practice departments. During the transition, listen for comments like… “that problem may be fixed in the next release.” Whenever you spot a problem—a bug, a navigation error, anything you don’t like—get it fixed now!

6. Conduct a workflow assessment
EMR systems change workflow; that’s a given. Conducting a workflow study after implementation is not the way to address these changes. You need to know exactly how your workflow will change before you buy. Don’t let consultants tell you otherwise.

7. Create training goals
Before you train, know who gets what training, when they get it, and how long it lasts. Staff needs to demonstrate competency using the system prior to the ‘go live’ date. At some time, you and your staff need to use your EMR system without vendor support standing behind you.

8. Establish security policies
You need policies and procedures for system access. Each employee needs training in the patient data privacy requirements established under the Health Insurance Portability and Accountability Act and the Health Information Technology for Economic and Clinical Health Act. It’s the law and you can’t avoid it.

Don’t forget to include your external business associates. Integrate your security training with your system training and plan for ongoing sessions at regular intervals. Be sure to document them.

9. Plan for a security breach
You need policies and procedures for handling a data security breach. Do not store patient data on a laptop computer unless you can document that it is fully encrypted. In the past several years, hundreds of laptop computers with patient data have been stolen, resulting in major headaches for patients and providers.

10. Make the top-down commitment
As the leader(s) of your practice, you need to demonstrate your commitment to training and data security. You need to know the intricacies of your EMR system. Your action, your knowledge, your attitude, and your use of the EMR system will create a culture that guarantees success.

These 10 tips will help you implement a full-featured EMR, with computerized order entry, billing system integration, all necessary clinical data interfaces, e-prescribing, and claims clearinghouse functions. Then, you, your colleagues and your staff can use the system effectively everyday.

Richard Dell, MD, and Charles Rhoades, MD, are members of the AAOS Electronic Medical Records Project Team who have successfully made the transition to EMRs. Howard Mevis directs the AAOS department of electronic media, evaluation programs, course operations, and practice management.

Additional Resources

http://www.gatewayedi.com/aaos/