Software Solutions/EHR

Transition to EHR: Educate, Implement, Train…and Optimize

By Gregory D. Foley, OD, FAAO

Effective transitioning to electronic records requires doctor and staff education and training. Work with your EHR vendor to optimize the technology.

Your transition to electronic records (if it hasn’t already happened) may be something you’ve been dreading. New technology is exciting, but the work it will take to get your staff up to speed on a new system, and the time it will take you as doctor to adjust, is challenging. Here is how my practice made it through this process, including some areas where we will be working to improve in the coming months.

Educate Yourself and Less Enthusiastic Partners

What is the Goal of Your Conversion?

When I became a partner at Eye Central, one of my biggest concerns was the form of paper chart we used. It was an old version of a pocket chart from the 1960s. After all these years, many of the charts looked like mini rats nests. Paper was crammed everywhere and nothing was perfectly chronologically ordered. There were extremely small data fields making it nearly impossible to properly document anything in a legible fashion. Add to that,that allof us doctors have bad handwriting, and you have an untenable situation.

Tracking the charts was another challenge. We are a busy practice in two locations, McLean, Va., and Washington, DC. The paper charts had to travel through the office to different departments to serve patients. For example, after an exam, optical needed the chart to produce eyeglasses, and then the chart would need to be moved to the contact lens technicians to order contact lenses. And then onto our insurance department for coding and billing. If the patient was seen in each of our locations, the paper chart had to be transferred between offices ahead of their visit creating room for error. As you can imagine, all this moving around also created the risk for lost charts.

Educate Reluctant Partners

Despite these challenges, my senior business partner, an optometrist who began practicing decades ago, was slow to get on board. He’s not very techno friendly and he was dreading it. But he recognized this was the future of healthcare. You convert or eventually you will be left behind. I personally wanted to convert while it was still possible to take advantage of the federal government’s EHR incentive program to help pay for some of the expense.

I chipped away at my senior business partner for a few years, repeatedly suggesting EHR. I kept giving him articles and other information about the advantages of EHR. I think the real changing factor was when we went to a Williams Group seminar. They asked for a showing of hands for how many practices had converted to EHR. There were only about five out of 25 practices there who had NOT converted. We were one of the five. I think he realized then that the world was changing.

He kept saying he had hoped to be retired before we converted. I’m sure he was worried about the expense coming within three years of wanting to slow down his role in the practice. It’s a valid concern, but if we waited, we would loose out on the federal government’s EHR conversion incentive payments.

Lean on Enthusiasm of Staff

Our staff was easy to work with during the transition. They are younger and many had their own frustrations from our “old” way of doing things. They were tired of lost charts and illegible writing. So, they were extremely excited to do something to remedy this.

Choose Software and Any Needed Hardware

Tap Help, If Necessary, to Select Software

In May 2011, I took a continuing education course on converting your office to EHR taught by computer consultant Wes Strickling. He is the owner of Codex Tech Works specializing in information technology and EHR for optometric practices. He visited our office and analyzed our work flow. We then sat down for a summary meeting to review all our CMS-certified optometric EHR software system options. Codex Tech Works’ total services for consulting cost less than $17,000 and included the hardware set-up cost. There was a separate charge for the hardware I purchased through them. Codex now does my monthly IT maintenance service which has its own monthly charge. With Codex’s help, we decided that CompuLink was the best choice for my office because it has many customizable features giving it the ability to keep up with our evolving practice.

Choose EHR Software and Any Needed Hardware

Wes suggested different hardware pieces we needed to make the system run well. But before Wes could bring all the hardware, I had to hire a company to come and network-wire both my offices–no easy task for our 1850’s storefront Capitol Hill office. We are both hardwired and wireless. Some of our desktop computers needed to be wired while some of our work spaces are equipped with laptops that could function wirelessly. However, our server runs best wired out to most terminals. That project ran into several delays architecturally to pull wire. Then once everything was wired up, I had to make sure our internet service provider had signal strength up to par to support our offices.

Wes then delivered the hardware and installed it. The hardware and server were installed in our office with CompuLink already downloaded into it by Codex Tech Works. They were on-site to then simply install the ready-to-go hardware into the correct electronic ports in our office.

Train On-Site and Remotely

Decide on Training Plan

We relied on training provided by CompuLink. Once we signed with CompuLink, they were proactive about contacting us and explaining the timeline of installation. They sent us information about live training webinars and pre-recorded instructional videos. We got about 16 hours of web-based training with our purchase in addition to the initial five days of live, on-site training.

We went live at the end of September 2012. In the middle of August, a Compulink trainer came for two days for what vendors call “implementation.” This is where you start building out the data fields in the system and enabling provider and staff user profiles. This also is the time you create pricing tables for products and insurances. I closed our Virginia office for those two days while keeping the DC office working. I assigned key staff to work with the CompuLink trainer for those two days, including myself. That way we at least had a skeleton crew working in the DC office providing a revenue stream.

Have Up to a Full Week of Focused Training

In mid-September, we had to close both offices for a full week of training. This was financially traumatic and traumatic for our patients who are accustomed to nearly always being able to access us. To make it easier, we opened the office for about an hour each day to accommodate dispensing of eyeglasses and contact lenses. This week of focused training took advance notice to our patients and required us working with the CompuLink instructor to get the exact training schedule worked out. A month ahead of our one-week closure we had signs and notices in our offices and on our web site alerting patients.

During this week, the Compulink instructor trained us on all aspects of the software for each department of the office. The final day was a “light” go-live day. That way the trainer could be in the office and follow a patient through each step of the process of the office. We scheduled about one patient per hour/ per doctor in the office (with two doctors working that day). Believe me, it took an hour! Those patients were pre-informed of what was going on that day.

Continue Learning With Remote Training

After that week of training, we had access to 16 live hours with trainers by phone and webinar. Those hours have been very helpful for the staff to call in and get help learning how to better use the system.

CompuLink also has a lot of prerecorded training sessions. The only downside is the videos can be anywhere from 10- to 60-minutes long and you may have a very specific question and have to watch the whole video for the answer.

Continue Working with EHR Vendor to Optimize Software

Learn How to Use EHR to Track Meaningful Use

CompuLink comes with a program that generates your Meaningful Use scores for each of the 26 MU requirements. During the first two weeks after implementation, I was generating reports almost daily to watch our scores. I slowed to once a week and gave those reports to the other doctors so they could see what they needed to be doing better week by week. And if they didn’t know how to do something, I showed them how to use the software.

The bigger challenge for me was to learn and understand the requirements of MU. I do believe we meet MU and I’ve submitted/attested to CMS, and their web site said our doctors were accepted as MU providers. I’m just waiting to see exactly what our check amounts will be.

Get Accustomed to EHR in Exam Room

It took some adapting to get accustomed to this, but I can now maintain some eye contact with the patient while inputting data. Plus, I’ve mounted the computer screens on swivel arms that make it adjustable so I can face the patient. Loss of face time is a real concern. I find that facing a patient with a paper chart and making notes makes it much easier to maintain eye contact. You have to adapt your EHR set-up in the exam room to try to maintain that patient attention. It gets easier as you become more accustomed to the system and no longer need to search for data fields.

I make our transition to EHR part of my initial conversation with the patient. I explain how we are modernizing and this first visit post-implementation is going to take more typing than it will in the future for me to build out their chart. I explain that if I take the time to “do it right” this first time then all future visits will go much smoother with more face time. I apologize in advance if it seems my “nose is in the computer.” Most people react very pleasantly and are impressed that we are becoming electronic.

Optimize EHR for Communication Between Exam Room and Optical

Now that there isn’t a paper chart following the patient to the optical dispensary we’ve had to develop new processes. We are still hammering out details for communication with optical and our contact lens departments. We have hired CompuLink to come back for two days in February to help us develop and improve new, electronic ways of doing this because we are still relying on trays with eyeglasses and contact lens prescriptions to communicate orders and dispenses.

Use EHR to Allow Patients to Fill Out Forms on Your Web Site

CompuLink has an online patient history form that you can post on your web site, and which then gets automatically imported into your EHR. On my web site I have a secure link to the CompuLink web portal where a patient can enter all their pertinent entry data/history/insurance information and that information can be directly imported into the patient’s chart.

Transition to EHR: Action Plan

Prepare financially. EHR transition is not only costly due to the network wiring, hardware and software you need to purchase, but also because you may need to close the office for training days. Then, once you re-open, the schedules need to be slower to accommodate the whole office re-learning all their duties, plus any IT hiccups that MOST LIKELY will occur. We kept a slower schedule for about one month. So, if you are borrowing money to cover the EHR, borrow enough to infuse into the cash flow of the office if needed, or at least have a back-up cash reserve.

Motivate the staff to read/ watch any pre-training videos. Devise a reward system, such as gift cards to local shops, for those employees who take the time to do the pre-training modules provided by your EHR vendor.

Don’t scrimp on the hardware. Make sure you give yourself the tools that will hold up to your volume and your data needs. It pays off in the end. If your system is bogged down or not processing as quickly as you like, it will only end up costing you money, frustration and lost time fixing the problems.

Related ROB Articles

Key to EHR Staff Training: Train “Super-Users” Who Then Train Others

Personalize Patient Care with Help from Your EHR System

Use EHR to Enhance the Patient Experience

Gregory D. Foley, OD, FAAO, is co-owner ofEye Central, PC, inWashington DC and McLean, Va.To contact him: gdfdoc@me.com.

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