EMR : The Training Plan

Until this point we've been discussing the different elements of the electronic medical records (EMR) system: from choosing hardware, to software, to infrastructure. Now it's time to integrate these parts in order to make our paperless office into a reality.

Our Internet technology team did a great job at the beginning, planning important tasks such as satellite office wiring; we required a fully integrated plan that ties in to the technical aspects of the project, with training aspects to maximize efficiency to make the best use of staff time.

Important personnel from a variety of departments (including clinical, IT, admin, and clerical) met with Frank Polack of Evitor Consulting, a project management facilitator, to creat a work breakdown structure (WBS) for the project implementation.

The major processes which needed address included Hardware acquisition and set-up, Software set-up, EMR configuration, Infrastructure, Training Plan, Testing, Process Review, and Roll-out Phasing.

These processes can be broken down further into smaller steps. These steps can then be delegated to someone who then 'owns' that sub-process. In these cases, the main process of EMR program configuration is divided into particular issues (templates or configuration, for example), then sub-divided down to specific tasks (which templates to create, which standard templates to use, who creates each, who will review them, and how they will be tested).

In our own example of electronic medical records configuration, the IT and physicians work group analyzed the existing clinical templates within the EMR application. The workgroup then only makes modifications as necessary, as determined by the current workflow in use at the practice. In this way, change has the most visible effect on patient examinations. This is particularly true for tech-savvy physicians, who will of course expect the new system to be more efficient than the one currently in use.

Some changes in the work flow will be required, considering the hierarchy-based design of the EMR system. As an example, if we currently make a dictation to a scribe that looks like, "2+ NS (nuclear sclerosis) and PSC," we may need to say, "lens, NS 2+ PSC 2+." This may at first seem a minor difference, but it can surely have an overall work flow efficiency when compounded by hundreds of patient examinations daily.

The onus is placed upon the configuration, who must come up with another method to sync the way staff and physicians find comfort working with the EMR system effectively. A separate database test of the EMR system is accessible from home, via remote desktop services by any particular member of the work group. The work group can then do a final review before making changes to the working database.