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Lessons Learned: How to overcome the cultural barriers to EMR implementation

by Michael J. Koriwchak, MD •

We invested in an EMR system because it is good for our patients and our practice. We save about $1,000 per physician per month in transcription costs alone. Over five years, we will save $60,000 per physician, much more than the $44,000 promised by the federal government’s “meaningful use” incentives introduced last July. With our savings in office space and staffing, the total is over $20,000 per doctor per year. Patient complaints over missed phone calls have been sharply reduced. And we have barely scratched the surface.

The timely acquisition of EMR is a vital step toward controlling our destiny as otolaryngologists. Eventually all practices will become electronic; only by embracing EMR soon can we do it on our terms and on our timetable. From a leadership role, we can engage the IT community to improve EMR products for otolaryngologists, while also gaining enough credibility to work with the government and private insurers in a more equal partnership than currently exists. Surely it is worth leaving our comfort zone to reach these goals.

Dr. Koriwchak, MD, is attending physician at Ear, Nose and Throat of Georgia in Atlanta, Ga. Read his blog, “The Wired EMR Practice,” at wiredemrdoctor.com.

Take It Step by Step

Learning how to use EMRs is like learning how to play a musical instrument. Through practice, proficiency is built slowly over time. Our physicians first practiced at home using a training version of the EMR program. When they felt comfortable at that level we transitioned them to step two, making the task a little more complex by adding the server login and our custom templates to the training EMR experience. Then they started using the real EMR on patients in the office. We started with easy tasks: follow-up visits, patients that are doing well, and so on.

Next, we brought in the medical assistant (MA) and began designing a two-person documentation workflow. The MA would interview patients first and enter their data into the EMR chart note. The physician would then open the chart note on a separate computer, review the data, see the patient and complete the note. We looked at the appointment schedule ahead of time to identify appropriate patients for our first EMR notes. It was slow and awkward at first but improved with time.

When physicians and staff were ready to progress to another level, we added EMR-based prescriptions (paper at first, e-prescribing later), test ordering and, finally, charge code/diagnosis code entry.