by Helen Larkin and D. Michael Williams
Helen Larkin is administrator for Watauga Orthopaedics,
PLC, an orthopaedic clinic in Johnson City, Tenn. D. Michael Williams,
president of Williams Information Engineering, Johnson City, Tenn.,
has more than 16 years of experience in the development and deployment
of business applications. In the spring of 1995, Watauga Orthopaedics
and Williams Information Engineering began to develop an electronic
medical record (EMR). They have successfully implemented several
EMR system components, and are continuing with the development
of an EMR, Samaritan, which is a multiuser client-server
application designed to work in a networked environment using
wireless pen-pad computers as the primary physician interface.
Are you thinking about purchasing electronic medical record software? Do you expect the electronic medical record to make you more productive and your office staff more efficient? While it's true that it may help, there's no guarantee, especially if you are unclear about your objectives and the benefits you expect to reap. Automating for automation's sake won't always yield a positive return on investment. Before you take a giant leap of faith with your favorite salesperson, develop a solid business case and a clear set of objectives for an electronic medical record.
Here are the first four steps to take to establish a clear set of realistic objectives and develop a solid business case for an electronic medical record.
What is my average revenue per office visit? This can be calculated by simply dividing your gross revenue by the total number of office visits for the past six months. Assuming that the number of office visits has a reasonable correlation to the number of surgeries you perform, an increase in the number of office visits will result in a proportional increase in revenue.
With this figure in hand, examine what activities you perform day in and day out, and question how an electronic medical record, or an increase in office staff or a shift in clinical responsibilities might make you more productive, i.e., allow you to see more patients per day. You can quickly calculate the net annual return on investment that you can expect to receive from an increase in productivity by using this simple formula: (additional office visits per day) X (number of clinic days per year) - (annual cost of change) = (annual return on investment).
Once you have completed the preceding steps, you are ready to "talk turkey" with the sales people. Ask each potential vendor to visit your site, review your current business and clinical process descriptions and cost estimates, and your ideas on how physician and office productivity and efficiency might be increased. Ask each vendor to respond to your documented results in the form of a proposal which shows how their system might improve each of the business or clinical processes noted. Also, ask them to document other benefits that your practice might expect to accrue by using their system.
Once the vendors have responded, review their responses and ask those that appear to be contenders to arrange for a demonstration of their system at your site and a visit to one of their installed sites. These steps should provide you with sufficient information to make an informed decision. But here's a few keys points to remember:
Once you have selected the system that best fits your needs it's time to buckle down and learn a few new tricks. Implementation is the process of getting the installed software and hardware up and running and integrated into your current and new business and clinical processes. While training is key, it still requires significant effort on the part of you and your staff to maximize your return on investment. The following few pointers might help.
Implementation must be a planned process that should be taken one step at a time. As you plan for the installation of each segment, think about all the business processes that will be affected. This is the perfect time to eliminate unnecessary processes and to shift responsibilities to more appropriate staff. Solicit the input of those who actually do the work.
Training cannot be emphasized enough. Most physicians' practices employ staff (both clerical and clinical) with a wide variety of educational backgrounds and experiences. Some will be quite knowledgeable about computers. Others may not be so comfortable and will be extremely reluctant to use them. A conversion to electronic medical records means that everyone in the practice must be knowledgeable about using computers.
What is the best way to train? It is best to use a variety of methods. You might purchase training manuals and videos for your staff and physicians to use at scheduled times, or you may want to have training sessions where you close your office and have the lunch catered while the staff listens to project updates and related lectures. Sometimes, it is necessary to hold one-on-one training sessions and other times it is best to send some staff to more intensive, outside training classes. Training should be made mandatory for all staff and physicians. It is important to remember that training is not a one-time task, but an ongoing process. The staff becomes more like the physicians in that regard. They can no longer just "graduate and practice" forever, but must continue to train and learn better ways to do what they do. Attention to training is what makes everyone an expert.
As you work through the implementation process, you will encounter some problems along the way. Obviously, you will have technical and business issues to work out, but you also will encounter other issues. They fall into three related categories: resistance to change, fear of new technology and morale.