One foggy morning last week, I made my way to the Georgia State Capitol for a Technology Association of Georgia (TAG) Health event relating to the intersection of healthcare IT and state legislation. Little did I know that the state’s government is somewhat unaware of the benefits HIT can bring, both to the patient in terms of more coordinated care and improved quality outcomes, and to the state in terms of job creation and revenue.

I also was not aware that, when it comes to moving from paper to electronic health records, some doctors take a bit more convincing than others. And when I say “a bit,” I really mean they may need to be gently dragged kicking and screaming into the digital age. At least that’s the impression I got at the TAG event after speaking with Sherri Mesquita, an EMR/EHR Consultant – Project Manager, at Community Health Systems Inc. She works with ambulatory clinics and hospitals to help them establish strategy around meeting Meaningful Use deadlines, and has developed a keen sense of when doctors may need an extra “bit” of convincing.

What do you think the biggest challenge is for doctors when it comes to accepting that it’s time to change – to make the move from paper to electronic health records?
I believe the biggest challenge is that in order for them to understand how the EHR experience will be beneficial, you have to get them to actually buy into the idea of an EHR. Doctors want to know that the ROI on their investment is going to bring increased revenue to the practice/hospital, provide more efficiency in the practice, and above all provide the best possible quality of care while keeping costs down.

Physicians talk to other physicians about these newer technologies. If they see their cohorts are doing well, and consistently discuss the positive attributes of the EHR software, other physicians are more likely to follow them in adoption – depending on how much money, time and staff resources are currently available.

In addition, some physicians have already implemented an EHR system in the past and, unfortunately, did not get the right information or customer support, or the vendors were not trained in how and which system works best for that specific clinic. Therefore, those doctors have not had a positive experience in the past, and even went back to using paper after spending thousands of dollars on a system that either was not customizable or did not integrate well with the other practice management or billing programs.

In your experience, when does the light bulb go off in a doctor’s mind – when do they realize that it will truly be to the benefit of their practice, their bottom-line and, ultimately, their patients?
There needs to be a lot of hand holding in the beginning stages, and education is key to them seeing what benefits to the practice an EHR can be. Other doctors again are a very important and vital aspect to implementing an EHR. They bring actual experience and important testimony for the process of going electronic.

Last year, I worked on a program with the Rockdale Chamber of Commerce in Georgia to provide a “transfer of knowledge to doctors” by educating them on the important benefits of implementing an EHR, as well as adopting “Lean” and “Continuous Improvement” in their practices. The purpose of the CI/Lean techniques is to achieve unity of purpose to identify and sustain improvements to patient critical needs.

How do you help them reach this point? What examples do you typically give to show them the value of an EHR?
Though the initial costs and implementation challenges are considerable, delaying implementation today may create additional resource drains tomorrow. The availability of an EHR may soon be a minimum standard for new physicians, public and private payers, and patients.

• EHRs are an essential component of reform-related efforts such as the Patient-Centered Medical Home (PCMH).
• Practices that do not meet Meaningful Use criteria will face Medicare penalties in 2015.
• A certified, operating EHR will be essential to participation in both public and private pay-for-performance programs expected in the future.
• According to the Deloitte Center for Health Solutions, 42 percent of consumers are interested in establishing an online connection to their physicians through a personal health record and 55 percent of consumers want the ability to communicate online with physicians.

Can you give any specific examples of EHR implementation success stories? Or perhaps from the other viewpoint – an example of a doctor or practice that absolutely refused to make the transition, and why?
Most recently, I have worked with ambulatory practices in Toledo, Ohio – Catholic Health Partners. The doctors and nurses fought it every step of the way, and even threatened to leave the practices. It was a very hard adjustment in the beginning, and for me as a consultant to come in and change the workflow processes and implement new software rollouts was such a challenge.

I was able to work one on one with the clinical staff and help them to understand they had someone there to guide them through the entire process. They definitely demonstrated gratitude when they could see the end result after two weeks of being live with the software. The practices needed to make sure they scheduled their patients at a 50-percent reduction rate to accommodate the change in software for the first two weeks.

The practices gradually implemented the EHR software of Epic, which resulted in maintaining positive patient-physician relationships and fostering the sharing of medical information. After demonstrating proficiencies, the physicians and other clinical staff were comfortable with the new EHR systems and even say they could then see the potential benefits of the new changes.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I can’t believe that this is the last post in the series. I think it’s been a good series chalk full of good tips for those looking at implementing an EHR in their office. I’d love to hear what people thought and if they’d like me to do more series like this one. Now for the final 5 EMR tips.

5. Automatic trending helps all over the place – A picture is worth a thousand words and this is never more true than when we’re talking about trending. Make sure your EHR software can quickly take a set of results and/or data points and graph them over time.

4. Keep training over and over – Are you ever done learning software? The answer for those using an EMR is no. Part of this has to do with the vast volume of options that are available in EMR software. However, the training doesn’t necessarily have to come from formal training sessions. Much of the training can also come by facilitating interaction and discussion about how your users use the software. By talking to each other, they can often learn from their peers better ways to use the software.

3. Infrastructure is key to performance – I love when people say “My EMR is Slow” cause it’s such a general statement that could have so many possible meanings. Regardless of the cause of slowness, the EMR is going to get the blame. For those wanting to dig in to the EMR slowness issue, you can read my pretty comprehensive post about causes of EMR slowness. I think you’ll also enjoy some of the responses to that EMR slowness post.

Infrastructure really matters when someone is using an EMR all day every day. There’s no better way to kill someone’s desire to use an EMR than to have it be slow (regardless of who’s responsible).

2. Quit pulling charts as soon as possible – I think this tip should be done with some caution. In certain specialties the past chart history matters much more than in others. Although, it’s worth carefully considering how often you really look through the past paper chart in a visit. You might be surprised how rare it is that you really need the past paper chart. If that’s the case, consider only pulling the chart when it’s needed. If you only find yourself looking through the past paper chart for 2 or 3 key items, then just have someone get those 2 or 3 items put into the EMR ahead of time. Then, it will save you having to switch back and forth. Plus, then it’s there for the next time the patient visits.

1. Crap process + Technology = Fast Crap – Perfect way to end 101 EMR and EHR Tips! I like to describe technology as the great magnifier. The challenge is that it will magnify both the good and bad elements of your processes. Fix the process before you apply the technology.

If you want to see my analysis of the other 101 EMR and EHR tips, you can find them all at the following link: 101 EMR and EHR tips analysis.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I met someone at a conference who commented that they liked this series of posts. I hope you’re all enjoying the series as well. This is the second to last post in the series of EMR tips

10. Build performance dashboards, not just quality dashboards
Yes, Dashboards can work well for clinicians, but for support people as well. If you start measuring something and displaying the results of that measurement, then the measurement improves. Study after study has shown this.

9. Flexibility with physician devices is important, but you still need to standardize
I think this is a little bit of an evolving issue. However, it’s unreasonable to expect your IT staff to support every platform, every version, and every type of device out there. Tech innovation is moving way too fast and an attempt to go this route will lead to failure. Create some standards so you don’t have your IT staff spinning their wheels and cursing your name for a bad policy.

8. Do time studies
My gut reaction to this one is two fold. First, get the data. Don’t assume you know the data. Get as much data as possible and focusing on the time it takes to do things is one of the best places to get data since this is incredibly important for users. Second, don’t shy away from the truth. If your EHR software has doubled the time it takes to do something, don’t be afraid to find that out. It’s better to know that there’s a problem and try to fix it than to let the problem fester because you didn’t want to know the truth.

7. Make sure IT shadows the clinicians
I’d probably take this one step further. If your IT doesn’t want to shadow the clinician, then you might want to find other IT. There’s no way that IT can help to design the proper system for the clinicians if they don’t understand the daily processes that the clinician has to do. Clinicians need to be willing to let IT in on what they do as well. It takes two to Tango and this is certainly true when you’re talking about implementing an EHR. It’s not nearly as pretty if they aren’t dancing together.

6. Use predicative analytics
I’m definitely not an expert on predicative analytics and its application, so I’ll just give you Shawn’s summary:
Predictive analytics are old hat in most industries. However, health care hasn’t put PA in a real forefront of the clinical practice. If you want your physicians (especially in a ED / UC) to be able to prepare for trends due to environment or time, make sure to have PA built into your EMR and easily available for all providers.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

I’ve blogged before about the importance of decreasing the digital divide in this country in order to truly move healthcare interoperability forward. As I mentioned last month, “Only those patients who have access to these digital healthcare technologies will begin to clamor for them at their next doctors’ visits. Only patients’ whose doctors in turn have reached out to them via email, text or social media regarding the switch to electronic medical records, development of health information exchange and the benefits to care these will hopefully bring will be ready and willing to go with the digital flow.”

When news came across my somewhat cluttered desk of Emdeon’s initiative to provide electronic health record (EHR) technology to physicians in New Jersey’s underserved communities, I first thought, “Yes! That’s what I’m talkin’ about!” Then I put on my journalist/blogger hat and thought, “Will this truly change anything in these particular communities, or is this just good PR?”

A quick bit of background: Emdeon is partnering with the U.S. Department of Health and Human Services’ (HHS) Office of Minority Health, New Jersey Health Information Technology Extension Center (NJ-HITEC), the state’s REC, and the HIMSS Latino Community. Through the initiative, Emdeon will donate Emdeon Clinician licenses to 100 healthcare providers who practice within medically underserved areas and/or healthcare provider shortage areas, as designated by the Health Resources and Services Administration (HRSA), according to a recent Emdeon press release. The company will waive the license fee for these physicians for one year.

The same press release also mentions “EHR adoption is lower among providers serving Hispanic patients who are uninsured or rely on Medicaid, and is lower among providers serving uninsured, non-Hispanic black patients than among providers serving privately insured, non-Hispanic white patients.”

The initiative sounds like a great idea, but the one-year stipulation got me thinking (a bad habit, I know). What will these physicians, who presumably can’t really afford this technology now, do after their year is up? I reached out to Miriam Paramore, Senior Vice President – clinical and government services at Emdeon, to learn more about the ins and outs of the program.

How did the initiative come about?
Miriam Paramore: During the fall of 2010, leaders from the Office of Minority Health (OMH) and Health Information Technology issued a public, written request to health IT vendors, asking them to pay special attention to healthcare providers within underserved communities. This initiative is known as The Alliance to Reduce Health IT Disparities. Emdeon is serving as a private partner with the OMH to offer access to health IT products and services to providers within undeserved communities in New Jersey. We were thrilled to volunteer and to work within these communities.

Has Emdeon ever done anything like this before?
We’re happy to do part of this effort with HHS and it is the first time we’ve partnered with them.  We have great empathy for the challenges of the physicians in underserved communities and we want to help.

What sort of challenges do small physician practices in underserved communities typically encounter?
In addition to challenges like poverty and health disparities amongst their patient population, providers in underserved communities and smaller practice offices face expensive costs associated with on-boarding EHRs. Emdeon created the Emdeon Clinician solution as an affordable EHR “lite” solution for these small practice physicians or those working in underserved communities. They now have an affordable, easy-to-use solution that will help them to qualify for federal HITECH stimulus dollars without unnecessary disruption and expense of a full-blown EHR system.

How will you work with these 100 physician practices to ensure they are able to continue using the donated EHR after the year-long license expires?
Once the 12-month period expires, providers will be able to continue using Emdeon Clinician for only $99 per provider, per month. Emdeon usually has a $500 implementation and training fee [that, for this program,] has been discounted to a one-time fee of $200 for the providers participating in this project. This is a considerable discount and the fee would only have to be paid once. We will begin outreach to these providers in advance of the expiration date so they are aware of the opportunity to remain with Emdeon Clinician for the low fee following the initial 12-month period.

How will Emdeon work with NJ-HITEC and the HIMSS Latino Community throughout this year to ensure that these practices receive continued training and support?
Emdeon has taken the lead with managing this initiative between all partners with monthly meetings to monitor progress. We have a dedicated project manager, who has mapped a process with the internal team to assist with implementing these physicians as soon as possible. Our custom phone number (1-855-840-7120) connects interested providers directly with a dedicated clinical sales executive who can assist them throughout the enrollment process.

The NJ-HITEC and HIMSS Latino partners are assisting in the recruitment of providers who practice within medically underserved areas for this program from their vast networks across New Jersey communities. These partners are working cooperatively with Emdeon to create a strategy that focuses upon identifying and recruiting providers within underserved communities who are willing to adopt EHRs, especially those interested in qualifying for federal incentive dollars.

How many practices do you anticipate being eligible, and how many do you expect will apply?
While we aren’t sure how many will apply, the HHS OMH recognized that the counties of Camden, Essex and Passaic have the largest percentage of underserved communities. Through our collaborative efforts with the OMH, HIMSS Latino and NJ HITEC, we hope to reach many of those physicians within those counties to take advantage of the 12-month program.

How will Emdeon and its partners determine if this program is a success?
Together with our partners, we believe success will be donating all 100 licenses to providers in underserved communities. The reporting element of this project will help OMH understand the progress of EHR adoption in the context of how long implementation takes in its entirety.

So it seems that Emdeon and its partners certainly have their ducks in a row when it comes to aiding and abetting these physicians before, during and even after the program is technically over. I’ll be interested to see if this model will, in fact, be successful, and if it can be supported in other underserved areas across the nation.

For more information on participating in the program, check out: http://www.emdeon.com/newjersey/

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I met someone at a conference who commented that they liked this series of posts. I hope you’re all enjoying the series as well.

15 Avoid multiple sign-ins if possible.
One thing seems abundantly clear to me: healthcare IT will be a heterogeneous environment. This is particularly true in the hospital world. Even the biggest behemoth of an HIS can’t satisfy all of the healthcare IT requirements of a hospital. So, getting a great SSO (single sign on) solution will be really important and turns out to be a great thing for your users and your help desk.

14 Make sure security is solid, but not prohibitive.
One thing about healthcare security and HIPAA that’s often misunderstood is that it should protect patient’s information, but it should also not get in the way of a clinician doing what they legitimately need to accomplish. Many security policies go too far and make legitimate healthcare work too hard. This is a huge mistake.

13 PDSA – Use it! Plan – Do – Study – Act
In this one, Shawn talks about the idea of continuous improvement which is a really good one. I also think far too many companies get stuck in the planning and do far too little doing and acting. All four steps of the process are important and useful, but don’t over think it either.

12 LEAN
Lean isn’t about being cheap. Lean isn’t about providing substandard care. Lean is about spending where it matters most. It’s about focusing on what’s most important and creating value from the things you spend money on. I’d love to see more LEAN concepts used in healthcare.

11 Buy MORE printers
Yep! Printing increases dramatically with an EHR. Almost all those forms that you use to print in bulk will now be coming out of your printer. Also, just because somewhere is fully electronic doesn’t mean that they are paperless. Paperless is a mythical creature that will likely never be achieved in our lifetime. Make the printers accessible for your providers.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I met someone at a conference who commented that they liked this series of posts. I hope you’re all enjoying the series as well.

20 Data collaboration is key to patient safety
I think this tip might need to be worded, “Data collaboration should be key to patient safety.” Unfortunately, it’s a mostly unrealized dream at this point. You might even be able to say that data collaboration will be key to patient safety. There really are amazing use cases where data collaboration can improve the care patients receive. It’s a sad state of affairs that so many of the major EHR companies are dead set on protecting their walled gardens. One has even gone so far as to say that patient safety is in danger with multiple systems. Certainly there are some risks associated with multiple systems, but the benefits far outweigh the risks. In fact, patient safety is at stake thanks to those who won’t participate in healthcare data collaboration.

19 Know how customizable the clinical work flows are!
This is a good tip when doing your EMR selection. It’s incredibly valuable to understand how the EMR handles clinical workflows and how well those workflows fit into your established clinical workflows. I’m a proponent of doing the best you can to use established workflows when implementing an EHR. Then, over time adjusting those workflows as needed to gain more efficiency.

18 How easy is it to customize the system overall?
I’d take this EHR tip from a couple angles. First, is how easily can you customize the EMR system. Yes, some of it could be the EMR workflows that I talked about in EMR Tip #19 above, but it could be a whole set of other options (billing, scheduling, messaging, etc). The second part of this suggestion relates to how well this EHR will adapt to the constantly changing clinical environment. Will they be able to handle ICD-10 without too much pain for you? Will you be able to make it work in an ACO environment? Healthcare is constantly changing and so you want to make sure your EHR can be customized to fit your changing needs.

17 Know work flow can be hard coded to ensure compliance.
There are times when hard coding the workflow is incredibly valuable. Certainly this will frustrate some providers, but if done correctly most will understand the need to hard code the workflow to ensure compliance. It’s a fine line to walk, but there are plenty of instances where hard coded workflows can do wonders to improve the care you provide.

16 Ensure easy access to the system via multiple platforms.
As much as providers might not like checking in on the EMR remotely, it’s often absolutely necessary. So, it’s important to ensure that your EMR is available on every medium possible. Can it be connected to remotely? Does it work on the latest devices? Yes, the iPad has a huge portion of the physician market share right now, but we’ll see how long that lasts. Every year a new device comes out and you’ll want an EMR vendor that’s keeping an eye on this movement and making the EMR available on the best technology.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

I don’t know about the rest of you, but ever since David Blumenthal left ONC he’s had plenty of interesting things to say. I think he’s still somewhat cautious, but you can tell he’s given himself more freedom to comment on the state of EHR software and how it could be improved.

One example of this was in Andy Oram’s writeup of David Blumenthal’s speech in Boston a little while back. Here’s one section of Andy’s write up that really hit me (emphasis mine):

Perhaps Blumenthal’s enthusiasm for putting electronic records in place and seek interoperability later may reflect a larger pragmatism he brought up several times yesterday. He praised the state of EHRs (pushing back against members of the audience with stories to tell of alienated patients and doctors quitting the field in frustration), pointing to a recent literature survey where 92% of studies found improved outcomes in patient care, cost control, or user satisfaction. And he said we would always be dissatisfied with EHRs because we compare them to some abstract ideal

I don’t think his assurances or the literature survey can assuage everyone’s complaints. But his point that we should compare EHRs to paper is a good one. Several people pointed out that before EHRs, doctors simply lacked basic information when making decisions, such as what labs and scans the patient had a few months ago, or even what diagnosis a specialist had rendered. How can you complain that EHRs slow down workflow? Before EHRs there often was no workflow! Many critical decisions were stabs in the dark.

Lots of interesting discussion points there, but the one I take away from it is that there’s no such thing as the perfect EMR. Blumenthal is dead on that many doctors have this abstract ideal of what an EMR should be and it will never be that way. Certainly there are benefits to implementing an EMR, but there are also some challenges to using an EMR as well. No amount of programming and design are going to ever change that.

I wish I could find a description I read 4-5 years ago from an EHR vendor talking about the doctors they liked to work with. In it they described that they liked working with doctors who had reasonable expectations of the EHR implementation. They wanted to work with doctors who wanted to go electronic. They wanted to work with clinics that understood that some change was required as part of any IT implementation. From what I can tell, that EHR vendor has basically done just that.

Reminds me of trying to force my kids to do something they don’t want to do. Never seems to end well. Instead, it’s a much more satisfying experience for all when I help them understand why we’re doing what we’re doing. They still don’t like some of the details in many cases, but at least they understand the purpose for what we’re doing.

As long as doctors cling to some abstract ideal of EMR perfection, no EMR vendor will ever be able to satisfy them. A perfect EMR is not reasonable. Just because an EMR doesn’t offer everything that you could dream, doesn’t mean it’s not an incremental improvement over what you’re doing today.

Don’t let the quest for perfection get in the way of incremental improvement. Perfection is more nearly obtained through many incremental improvement than giant leaps.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I met someone at a conference who commented that they liked this series of posts. I hope you’re all enjoying the series as well.

25. Care coordination is much easier in an EMR and should be evaluated to be used
The idea of care coordination has never been more important in the history of healthcare. It’s the future of healthcare (at least in the US). Whether they end up being called ACOs or some other term, the switch to needing to coordinate care in order to improve the health of a population is happening as we speak. Luckily, EMR software is a great way to facilitate this care coordination.

24. Take advantage of E-Health tools
I actually think that this is a big call to EMR vendors to integrate their EMR software with the various e-health tools out there today. EHR vendors that think they can create every e-Health tool a doctor could want are going to be left behind by those systems which support the most popular consumer health tools on the market. However, that’s not to say that doctors can’t do their part. Start getting your patient using the e-health tools that will benefit them as a patient and then start requesting that your EMR vendor support the tools you’re using.

23. Make certain all caregivers know that logs are kept for any system overrides
Don’t hide the fact that everything is logged. Let everyone know that whatever is done on the system is logged. While some may see this as big brother watching them, most will realize that the logs are a protection for them. They log exactly what was done and said and who did it.

I remember one time there was some problem in our EMR system. I can’t remember the specific issue. Well, it was brought up in our staff meeting and the director said, whoever made this mistake is going to be providing breakfast for the whole staff. I went into the logs to see who’d accessed the patient to do the offending task. Little did the director (who was also a practicing provider a few times a week) know that she was the offending party. Everyone in the clinic enjoyed a nice breakfast that week.

22. Give caregivers the ability to override the system when necessary
Mistakes happen in documentation in an EMR. We’re all imperfect human beings (except for my wife) who make mistakes. So, you need an option and likely a process for how and who can make corrections to what was done in the EMR. Just be sure that everything that’s “overwritten” is logged and the reason for the change is well documented.

21. Develop a root cause analysis process for the EMR
I’m not that familiar with root cause analysis processes, so I’ll just share what Shawn says about it:

You very likely already have a root cause analysis model for your practice. You will need to adopt that model to the EMR. If you don’t, you will create a likelihood for the same errors to continually repeat. The EMR process is different than a usual root cause analysis. You will need to take into account interfaces, security roles, single sign on, and several other things beyond the “simple” human process.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I met someone at a conference who commented that they liked this series of posts. I hope you’re all enjoying the series as well.

30. Remember that the EMR is only part of the safety problem
Remember that the EMR is just a tool. How you use that tool still matters. How you manage that tool matters. How you implement that tool matters. Safety is a result of great processes and that doesn’t change when you implement an EMR. In fact, I’d say it’s even more important. The same applies to bad clinical workflows. EMR won’t solve those bad workflows either. You can try to do a redesign of the workflows with the EMR implementation, but that often doesn’t go over well.

29. Errors should be easily reportable
To be honest, I’m not sure exactly which errors Shawn is talking about. I think I’ll take a different spin on it than what he intended and talk about the errors or issues that someone has using an EMR. This is particularly important when you first implement an EMR. You should want to know the errors that are occurring regularly so you can fix them. Make it easy for them to report them and provide proper encouragement and/or rewards for reporting errors they have with the system. Ignorance is not bliss…it always catches up to you eventually.

28. Use data to show both individual and system safety metrics
The key component that Shawn is describing here is the ability to report on various cross sections of data (individual vs system). If you can’t chop up your data to really know what’s going on in your system, then you’re not going to be able to really pinpoint the issues that users are having. Maybe it’s only one person who’s bringing down the average for the entire hospital. You don’t want to make sweeping changes to the system that annoy the majority of users when all you really needed to do was address the issues of an individual or small group of individuals.

27. Record management in the EMR is just as important as in paper
You thought HIM was done when you got the EMR. Wrong! Their role is still very important. Granted, it changes pretty dramatically, but in the clinics I’ve worked in the records management people were able to do a much more effective job improving the patient record in the EMR. Many of the things they did they never had time to do cause they were too busy pulling and filing paper charts.

26. Evaluate decision support tools for a fit to your needs
I believe that the clinical decision support tools are going to be the thing that changes the most over the next 5-10 years. You should definitely see how the clinical decision support tools they have available fit into your environment, but also spend as much time seeing what they’ve implemented and what their road map and method of implementing new clinical decision support tools is so you know where they’re going to be with their tools and product in five years.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

On my far-too-frequent visits to my younger daughter’s pediatrician, I’ve noticed pristine new monitors and keyboards wrapped up and sitting in the corner of the exam rooms. Over the last six months, there they’ve sat, waiting patiently to be unwrapped and plugged in. “What’s the hold up,” I think? As a parent, I’m hoping this new system will offer the doctors e-prescribing capabilities. As a healthcare IT observer, I’m wondering why what I presume to be an electronic health record (EHR) is taking so long to come out of the box and into operation. Is it a question of resources? Is the facility waiting for a training team to be made available? Is there back-end infrastructure that has yet to be put in place? These are the things I think about while dealing with low-grade fevers and scheduled immunizations.

Needless to say, my interest is always piqued when I come across stories of pediatricians adopting EHRs and/or realizing the benefits of that technology. So when I came across news that Sandhills Pediatrics had received $184,000 in EHR incentives, I was intrigued. The Columbia, S.C.-based practice has been using an EHR from SRS since 2010.

“Even our initially most skeptical physicians became committed SRS EHR users in a very short period of time,” said Kevin O. Wessinger, M.D., president of Sandhills Pediatrics, in the release announcing the pay out. “All fourteen physicians and their staff value the efficiencies that SRS has delivered and the patient care and practice improvements that SRS has facilitated.”

I recently spoke with SRS CEO Evan Steele to learn more about how Sandhills implemented the EMR back in 2010, and the benefits they’ve realized from it.

This being the practice’s first EHR, what prompted them to make the move from paper to digital?
ES: “The driving force was the quality of care Sandhills was providing. With 4 locations and Saturday and Sunday office hours only at the central location, patient chart review was a big challenge. The patient charts that were housed at the satellite offices, because that’s where the patients were normally seen, and so were not available to review for weekend care. Additionally, the practice provides nurse triage in the evenings until 10:00pm and again, the satellite patients’ charts were not available.”

Did you, as the vendor, encounter any barriers to adoption from the Sandhills staff?
“No, we did not encounter any barriers to adoption. Our implementation plan is highly developed and assures 100% adoption. In addition, the Sandhills team’s dedication to success allowed them to achieve their EHR goals. Furthermore, the decision to implement the SRS EHR was driven from the top down. Sometimes the age of the physicians may impact adoptability. At Sandhills, 12 of the 14 physicians are under the age of 50 so they are more computer-savvy and willing to make the change.”

What sort of “extras” do the pediatric practices look for when selecting an EMR?
“Unique to pediatrics are immunizations. The SRS development staff worked closely with Sandhills on immunizations and pediatric growth charts. SRS secured the integration between Sandhills and the World Health Organization, developed a table for displaying and storing vaccine information, and enabled Sandhills to provide this information to their patients in a usable format.

“With a patient population of 57,000, Sandhills had to provide every kindergarten, grade school, and day care with proof of immunization. In the past, the practice had to hand-write 20,000 immunization certificates each year. SRS was readily available to provide a solution to this issue and saved the Sandhills staff many hours of aggravation. SRS created a form that auto-populates the immunization information so now the Sandhills staff no longer needs to hand-write each certificate.

The same process and benefits were developed for growth charts. The SRS EHR provides the patient’s age, and the Sandhills staff only has to enter height and weight, and this information auto-populates on the growth charts.

SRS created efficiencies, which coupled with our uniqueness in allowing physicians to continue to document notes as they are accustomed, has led to a successful implementation and positive EHR experience.”

How have clinical outcomes and patient satisfaction been improved since the EMR was installed?
“Clinical outcomes have improved as the physicians have access to pertinent clinical data at any time from any place. Additionally, the staff is quicker to respond to patient inquiries. They’ve experienced tremendous improvements in efficiencies and patient outcomes as a direct result of using SRS Order Management. Sandhills used to have manual paper tracking of lab tests and now with the SRS EHR, an expected date pops up in the system and if a test is not back by then, an alert is shown calling attention to the fact that it needs to be addressed.

“The patients, especially those seen on the weekends and evenings, have commented that they appreciate the improved and quick service. When they call in to the office with questions and concerns, they are comforted and given peace of mind knowing that the Sandhills’ staff is completely familiar and up-to-date with their situation.”

What do you think will be the next evolution of EHRs for pediatrics?
SRS Development recently unveiled vaccine inventory control. This process is entirely manual now, but the new enhancements will automatically track down the vaccine to the lot number. It’s also a double-check for safety that the lot numbers they have match what’s in computer. This is a double benefit – quality control and inventory control. This new development will especially find favor with the nurses, who are so happy that a daily occurrence that used to take 2 hours will now take 2 minutes.”