Home Forums Discussions General Discussion Transitioning from paper

We are still in the trial period and are looking into other practices in our area who are users of amazing charts. We are a 2 physician practice in Central/Northcentral Illinois. How were you able to successfully transition from paper to an EMR? How did you get your staff excited for this transition?

When I first began with a scheduler, I had to literally tear the appointment book away from my front office staff. Once they were sold, they quit duplicating entries.

Then, when I gained confidence, I stopped printing out encounters. Then we set up receive to fax and imported everything new and faxed scripts and refills right from the room. The ladies loved me handling the bulk of the refills rather than them being stuck on the phone pressing button after button to get the pharmacist.

Then they realized how great it was to be able to sit at their desks, not getting up to fetch a paper chart, and find an imported item and fax it where it needs to go.

Then we started scanning in old records and "VOILA!"

Our office of 2 MD's, 2 Pa's and staff has doing it in a fashion very similarly to Leslie. We have a mix of Nerds and very computerphobic. We started playing with it for a while, then wiped the database clean and used it "for real" and but printed everything out for the paper chart for a while, then did it just electronically, then added faxing, etc.
We held pretty much daily office meetings at noon. I pointed out to the staff that if they thought they had a future working in medicine beyond our office (they are all younger than I), that using an EMR was inevitable, and they were much better off learning it when ALL of us had to suffer through the transition than walking in to a new position where everyone had been using it for some time and knew the drill. Granted, the program may not be the identical, but they will know the environment. That actually seemed to strike a chord with most.

I am in a solo practice and started almost exactly like Leslie. I had my office staff start entering data in the patient record prior to the visit.Like Allergy, Meds, PMH. All form the old charts or if you have information from the referring physician. This will speed up the completion of encouterwhen you see the patient. You have only HPI and exam , Dx and plan.

I work with Dr. Grauman above, and I can tell you that we and staff have been stressed. We have been using AC since mid-April and while we seem to all still think that we are heading the right direction, everyone is a little bit on edge. We have tried to be up front about the stressors and have tried to light-load our schedules. I would say we are working at 2/3 our usual. This gives more time for the front desk to input data (demographics did NOT come over perfectly from previous program), the nurses to do vitals and add medication list, and for us to do what feels like everything else. We are less likely to close out of the chart without sending it to ourselves (in which case - poof, it's gone), we have renamed our top ICD9 codes to something a practicing medical person can identify, we have our consultant rolodex in, and I have ALMOST learned to be sure that the diagnoses are coded BEFORE I go to request labs.

Yes, there is stress with staff. We are also stressed. The good news is that there is something new to be stressed about every few days :o) I guess that means we're making progress. We sort of got staff buy in before we made the move too - so we are sharing in the culpability for this situation.

First, I'd advise to take it in "baby steps." Planned baby steps.

1)I'd begin with the scheduler. The scheduler is pretty easy, so you start by having all appointments through the scheduler. Many people are used to having their electronic calender/appointmetns due to MS Outlook or even their Palm.

2)Get the HL7 interface for you lab. This is easy assuming your lab is Quest or Labcorp. When your staff no longer has to file paper labs, "the light will go on." Of course their is the issue of tracking labs. Speak with others concerning use or "Orders." and if it can be used to track labs.

3) Start off only trying to chart 2-5 patients/day using AC. That way it doesn't slow you down too much while you are figuring out how to use it.

4) You may only want to start off with them scanning in old charts when the patient comes in.

5) Make no new paper charts for new patients. All new patients go into AC only.

The idea here is to try to give them some things where they see and feel the benefits and they aren't overwhelmed. In fact, their job becomes somewhat easier. Not having to file labs. Not making up a new chart. Not filing/pulling charts on the newer patients. Not pulling a chart on the established patient (once they came in and had their chart scanned).

I'm actually considering if I can start a side-business helping offices transition to using AC. But for the time being it would only be local.

This thread has started me thinking about repressed memories and I now recall one weekend during the first year when I thought we had made a terrible mistake and we should pull the plug on the whole EMR thing. It was very depressing but I just couldn't see how we would ever recover our work speed or be able to get the work done without hiring twice as many staff. It only lasted a few hours, (or days actually) and it only went away as Monday rolled around I was simply TOO far behind to think about anything else. Later it got better, so don't give up!.

All this advice has been great. We will start with the scheduler and only putting in patients who are scheduled for that week. I think our biggest challenge will be getting the staff on board as they have been using their current system (and working with the same people) for 25 years. Any suggestions on how to make a computer seem less intimidating for people who never use one?

@AKbeth, we feel your pain!! We have been gradually using more and more of AC for the past 4 months and we are at our wits end!
We have hired new staff to handle the extra work (which, unfortunately, has put a real strain on our finances such that we can't finish buying the equipment we need - but that's another story). We are in this awkward phase of half-paper half-AC which is driving everyone crazy, especially the doctor. She is trying to document things in the paper chart AND in AC, which invariably results in lost information...

It is so good to hear that other offices are struggling with this.

@DocMartin - it is also good to hear that there is a light at the end of the tunnel!

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@elipra - Now to answer your question on how our office stared (and we are not complete yet with our process).

1) First I moved patient data we had in Quickbooks to AC. This helped us to at least get all of the names, addresses and phone numbers in. AC did require birth-dates, though, so we just made up 1/1/1900, and we've been updating them as we go. (Let's just say we still have a ton of 110 year old patients, but it's getting better!)


2) Next, we started with the Scheduler. The doctor still likes to have a printed copy to see in front of her face, but now the staff has gotten used to using it and looking at it (it takes some time to adjust to the sight of it). This helped us to quickly realize the benefits (no double booking! no searching through pages and pages to see if a patient has an upcoming appointment, etc.)

3) We were using a transcription service for the Doctor's notes. This was taking up a lot of time and money so the next thing we decided to do was just write the patient notes in AC (HPI, physical exam, assessment and plan).

4) Before we did this, we had front desk staff input PMHx, FamHx, SocHx and allergies into the note before the patient was seen by the doctor (we try not to get too ahead of ourselves because we forward the charts to do this without saving the note until the patient completes the encounter - we don't want a ton of forwarded charts floating around).

5) Then we gradually started to add Medications and Orders to the list

6) Finally we are in the process of documenting progress notes via the message system (but we are first working on a system to categorize these messages for easy browsing by the doctor)

7) The only other issue we haven't resolved or come to a decision upon how to do is flow-sheet tracking of labs. We will likely implement an excel spreadsheet for this, but we haven't figured out how we're going to do the labs (electronically by interface, or pdf by fax).

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The next step is to do new patients in AC only, but our doctor is a bit frightened by this concept at the moment. She has really struggled up to this point and is not ready to give up the comfort of paper!

Anyway, I hope that helps. Baby steps is the way to go for people who are computer-phobic. However, this does create extra stress during the awkward transition period of using both paper and electronic charts! I am glad to know we are not the only ones struggling with this... we hope to get some insight at the ACUC conference in June. Hope to see some others there!

- S.K.