1. The present
Whether you are using paper and pen to currently gather and store information either clinical or administrative the transition into an Electronic Health Record should be a smooth transition for the end user.

2. The Future
The use of the computer does not minimize the need for personnel in your practices or health centers, it simply reforms their duties. The computer does not work without a “driver”

3. Reality
The reality is the pen and paper never really goes away entirely. Some processes will keep your system moving more efficiently when done with combination of paper and computer. However, some will be found redundant on paper when not initially done electronic. The fact of the matter is when learning something new, it isn’t always realistic to expect these new processes to increase efficiency immediately. It will more than likely, as with our experiences, slow your systems down initially, even decrease productivity.
The trick is to find a happy medium.

4. A broken heart – Lessons learned

5. Processes to review Scanning New employees Referrals
Insurance verification
Down time
lessons learned:
some hard
some not so apparent
and others that just seem so foolish that they were overlooked to begin with.
The first steps to implementing the EHR is understand it’s complexity, ability to go with the flow, and to keep realistic expectations both within management and for staff members alike.

6. Scanning Equipment choice Guidelines Implementation Prioritize
Ongoing assessment
Choosing equipment will definitely impact the outcomes of scanning implementation. The pace of your office needs to dictate the machine selected.
Guidelines for scanning include what can and cannot be scanned into the EHR – identifying those documents / records that need to be abstracted or entered into the EHR in an alternate fashion. Most importantly these need to remain “guidelines” making them too strict may result in lack of provider buy in and making them too lenient may result in inability to locate items after a turn over of staff.
Start Scanning ASAP. The initial scanning process is significantly overwhelming. Registrations, insurance cards, consent forms, HIPPA notices, advanced directives, all needing to be entered on every patient. For some of you, implementation of the practice management section prior to the full blown EHR will allow you to do just that..
Prioritize, prioritize, prioritize……… scanning must be part of daily functions of your administrative staff. A backlog can affect patient wait times during appointments, staff morale, and quality of care.
And just like any other significant process that has potential to impact such outcomes, quality assessment or CQI is imperative. Audit the work of others, we decided to do this through peer review.

7. Know functionality of your system and required upkeep
Referral process
Know functionality of your system and required upkeep
Know the capabilities of your system and understand the reality of what your staffing model will allow you to implement or utilize with go-live. Many functions of our system are limited by manpower requirements to build and most time consuming maintain databases,
Create network providers list
Internal vs. external referrals
Will ancillary referral accept EHR printed referral form.

8. E verifications Time Errors Resources Follow up
Real time verifications
Time saved
Decreased errors and increase accountability
New processes shifted job responsibilities

9. Employees Orientations Skill level Time off Established workflows
understanding the complexities of these processes is key and is not to be taken advantage. When a new hire is brought into your system in any role orientation and training becomes most important.
Training new hires / cross coverage
Interview questions
Another way to ease the training process of new staff members is to have clear, precise, and realistic established workflows. Documented processes provide a resource for these new hires to provide reference. IF they are easy to read and follow when a new hire gets stuck in a process they should be able to refer to these workflows and continue with little impact on other staff members and not impede the flow of the patients to which they are helping.

10. Down-time functions Back up of Data Workflow
What do we do when the connectivity or power is lost.
In our centers, one scanning PC in each center is designed to create a back up of all patient’s MRN charts which includes, demographic information, problem list, medication list, allergies, and their last office progress note.
This back up is created daily and can be retrieved as long as the site has some power to that machine.
This assists us when there are connectivity issues which do occur however, if a full power outage at a particular center is handled by contacting another center where power is not affected to retrieve these down time reports.
An alternative to that process if an alternate location is not an option for some a generator or back up power system can be installed or extended to this one PC for these purposes.

11. Michelle Surinach Institute for Family Health AVP, Practice Administration
Telephone Number x 134