Success and the EMR: Facilities Show How It's Done

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Mary Koski, RN, at Memorial Hospital CentralLess than 20 percent of physicians in the United States and Canada are using electronic records and the failure rate of EMR system implementation hovers around 50 percent. Preparation and communication go a long way to boosting the potential for success, but where there’s a will, there’s a way. Health Imaging & IT talks to several organizations that are successfully using electronic records about how they got there.

Race against time

Installing an electronic records system is challenging under the best of circumstances.  Drew Nietert, interim IT director of Manhattan Physicians Group in New York City, had to quickly implement an EMR when the group split from another practice. Agreeing to tight deadlines was part of the arrangement involving a smoother transfer of records. And, the group needed a new EMR in place before its contract with its previous vendor expired.

The group hired NetGenIT (now known as ITelagen) to help upgrade the practice’s computer infrastructure and support system. The company loads software that proactively and usually remotely monitors the equipment, including virus protection, CPU temperature and fan feed.

The next step was assessing the equipment’s capabilities which Neitert calls “pathetic.” The six-year-old system was not capable of running the new EMR selected and a lot of the printers were dot matrix. Overall, more than 500 computers and printers needed to be replaced. Once the new equipment was in place, an EMR implementation team started converting the old database to the new WAN infrastructure. Because the group’s nine locations had hours from 7 am to 10 pm, “we needed redundancy and 24/7 operations,” he says. Because the practice relies on the EMR so heavily, “we need backup for our backup for our backup.”

Then Nietert focused on setting up a support process for the EMR implementation. Ideally, that would be set up 14 to 30 days before the go-live date. Due to the short timeframe and lack of space, Nietert decided to outsource the task. Although he would have liked more time to train, he says three locations, followed by three more locations two weeks later, successfully went live.

NetGenIT was the best value, Nietert says. “It’s one of the few companies that has the infrastructure here and now.” Being local to New York City helped. And, the company didn’t have to build anything—a big plus when every second counts. “They were already up and running. We didn’t have time for a build and it would have cost more.” When Neitert needed support people within 30 days, the company had people ready within two weeks. Other companies would have needed two months, he says, and would have outsourced the work to relatively untested people in the New York area.

The day would come

Although Mount Kisco Medical Group in New York originally went live with an electronic records system in February of 1998, the practice has been a Misys shop since late 2001. Back in the 1990s, EMR systems weren’t as sophisticated as they are now but internist Abe Levy, MD, said that the practice leadership recognized “great value in electronically storing patient information. We knew there would come a day when it would have greater value than a paper chart.”

Levy’s philosophy regarding return on investment for an EMR is improving physician efficiency rather than simply paying for the system through savings on transcription costs. “The return on investment is in making doctors so efficient that they spend less time chasing paper charts and more time seeing more patients. I would argue that seeing more patients is a better ROI than saving money on transcription.”

After implementing the Misys EMR in 2001, Mount Kisco became paperless in about six years. None of the 110 physicians now prints notes on paper, Levy says. After struggling with thick paper charts, Levy didn’t have to convince any of his colleagues of the value of the EMR. “They could see in five seconds that they had everything they needed.” With the ability to order lab tests and prescriptions electronically, and scan documents, Mount Kisco could abandon paper records. Scanned documents from outside the group made the electronic record a complete record.

Levy cites the “banishing of human handwriting” as the greatest feature of the EMR. “Early on, I developed a distaste for human handwriting in medical records.” He sometimes couldn’t read his own notes so he recognized that “storing medical information as human handwriting was not fulfilling our responsibility