1. The EMR: How to do it better and lessons learned
Jennifer Frank, MD
Appleton, WI
April 27, 2007

2. EMR Implementation Cost People Timeline Set-Up Training Go-Live
Workflow

3. People Extraverts Introverts Thinking Feeling
DonFrancesco D. Preparing employees for EHR changes is like inviting Martha Stewart to dinner. Advance 2004.
Extraverts: talk about what is going on, have a voice that is heard, be involved and have a visible role in the change
Introverts: time alone to reflect what is going on, written or one-on-one communication, time to think about their opinion before brainstorming meetings, time to assimilate changes before taking action
Thinking: show that: logic was made in the decision process, leadership is competent to manage change, change is fair and equitable
Feeling: show that impact on people was recognized, leadership cares, values underlie the change, appreciation and support will be given during the change

4. Sample Timeline T-180 days: Start looking for an EMR
T-175 days: Purchase an EMR
T-174 days: Buy hardware
T-173 days: Tell everyone about EMR
Stuff happens……
T-30 days: Remind everyone about EMR
T-29 days: Establish training schedule
T: Implement
T+1: EMR Utopia

5. Pay attention to Staff Morale as well as your own

6. Training Understand workflow Distraction-free training
Spread out training so it sinks in
Mental preparation
“When employees are in the dark, they tend to think dark thoughts.”
Train the trainer
Creeping disability
Lowes R. EMR success: training is the key. Medical Economics May 7, 2004.

7. Patient-Physician Interaction
Spatial
Relational
Educational
Structural

8. “I feel like my typing is interfering with my relationship with a patient, I stop typing – only then I’ve got a lot of typing to do later on.”
Ventres 2006

9. Clinicians’ coping with the computer in the room
Type while patient is talking
Alternate between typing and talking
Immediate documentation after the encounter
Putting off documentation until later

10. Relational
“There are times when it’s obvious you’re going through a structured way of dealing with a presenting problem. It’s click, click, point, and your note is done. Then there are these much more complex, human interactions. It just isn’t appropriate to be sitting there typing at the time.”

11. Physician Style Informationally-focused Interpersonal style
Managerial style
“Nothing about me without
me”

12. Educational
“The question is how to provide quality care. There are a lot of different components involved; some are electronic, others not. The EHR is but one part of a larger system.”

13. Educational Issues Physician comfort with computer
Patient understanding of EMR
Medical students/resident use of EMR
Patient education

14. Structural
“The algorithmic part of medicine feeds into the resistance against the EHR. From my perspective, that’s a huge benefit of the EHR with patient interaction. I can say ‘Here we have all these protocols set up. Let’s pull them up.’”

15. Structural Cookbook medicine facilitated by EMR Duplicate costs
Degrees of acceptance

16. Lessons Learned Complex link between IT and organizational strategy.
Great leadership has extraordinary value.
Clinical informatics systems can deliver great value.
Making healthcare professionals members of the IS team is essential.

17. More Lessons Learned
First-rate implementations require skill and talent in a few critical areas.
Planning, relationship, support
Back to school
Glaser JP. Lessons learned. Healthcare Informatics Online, September 2002.