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What I Wish I’d Known Before … Bringing an Ambulatory EHR Live

February 3, 2018 What I Wish I'd Known Before 3 Comments

That technical dress rehearsal issues would get ignored or not addressed before the go-live. Wasn’t that the point of the TDR?


I wish I knew ahead of time that the EHR vendor outsourced their support to a third party. This arrangement created speed bumps to getting real support answers relayed from the EHR vendor through the support vendor.


I wish I knew how effective running a mock clinic was for training providers, especially physicians. An EHR analysts plays the role of a mock patient and gets checked in, roomed by the MA or nurse, seen by the doctor, and checks out. Ideally, the provider completes common orders, does a note, and charges. Any system problems can be caught by the analyst and a trainer can be at the elbow of each users. It is a little labor intense, but the clinics come back up to full speed much sooner. We had one ophthalmologist seeing 87 patients a day within one week of go live. His partners that didn’t do the mock clinic took weeks to get back up to full speed.


To what degree provider productivity would be negatively impacted and how that would impact the productivity-based comp plans of physicians and administrators. There’s a reason CIOs have a hard time surviving an EHR implementation, first among them messing with peoples’ pay checks.


How to generate sincere engagement for the implementation with the clinicians and staff as beneficial to their patients and care delivery. And helping all to make the project not just about the billing.


We learned after the CIOs and people allowed in the room had chosen Epic just because, that all non-Epic apps that were to integrate into the EMR had to have a test environment, or else integration was denied. Even apps with fewer than five users. Go-live was pushed back months, there no budget for this, and rebuilding non-Epic apps took time away from learning and building the actual future EMR and getting certified.


Focusing on optimizing physician workflows and making them as efficient as possible is absolutely important, but the same amount of effort must be made for the other roles on the ambulatory clinical care team: nurses (especially nurse triage), medical assistants, in-house laboratory and radiology, as well as all other ancillary services provided by the practice. Ensuring that the physicians are happy should not come at the expense of everyone else in the practice.




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Currently there are "3 comments" on this Article:

  1. Someone needed to go through an EMR implementation to find out that apps used in a healthcare setting must have a test environment… Does anyone else think this borders on the ridiculous?

  2. I wish I’d known how naive and inexperienced some HISTalk readers were.

    This series is not exactly instilling confidence in the competence of the profession.







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