Implementing EMR happens once.
Adoption happens over time.

EMR Implementation vs. EMR Adoption

Regardless of whether you implemented an EMR for the first time or changed from another vendor, EMRs are designed to help automate key manual clinical workflows which ultimately impact the people doing the work and how they get the work done. The change from a paper-based workflow or the change from a prior EMR workflow can be challenging because it’s hard to know what to plan for and expect. Everything changes, not just a few things. New processes and policies may need to be implemented. People may have new roles and responsibilities. All this takes time to adjust. It’s no less daunting to change to a new EMR. While most EMRs offer the same basic functionality, each does it slightly different. A new vendor may excel in areas your former vendor didn’t while at the same time it may not be as strong in another area. Getting used to those changes and adjusting workflows are critical to speed adoption and user confidence.

It’s one thing to say “Our staff has implemented EMR.” Quite another to say “Our staff has adopted EMR.” Implementation typically means your 1x purchase, implementation project planning, hardware upgrades, data conversions, interface setups, training, and go-live. Adoption can mean many things. To the industry, EMR adoption often means the percentage of organization that have purchased and implemented. To vendors and users it means how efficiently, effectively, and satisfactorily an organization is making use of their EMR to improve the healthcare experience for both patients and providers, advance the quality of care across populations, and reduce healthcare costs…all while running a revenue-generating, profitable business.

EMR adoption happens when the real work begins

While an implementation can be onerous, it’s over once the go-live occurs. Adoption starts when the real work begins and is enabled through EMR optimization, customization, and personalization initiatives, as well as EMR governance, vendor support, ongoing training, product enhancements, and add-on clinical tools. EMR is not a “set it and forget it” solution. The digital and manual workflows a staff plans for, learns, and puts into practice during an implementation is often just the tip of the iceberg for EMR use. Also, as the healthcare landscape evolves, organizations may have new goals that an EMR can help reach. Even pre-Socratic Greek philosopher Heraclitus must have been predicting the fast pace of EMR evolution when he talked about change being the only constant. The key is to always keep adjusting. EMRs are always evolving to include client requested features, functionality to meet regulatory requirements, and, yes, even to address bugs. Let’s review a few ways to continue adjusting with the goal of improving EMR adoption.

Optimize workflows

Map out your workflows with dedication. Step back. Take time. Engage those impacted. Review exactly what steps different users take in their daily work and how they do it. Look for workflows the EMR can help automate. Also, look for ways the EMR possibly complicates a workflow. Then determine if there are new workflows, features, or steps users and/or support staff can implement to improve. Don’t forget to document the changes, share them with those impacted, train them, monitor success with the changes, and make tweaks or provide additional training as needed. Many providers have another staff member take and enter vitals, as well as update demographics, medications and family histories for providers to review and sign off. Consider other functions a staff member can do rather than taking up provider time. Also, keep in mind that not everything in an EMR is automated. There will be some things that still need to be done outside of your EMR.

Engage teams in continuing EMR education

An AmericanEHR study highlighted the following results:

• At Least 3–5 days of EHR training was necessary to achieve the highest level of overall EHR satisfaction
• Nearly half of respondents indicated that they received 3 or fewer days of training
• Ratings on ease of use for basic EHR functions required for EHR payment programs continued to Improve with 2+ weeks of training
• More training—at least one week—was correlated with improvement in the reported usability of advanced EHR features

While training is just one area that helps improve EMR adoption, these results show that there is more work to be done after implementation. Over time, this will improve provider satisfaction with their system. Continuing EMR education is key to implementing a new skill, finding new ways to do something, improving confidence, and promoting speed and ease of use. Build training into monthly department meetings. Take advantage of self-study tools like videos and reference manuals. Ask your vendor to provide dedicated training.

Customize and personalize your EMR

KLAS research showed a correlation between EMR satisfaction and use of personalization settings, noting that “Successful organizations understand that personalization settings are the key to making a one-size-fits-all EMR work for everyone. Personalizations that allow clinicians to quickly retrieve data or review a chart are the most powerful in improving clinician satisfaction. In addition to achieving a more positive user experience, clinicians that take advantage of EMR-personalization tools also report better ambulatory documentation efficiency.” MicroMD EMR allows for customized dashboard views, as well as multiple documentation styles and unlimited creation of templates to craft specific workflows that address the needs of not just individual practices and specialties, but individual providers. While it takes work to gather the feedback needed to customize, personalize, and train, the reward resulting from improved adoption are high.

Chair an EMR governance team and work with your vendor as a partner

Identify and bring together a passionate team of EMR users in your organization to create, review, and update policies and procedures. From there, meet to determine areas in which to engage your vendor partner.

HIMSS highlights some areas for which the EMR governance is critical to developing:

• Electronic Documentation – How/when to create it, sign/authenticate it, use it?
• Medication Order Standards– How/when to order certain medications? Non-formulary medications? In code blue/emergency situations? Over the phone?
• Standards for lab/radiology orders– How/when to order certain tests?
• Training standards – How do you train new employees? Existing employees?
• Clinical Tool Development – How do you develop order sets? Policies? Protocols? Documentation?

Then ensure your governance team works with your vendor as a partner. Are there features and tools you want to learn more about? Do you need to report a bug? Do you have a feature request that will benefit not only your practice – but all EMR users? Do you have specific support or training needs? While software is never bug free and it’ll never automate everything – exactly the way you would – it’s important to that you’re able to work with your vendor as a trusted partner. Most vendors will offer channels to submit bugs, feature requests, ideas, feedback, etc. Others offer free educational resources via eBooks, webinars, and ongoing training resources. Engage your support teams when you have questions, need training, or are considering implementing additional tools.

Implement clinical add-on tools

After implementation and the successful adoption, consider additional tools to enhance user experience, efficiency, and effectiveness. Utilize Clinical Decision Support (CDS) tools for rules, intelligent alerts, and quick reference standards. Enable speedy documentation with voice recognition. Turn on Electronic Prior Authorization for Prescriptions. Adopt ePrescribing of Contolled Substances (EPCS). Determine your goals, formulate your budget, implement and optimize usage, and monitor success to confirm your return on investment and impact on user satisfaction. MicroMD includes a host of integrated clinical tools, including FREE VisualDx visual CDS, Dragon voice recognition, ePrescribing of Controlled Substances with optional integration to your state PDMP, patient portal and secure messaging capabilities. And coming soon MicroMD EMR will offer a mobile patient population management tool and a robust rules-based CDS tool.