Allow time to implement EHR

Editor's Note: The first installment of this two-part guide (part one appeared in Ophthalmology Times March 15, 2010, pages 44 to 46) discussed the preparatory steps to installing an electronic health record (EHR) system, including forming an implementation team, analyzing processes, preparing for the technology demands, and customizing your software.

Now it is time to discuss the steps for actual implementation. This can be called the "go live" day. The following pearls will help the project manager and the implementation team on their journey to successful EHR integration.

The first step is to determine which records need to be digitized. Although most offices keep 7 years worth of paper records, it is unlikely that all of those patients will visit your office again. Many offices work with the most recent, "active" charts and then are able to destroy the old records over time. You will need to decide if you will do all of this before your EHR implementation, or as patients come in.

The next step is to decide what information is the most important in the paper charts, and pre-load this into your EHR. Some of the most common things to be preloaded are PFSH, IOPs, Meds, Refractions, Problem List, Vitals, Alerts, and Testing History. Preloading data takes time, so it is important to determine what is really important to your clinicians beforehand.

The third step is to determine which of the remaining information in the chart needs to be scanned. It is important to remember that while scanning in pertinent records is important, scanned documents are merely images to be viewed. The information is not inserted into database fields and cannot be used to merge letters or create exam summaries.

Analyze the various categories of test results, hospital paperwork, and other information that flow into the office each day and decide how to manage them. If these data have not been electronically merged into the EHR, you will need to scan in these documents.

When you know what information you are going to scan, you can determine when scanning will be done and which scanner to use. A high-speed scanner is expensive, but could save you hundreds of staff hours.

No matter which method (or combination) you choose, the physicians must review the data that have been scanned or pre-loaded and determine if everything needed is available. If not, you need a protocol for scanning/pre-loading additional information.