The Frontlines of EHR Implementation
by Molly Hart
Dr. Edwin Munich is the Medical Director of Information Technology at LifeLong Medical Care (LMC), he is also serving as one of three interim Chief Medical Officiers at LLMC. He has been the EHR Clinical Lead during LMC’s implementation of the NextGen electronic health record (EHR) system at three LMC sites. Molly Hart, CHCN’s Meaningful Use Project Manager, was able to grab a few minutes with Dr. Munich to talk about his experiences implementing and using this high-tech medical charting system.
Molly Hart: How do you assist LMC with the implementation of EHR?
Edwin Munich: I oversee a lot of the clinical aspects of the go-live for the clinicians. I help to plan how the go-live will unfold and make adjustments where needed as the go-live proceeds. So far we’ve rolled out our EHR system at three of our sites. At our first site to implement EHR, we began using the system with 100% of our patients on the first day and had to reduce our patient load by half. After that experience, we chose to do a partial go-live at the next site. Providers chose only a couple patients to start with the electronic chart and the rest of their patients were continued with a paper chart. This method still included a staggered and reduced patient schedule, but it allowed the clinicians time to comfortably explore the product and to see what it would be like treating patients in the EHR environment without the pressure of having everyone on electronic charting at once. The second approach really worked better for us and for the clinicians and staff.
MH: What has been the most important NextGen EHR benefit for you as a clinician?
EM: There are so many different benefits; it’s hard to choose only one. For starters, the chart is always available; it doesn’t need to be chased down. This is a huge benefit for providers that work offsite and provide after-hours on-call coverage. It’s also much easier to keep problem and medication lists accurate and up-to-date. The charts are legible, which is a huge deal; everyone’s happy they don’t have to read my handwriting. Lab reports feed directly into the record now so you don’t have to try and find them. The list of benefits just goes on and on.
MH: What about the main benefit for the patient?
EM: The patient benefits are very much the same as the benefits for the provider, although the patient may not directly associate them with the EHR. Patients will oftentimes get discouraged and frustrated when their paper-charts can’t be found or accessed during their visit. With the electronic charts it’s easy to see what happened during a previous visit, especially if the member is seeing a new provider, they are reassured that nothing is falling through the cracks. Another benefit is that the chart can be in different places at once, so multiple people can be working on one patient at the same time. For example the provider is conducting the patient visit while the medical assistant is reviewing the chart to schedule a follow up appointment.
MH: It must have been a tremendous challenge to implement EHR. What were the most challenging aspects for you and others at Lifelong?
EM: The challenges vary from provider to provider. The biggest one is realizing you’re introducing a third player into the exam room. You’re putting a machine between the patient and the provider and it needs to be done gracefully so the provider’s face is not buried in the computer creating a barrier between the provider and patient. Also, the software we’re using is so different than the way we used to chart; some providers have adapted to it quickly and easily but others haven’t.
MH: What would you emphasize to others in their implementation of EHR?
EM: It’s important to do your research on the best practices of other organizations that have gone through EHR implementation. Documents from CalHIPSO and CPCA were very beneficial to us during our planning and implementation process and those organizations continue to be a resource to us.
Building a strong team and putting in some resources up front will really pay off in the long run. We were very lucky to get a strong project manager and we move the same implementation team from site to site as we go-live on EHR.
Training is also important but you have to remember it’s not effective to have an 8 or 12 hour training session in one day. You should break it up into smaller blocks and get people hands-on as soon as possible. This approach is more effective because providers can immediately apply what they’ve learned, and it helps to manage the anxiety that people feel with big changes.