The Trials and Tribulation of Going Paperless with an EHR

The following set of sagas appeared in the last little while.

The Five Biggest Mistakes of EHR Implementation

Five facilities share their stories of EHR disasters so others can learn from their mistakes.

By Ainsley Maloney

"Learn from the mistakes of others. You can't live long enough to make them all yourself."

The above quote by Eleanor Roosevelt is the theme of our article and the hope these five facilities had when they opened up to ADVANCE and bravely shared their stories of EHR disasters and downfalls. One facility watched as money drained out of its practice and its patients switched doctors; another made its physicians' workday even more cumbersome than it had been in the paper world; and a third unknowingly put its patients at great risk just by updating its system. In the end, however, all shared one remarkable similarity: They never gave up on their EHRs.

Read their stories and share their experiences. Hopefully you can learn from their mistakes.

Disaster at the start

In December 2004, Siouxland Women's Health Care, PC, Sioux City, Iowa, decided on an electronic medical record (EMR) to put its five physicians and one nurse practitioner on pen-based tablets.

As the go-live date approached, Julie Barto, BS, MS, administrator, started getting nervous. Absolutely nothing had been scanned in. They hadn't made a single template, and no one had any idea what their EMR tablets even looked like.

Barto called the value-added reseller (VAR) responsible for the EMR's sale and implementation, who assured her that he'd train everyone on site two days before go-live.

Barto didn't like that idea. "When we're talking 'live,' we're talking no paper," Barto said. "We told him 'No. We have to have things scanned; we can't have any downtime, we're an OB/GYN!'"

As the clock ticked down, the VAR finally arrived. He had promised to make the practice paperless and fully operational within five days. The VAR, Barto realized, was delusional.

"We had older physicians who didn't know how to use a computer. They hadn't even e-mailed before this! Things like how to turn on the tablet, we didn't even know that," Barto said. "We knew nothing, absolutely nothing."

Without templates, physicians had to start from scratch with each patient rather than being guided with yes/no checkboxes. They were soon moving so slowly that each provider was only able to handle one patient per hour.

"That's when the disaster happened," Barto said. The VAR hadn't told them to scale back their operations. The practice got so backed up that they had to cancel every appointment on the schedule and accept only emergencies. In the weeks that followed, they continued to call and move hundreds of patients back to different times.

"At first [our patients] were tolerant, but soon became less and less so," Barto recalled. "We definitely lost patients over this. We took a hit financially that first year."

Lesson #1: Know your product before go-live

The VAR, perhaps not surprisingly, was fired. MedcomSoft came in to save the day, said Julie Barto, BS, MS, administrator.

A few lessons can be taken from this. The importance of training and templates before go-live is one. Being cautious of hyped-up claims is another.

"The VAR used the, 'you could be paperless within a very short time' pitch to entice us into purchasing the product. Doesn't that sound pretty attractive? Well it's not realistic," Barto said.

This implementation also taught the vendor a few lessons. Most importantly, every VAR now has to be certified, and MedcomSoft strongly suggests that every client go through extensive training before go-live, said Mary Torrance, the vendor's vice president of implementation and training.

This includes reviewing learning guides and videos 2 months prior, and 46 hours of Web training 6 weeks before. At go-live they send two trainers for every three physicians on site for 5 days to 2 weeks, depending on the practice.

"The beauty of our department is that it's constantly changing and constantly improving," Torrance said. "We're learning something on every install."

It took Siouxland Women's Health Care 6 months to return to normal patient volume and a year to gain back lost revenue. But the good news is that -- once the cost-savings from the EMR were seen through workflow efficiencies, better charge capture and zero transcription costs -- the practice rebounded financially and is now more profitable than ever.

Currently 100-percent paperless, the practice is a proud example that, even when an implementation is a disaster, it doesn't mean it's a failure. "We pressed forward and showed that we could take on a challenge and come out a winner, that's for sure," Barto said. "We chose a very good EMR and stuck with it. That's the key."

Read the other four horror stories here:

http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?cc=110980

While clearly there are other things that can go wrong this article certainly identifies a few of the big ones!

One for the files!

David.