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Tech Notes

Ready, Set, Go Live

Implementing Electronic Health Records at every level isn't easy, but those who have done it say the hard work is paid back in ease in the long run.

By Joseph F Mambu, md and staff

Unique Opportunities, May/June 2008

Deciding whether or not to implement an EHR system is one of the biggest decisions a practice can make. If a practice decides to go paperless, it will affect everyone—from receptionist to nurse to physician. Having the support of all employees helps the office during the transition from a paper-based documentation system to the wonderful world of healthcare information technology.

Family Medicine, Geriatrics & Wellness is a two-physician, two-nurse- practitioner practice in Lower Gwynedd, Pennsylvania, that sees around 3,530 patients annually. When Joseph Mambu, MD, opened the practice in 2001, his goal was to design and realize a primary care setting that embodied characteristics that constituted “the practice of the future.” His goal was to operate a highly competent, open-access, full-spectrum and patient-friendly practice—and to document the excellence. Mambu realized that implementing an EHR had the potential to help his practice realize this goal. He immediately sought the backing of colleagues at the practice.

After a thorough search of EHR vendors, the practice chose to implement Allscripts HealthMatics® Office suite of products, which includes an EHR component and an electronic practice management system. The practice decided to schedule separate go-live dates in order to ease the transition for the staff. The practice went live with the electronic practice management system in February 2007 and followed with the EHR implementation in March. While the result for the team was the same—improved efficiency in the practice and quality of care for the patients—each team member’s process to get to that point varied.

What follows is a description of the process from three points of view: First, Jessica Schmitt, the medical billing specialist/receptionist for Family Medicine, Geriatrics & Wellness weighs in. Next, Angie Mambu, RN, who serves the practice as office manager and nurse, offers her perspective. Finally, Joseph Mambu, MD, a physician partner in the clinic, writes about his experience.

A Medical Billing Specialist/Receptionist’s

Perspective — Jessica Schmitt

When learning that we were going to implement an EHR system, I was very excited. I knew there were a lot of inefficiencies in our office workflow that could be solved by switching to a paperless system. Prior to moving to the new system, we were with a different practice management company and we needed to download all of our patient data to the new system. Once we got all of the information in place, it was all about the training. We had a week of training prior to go-live with two trainers on site. We broke up into small groups to do the training. We asked a lot of questions and kept going over information until everyone was comfortable with the system. Staff members also practiced on the training database while they weren’t in actual training sessions to continue the learning process.

Go-live with the practice management system was a little intimidating to do on a busy Monday morning at the end of flu season, but both of the trainers were onsite the entire week of go-live, which was extremely helpful. The second go-live was about six weeks later with the EHR. We again had training prior to that date and our trainer was here for go-live and a few days following it. From the receptionist side, the EHR implementation felt like a cake walk compared to the practice management, mainly because the receptionists only do messaging and refills through the EHR.

The biggest challenge for me was remembering how to do things in the new system verses how we did things in the old system. The old adage “practice makes perfect” really rings true. We just had to do things over and over again to get use to it. The trainers did provide hand-outs which are very helpful. I noticed results immediately after implementing the system. There was no more searching the office for a chart just to find out it’s in the doctor’s car. No more calling the pharmacy for refills and trying to figure out what was scribbled down on the message. It wouldn’t take hours upon hours to file all of the paper that comes in the office. The new systems have really made a major impact on our office. For new practices looking to make the transition to electronic systems: Prepare…prepare…prepare.

An Office Manager’s Perspective — Angela Mambu, RN

I’ll admit—I was hesitant when it came to implementing an EHR and electronic PM system. I was unsure if I would be able to learn it all and run the office. However, I immersed myself into the process and took on a “won’t give up” attitude. The go-live process was very challenging. We were “fast tracked” so we started on a Wednesday, training in 30-minute appointment slots, and by Friday were on 15-minute appointment sessions. I honestly thought I’d lose my mind, but my office staff all supported one another and we laughed, ordered lunch in, and pushed through it.

We saw results right away. Within six weeks I could see fewer papers on my doctors’ desks. Now at six months, my staff is done 30 minutes earlier every day. My advice for other office managers is: Do your homework. Be careful about the vendor you choose—there are many available, and it pays to ask them many questions and seek referrals from practices using various systems. Also, do as much prep work ahead as possible, such as preparing charts. Customize your EHR system by making specific doctor lists, short cuts, etc. If your EHR offers pre-populated forms, look into purchasing this option. The time savings are worth it.

A Physician’s Perspective — Joseph Mambu, MD

I would describe myself as an EHR champion. I knew what I wanted of our practice, and understood that shifting from a paper-based documentation system would be paramount in transitioning our practice into a state-of-the art medical facility. The process of go-live was preceded by several weeks of intense training for medical and non-medical staff members. We organized our training schedule so that small groups of office staff were formed and a detailed time schedule was created to avoid interference with patient flow during training session.

From my perspective, the training period is most crucial. Training personnel were on-site with us prior to go-live and stayed with us for several days after implementation to ensure we could go solo with the systems after they left. However, being honest, the go-live process is grueling. The transition takes work, patience, and practice. Lessening the number of patients seen in the first week or so of go-live helps but is only a temporary solution. Implementation requires leadership and perseverance.

Our practice leadership believed we could do it and were encouraging others during moments of frustration and doubt. It was our team’s general relentless desire to be successful that got us through the difficult times. In order to increase a company’s successful EHR implementation, it takes training know-how, experienced implementation training, physician champions, and a proven EHR company and product.

Three pieces of advice I would give to other physicians are to:

• Form an EHR committee composed of key front office and back office staffers in addition to committed, respected physicians who will research various products, travel to vendor shows, and make site visits. These people will champion the final EHR selection as well as its training and implementation process.

• Don’t skimp on implementation time and costs. More is better. Have a trainer shadow physicians and other staff members for one or two days after go-live. It is more expensive but worth every penny.

• Let all staff members know in advance that this is vitally important to the success of the practice and will not be easy—nor will it be a quick fix. Constant communication, patience, and diligence are critical to a successful implementation.

Making the leap to paperless documentation is a major transition for an entire practice. This affects every employee and requires thorough planning to ensure a smooth transition and go-live process. With thoughtful planning, the learning curve can be narrowed and results will be realized quicker. END

Joseph Mambu, MD, is a partner in Family Medicine, Geriatrics & Wellness, a practice in Lower Gwynedd, Pennsylvania. His wife, Angie Mambu, RN, is the office manager and a nurse in the practice. Jessica Schmitt is Family Medicine, Geriatrics & Wellness' medical billing/receptionist.