Begin with the end in mind. The goal of adoption is not to purchase an EMR system; EMR are only a tool. The goal of the practice should be to transform its existing workflows to make significant improvements over the status quo. Before ever looking at an EMR system, you (and your colleagues, when applicable) must answer several key questions:
- What are we trying to accomplish?
- What is it about the status quo that we want to change?
- How will we measure success a year after completing the transition?
- Do you know whether they are ready for change?
- Do they understand change?
- Are they threatened by it?
- Is there broad and vocal leadership backing the impending changes?
- Has the impact of the change been discussed with all people involved so they have a clear understanding of its impact on their personal future?
- And is the practice, as a team, prepared to go through the turmoil of change as a necessary step on a path to transformation?
A medical practice that addresses these 3 initial tasks sets itself up for a successful transition from paper to EMR. A good plan—in which goals are well defined and a sense of urgency is consistently communicated and supported by the practice’s leadership—has an excellent chance of resulting in the best possible selection and implementation of an EMR system and accomplishing the goals set for the practice.
In contrast, a transition from paper that begins with such a vague notion as “I guess we need an EMR eventually, so we might as well start now” is much more likely to spark turmoil among staff. The staff then embarks on a selection and implementation process that is heavily influenced by emotion and interpractice politics. They face a diminished opportunity for completing the transition efficiently and successfully.
Throughout this process, the staff should always bear in mind that this is a transformation that they plan, control, and execute. EMR are simply a means to an end—not the end itself.
Two types of systems, various material needs
There are 2 primary configurations of EMR systems: client-server applications and remote-hosted systems. The latter operate through an Application Service Provider (ASP). (See “What are the 2 types of EMR?”)
In addition to type of system, keep these material needs in mind as you plan:
Connectivity. Most medical practices rely on the Internet for a variety of functions; truly, the Internet has become a vital link in health-care information technology.
An ASP system depends on the Internet, whereas client-server applications require a dial-up modem connection or other Internet connectivity to obtain information from outside sources. I recommend purchase of broadband Internet connectivity because it facilitates transmission of large files, such as images and data-rich documents.
Hardware. All EMR require computers for data entry. One attractive option for a medical practice is the TabletPC, which is available from several manufacturers and which uses the Windows XP Tablet PC Edition operating system. Combined with a secure wireless network for moving from room to room, the TabletPC is a technological breakthrough for physicians to document information in a clinical setting. It permits cursive data entry using a special electronic pen, voice recognition entry, and keyboard entry. Whereas a desktop computer places a barrier—the monitor or screen—between physician and patient, a TabletPC emulates the flat, horizontal surface of a paper chart or clipboard.
Importantly, a TabletPC has all the functionality of a desktop computer. Although workflow varies from practice to practice, it can be said generally that most clinical personnel work best with a TabletPC because of its mobility and most clerical personnel work easily with a desktop computer.
The price of a TabletPC? Two to 4 times that of a desktop computer.
Infrastructure. Other devices—printers, scanners, wireless networks, digital cameras—are required to operate an EMR system. A practice that uses a client-server application must purchase a data server. One with a system that operates by remote access either requires a virtual private network (VPN) for secure Internet connection or must install an emulator (such as Citrix).