Implementing EHR in Your Practice Requires Research, Training, and Patience

Wayne Kuznar

February 2013, Vol 3, No 1 - Practice Management


Atlanta, GA—Implementing electronic health record (EHR) technology requires a commitment from every person in a medical practice to reap the benefits of the technology. At the 2012 annual meeting of the American Society of Hematology, Mark A. Sitarik, MD, outlined the principles of successful adoption and implementation of health information technology (IT), from selection to clinical decision support.

As the Medical Director for iKnowMed at McKesson Specialty Health, Dr Sitarik offered an insider’s perspective, explaining that expectations for ease of use must be realistic. EHR will not make you faster, he said, but rather it will improve efficiencies in your practice.

Assessing Your Needs

When making a decision to purchase an EHR, finding the right system begins with a practice needs assessment, he advised. Do you need a system with embedded transcriptions, or one that is compatible with voice recognition software that can help you write your notes? Consider the functions that you need the software to perform, whether it is management of in-office infusions, inventory management, scheduling, or order generation for external providers.

“Do you need a robust way to tell nurses what to give, and when to give it? Some packages do it better than others,” he said.

Dr Sitarik, who is also a hematologist/oncologist at Rocky Mountain Cancer Centers in Boulder, CO, also advised the listeners to keep in mind that most EHRs do not have clinical decision support built into them, “but it is the wave of the future,” he said.

An infrastructure needs assessment takes the capability of your hardware and the size and reliability of your bandwidth into account, as well as the level of IT support you have locally, which is separate from the support that is provided with the software. “Realize that all software is a work in progress—there is no perfect solution,” Dr Sitarik said. “Waiting for the best last version is an exercise in frustration.”

The chosen vendor should be financially viable and be able to offer the level of “at-the-elbow” support that you need. Know how often you will need to upgrade your software, and ensure that the vendor has a plan for data backup, because your data have to survive.

Get Your Staff Involved

The successful implementation of an EHR requires that all of the staff are involved early on. An administrative champion and a physician champion will ease acceptance into the practice. Investing in adequate hardware and IT support is also crucial. Appropriate training of everyone in the practice is necessary for efficiency, so take advantage of on-site vendor support.

A Paradigm Shift

“EHR implementation represents a paradigm shift from physician-centric to patient-centric workflows,” Dr Sitarik said. “This is an opportunity to put the right person with the right training in the right job at the right time.”

Clinical decision support, if offered, reduces the risk of nonreimbursement of services, reduces treatment variability by offering treatment pathways for individual disease types, improves treatment quality by fostering evidence-based treatment, and reduces costs, Dr Sitarik said.

The characteristics of ideal decision support are:

  • It is offered in real time
  • It is contextual
  • It is referenced
  • It determines eligibility in a clinical trial
  • It is integrated with nationally accepted guidelines
  • It is integrated with payer systems for precertification

Once you are ready to go live with your EHR system, Dr Sitarik advises temporarily reducing your patient load so that the staff has time to learn and fully optimize the system.