Cleveland Clinic’s Words to the Wise

If you were given the chance to “redo” your electronic health record (EHR) implementation, what would you do the same? Or what would you do differently? Some people who enjoy the adrenalin rush of EHR implementations may light up when asked this question. While others, may dread the thought of going through another EHR implementation.

Project teams implementing EHRs are usually working long hours to meet tight deadlines and major milestones. There are usually more meetings than one can fit into a workday with many decisions being made and others hanging in limbo. Analysts work hard to configure the system to meet the needs of the end-users while keeping in mind these end-users may not know what to ask for as they don’t yet know the capabilities of the system. Analysts try to anticipate how best to leverage the system’s functionality to meet, or even exceed, their needs while keeping long-term maintenance in mind. Even if you have no interest in repeating another go-live or you relish in the craziness of EHR implementations, everyone has a list of lessons learned from their experiences.

A recent interview with Kelli Mangino, Director of EHR Implementations at Cleveland Clinic, conducted by Melissa McCormack, Managing Editor at Software Advice, helps to explain what the key successes are for an EHR implementation from initial design to training and through go-live and support.

Mangino shares with us that physician engagement is one of the most important elements. Physicians should “…get involved in designing workflows: creating templates within the EHR to use in patient encounters, and selecting preference lists based on his common orders and commonly-prescribed medications.” Physicians who are involved with the system design help to create an effective clinical tool that is relevant to them.  By getting involved in this process, they will learn more about the system that allows them to be more comfortable on the first day of go-live compared to feeling like they are just learning the system.

Other ways to ensure end-users are comfortable at go-live is through end-user training. Mangino reveals that nurses and medical assistants are the “secret weapons for training success”. These staff members have firsthand experience of the workflows they are training and are relatable and can empathize with their audiences. Sometimes these employees are overlooked for training positions as they may not have the educational background usually required to be trainers. However, their interoffice and clinical skills allow them to be successful in those positions.

The ability to e-prescribe and reduced time spent on the phone are some of the earliest benefits end-users experience right away. However, the “wow” factor is when providers truly see the benefit of “continuity of care”. At Cleveland Clinic, providers can access their complete patient records when they are working at the hospital, their ambulatory offices, and easily from home without having to lug around clucky, heavy charts.

One of the most common mistakes or misconceptions about EHR implementations is how quickly one should feel completely “electronic” or “paperless”. “Getting comfortable enough to put the paper away for good is ‘parking the chart’. A physician will often want to take a patient’s paper chart into the visit for reference, even if the new visit is charted electronically. It usually takes 1-2 patient visits before the physician is comfortable putting away that particular patient’s paper chart.” To minimize the added stress of go-live, encourage providers to take it a bit slower. Let them electronically document on a portion of the patients scheduled or try to cut back schedules. “Especially at first, charting a patient electronically will actually take longer while they get accustomed to the workflow. They’ll eventually cut that time down but it may never be significantly faster to chart a patient visit electronically vs. on paper.” It is important to understand that the time providers spend with patients may remain the same even with an EHR. The gained efficiencies tend to be seen with practice staff and activities outside of the patient visit.

One of the biggest fears felt among employees is around their job security. There is fear that the efficiencies gained by EHR implementations will result in the reduction, or elimination, of their job. In order to minimize this fear, as well as lower the general anxiety level, is through effective communication. It is important for staff to understand that with EHRs, workflows will change and this will allow staff to work more efficiently and to be able to focus on important efforts that weren’t possible in the past.

Whether you are working on a new EHR implementation project, migrating from one EHR vendor to another, or are optimizing your current EHR system, these lessons learned can benefit your EHR implementation project.

We now want to hear from you. What are your lessons learned? Or are there areas that we can assist you with your EHR implementation?

To read the complete interview with Kelli Mangino, please find the article here:

Galen Healthcare Solutions is a professional and technical services company that helps healthcare organizations transition to electronic health records (EHR). Galen is on the forefront of the EHR movement and offers a vast array of skills and expertise that include database architecture, project management, implementations, and application development.



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