Experts offer timeline for converting to EMRs

National report - Experts estimate it takes six months to a year to convert a traditional dermatology practice with paper charts to one with an electronic medical record (EMR).

Why so long? There are a few things that can slow down the process, according to Inga C. Ellzey, M.P.A., R.H.I.A., C.D.C., president and CEO, Inga Ellzey Practice Group, Casselberry, Fla.

But a solid plan that encompasses five phases can help ease the transition over a period of several months, according to Lucy Zielinski, vice president, Health Directions, a consulting firm for healthcare organizations, with offices in Oak Brook Terrace, Ill., and Austin, Texas.

Ms. Ellzey says one factor that can impact the time needed to convert is the dermatologist’s decision on whether to keep or change the existing practice management system.

“Most EMRs are attached to a practice management system,” she says, and can’t work by themselves.

A dermatologist would either keep an existing system and buy an EMR that works within that framework, or start anew, Ms. Ellzey says.

Perhaps the biggest roadblock to efficient EMR implementation, she says, is the purchase of an EMR that is not dermatology-specific. Often, practitioners and EMR vendors must redesign systems to better accommodate a dermatology practice, a process that can be lengthy and cumbersome, she says.

“Traditionally, electronic medical records have been designed for family practice or internal medicine. What (vendors) have done is modified (EMRs) to accommodate the various specialties. It’s like trying to change a Chihuahua into a great Dane; it just doesn’t work,” says Ms. Ellzey, whose company is a joint venture partner with Modernizing Medicine’s EMA software, a dermatology-specific EMR.

Have a plan
Regardless of the system a practitioner chooses, there generally are five stages of EMR implementation, according to Ms. Zielinski.

• Phase 1: Discovery and selection. This stage - which typically lasts one to three months - begins when the dermatologist decides to move forward with an EMR. This phase includes conducting research on various options and scheduling demonstrations.

Ms. Zielinski suggests that practices establish EMR committees with dermatologists and staff members, or designate “champions,” staff members charged with coordinating and communicating the task.

“An electronic medical record is a clinical system. So, it is very important that the clinical staff (nursing staff and medical assistants) be involved because the workflows on how they see patients are going to change slightly,” she says. “Secondly, I would involve … maybe a representative from the front office … or somebody from the business office because some of those components will overlap with the EMR.”

Also during this initial phase, she suggests that dermatologists “develop a request for proposal (RFP) based on your specific criteria … (and) determine the total cost of ownership and the impact on your revenue cycle and collections.”

• Phase 2: Negotiating and executing the agreement. Negotiating and reviewing the contract, as well as having an attorney review the agreement, can take about a month, according to Ms. Zielinski.

• Phase 3: System installation and build. This stage takes from one to two months, Ms. Zielinski says, and includes:
• Installing and configuring hardware and EMR system software;
• Initiating the system build (clinical and business components);
• Redesigning business and clinical workflows for optimal outcomes;
• Developing a data migration plan (to determine what will be entered as structured data versus what information will be scanned);
• Building interfaces to other required systems;
• Reviewing federally designated “meaningful use” criteria and building in those measures.

Ms. Ellzey says this phase could take longer if dermatologists have to redesign the system.

• Phase 4: System training and going live. Ms. Zielinski estimates this stage will take about a month.

She says dermatologists should plan to reduce their patient schedules by half for about two to three weeks while the system goes live.

Also, “Arrange to have the (EMR) trainer onsite for support,” she says.

• Phase 5: System optimization. Monitoring the practice’s progress toward “meaningful use” measures is an ongoing process, Ms. Zielinski says.

“Just like anything else, once you learn something, it is hard to retain all of it and put it into use,” she says. “Users probably only retain about 70 percent of that knowledge (learned) during the training session.” She recommends that after a practice uses the new system for about a month, the trainer should return for a reassessment, to make sure users are optimizing the functionality of the system.

Ms. Ellzey says the implementation phase can be shortened by buying an EMR that is dermatology-specific and using a practice management system that accommodates that EMR. That way, the process can take as little as 90 days, from the day the dermatologist signs the contract to the “go live” date, she says.