EHR Implementation: A Journey, Not a Destination

Setting up an electronic health record (EHR) can be a challenge—one that doesn’t necessarily end once the system goes live. Those who actively use EHRs report that it takes continuous learning and optimizing to ensure that the system pays off.

Chad Jansen oversees the EHR system for LaTouche Pediatrics, a 3-office, 18-provider practice in Anchorage, AK. He says his job is to keep asking the question: How can we improve EHR functionality in our practice?

Christopher Beale, MD, who practices internal medicine in St. John, MI, advises practices to move to EHRs “wholeheartedly” by requiring providers to sign their notes before processing claims. But, he says, it’s important to be ready to “renovate once you’re in the building.” Give the system a try, see what works, and then make changes as necessary.

One way to do this is to make EHR use a standing agenda item for staff meetings. This routine creates a forum for questions and comments and provides an opportunity for staff members to agree on uniform ways to enter information into the record.

Although uniformity and guidelines are critical, it’s also important to give providers some latitude in how they use the system. For instance, would they prefer to dictate notes? Speech recognition programs can help. Some providers dictate in front of their patients, some type their notes as they talk to patients, and some record their notes after the visit. Any of these solutions can work, as long as they fit the provider’s work style.

Even simple things such as laptop battery life can make a difference in how the system gets used. In the examination room, the patient, computer, and physician should form a triangle so that the patient and physician can talk face to face and look at the screen together. A docking station with a monitor and full-size keyboard in a separate room can offer providers a quiet and comfortable area for correspondence and reviewing notes.

Ongoing training—integrated into the workflow—gives providers a chance to review problem areas and resolve challenges. A tech-savvy staff person (like Jansen) or physician champion (like Beale) may be more effective than an outside trainer because they are familiar with the practice and work styles of their colleagues.

Figuring out what works for each provider and practice can take some time; the transition to EHRs is a journey, not a destination.