Article
Best Practices When Transitioning Electronic Medical Records (EMRs)
Introduction
Since electronic medical records (EMRs) first began to appear in hospitals in 1972, their use has grown exponentially. The Office of the National Coordinator for Health Information Technology (ONC) reported that as of 2021, 96 percent of U.S. hospitals had adopted a certified EMR. This represents a significant jump from 10 years prior, when just 28 percent of hospitals had adopted them.
Despite rising costs and slow-growing operating margins, eight in 10 healthcare providers increased their IT spending last year, and nearly a third cited electronic medical records as an IT priority. Transitioning to a new EMR can help hospitals reap the benefits of workflow efficiency, greater data integrity, and downstream financial gains.
However, EMR transitions can also present substantial risks when not done effectively. One academic medical center shared that the purchase of a new EMR contributed to operating losses of nearly half a billion dollars over two years. Another hospital reported needing to cut staff after a new EMR system contributed to putting the hospital $38 million over budget.
To mitigate these setbacks and experience the full benefits new EMRs offer, it’s critical that hospitals and health systems manage EMR transitions carefully. This paper details challenges related to EMR transitions and shares best practices for ensuring an effective transition. With an approach that involves proactive education, clear security protocols, testing processes, and a tiered roll-out plan, healthcare organizations can ensure a smoother transition and set their facility up for long-term success.
Challenges
Technology Literacy and Security
- Staff unfamiliarity with the new EMR, its functionality, and capabilities leads to workflow inefficiencies.
- Transferring files from the old EMR to the new EMR presents digital security risks.
Multi-Site Systems
- Hospital systems with multiple sites often have different capabilities, initial EMR platforms, and data present on their EMRs.
- This differentiation frequently leads to slower and costlier implementations than predicted.
- Different sites may have different rollout capabilities that may not be documented or tested before new EMR implementation.
Technology Compatibility
- Systems often downloaded records and files in a previously generic format, and have found that the previous format is not backward compatible with the new EMR format.
Clinical Feedback
- Clinical needs, expertise, or point of view are often overlooked, leading to a less than user-friendly and inefficient EMR interface on their end.
Experience
- Hospital systems that have never transitioned EMRs before can lack internal expertise of the process and best practices
Best Practices for Solutions
Early Education
As the new EMR is built out and implemented, train necessary staff on the new technology early.
Establish a Security Protocol
- Before starting the transition process, take potential security issues into consideration.
- If a third-party vendor is helping to handle the transition, consider their certifications.
- SOC 2 + HITRUST is the highest tier of cybersecurity available. Organizations with this distinction demonstrate the ability to
fully protect patient and other sensitive, personally identifiable
information in accordance with HIPAA.
- SOC 2 + HITRUST is the highest tier of cybersecurity available. Organizations with this distinction demonstrate the ability to
Gradient Roll-Out Plan
- For multi-site systems, consider a tiered roll-out plan based on the capabilities of each site, region, facility, etc.
- Some sites may transition more slowly due to size, staff bandwidth, age of previous EMR, technology literacy, region, etc.
Regular Testing
- Test and retest file transfers.
- A common oversight in EMR transitions is assuming that a file from the old EMR will transfer easily into the new EMR.
- Files that do not transfer into the new EMR will have to be reformatted or adjusted before the transition is complete to maximize workflow efficiency.
Proactive Feedback
- Ask clinical teams what fields or tabs might benefit their workflow.
- Map required workflows and respective EMR involvement.
- Learn and reverse-engineer order sets for a smoother workflow.
Reincorporate What Works
Request forms from previous implementations that have resulted in positive outcomes.
Benefits of a Successful Implementation
Smooth and Seamless Transition
- Despite different site capabilities, the overall transition into a new EMR will be timely, relatively free of complications during the rollout itself, and will be done with cybersecurity in mind.
Improved Financial Efficiency
- Upfront costs may be large, but improved clinical documentation means optimized billings and collections in the long term.
Workflow Efficiency
- Proactive staff education means shorter downtime and learning curves with the new EMR.
- Clinical feedback on preferred record or data locations, fields or tabs help with workflow and concurrent review.
- Well-templated forms with previously tested optimal outcomes reduces upfront work and ensures continued positive outcomes.
Continued Innovation
- Continued partnership with outside experts and internal analysis prompt continuous opportunities to improve, upgrade, and innovate.
Conclusion
New EMR platforms, upgrades, and transitions present a host of potential benefits for hospital systems. This is representative of the trend within hospital systems for technology innovation to improve long-term financial health, patient care quality, and workflow efficiency. Similar to most changes, EMR transitions and upgrades can be complex, hampered by inexperience and capacity issues. Further considerations, such as staff affinity for the new technology and cybersecurity, are often overlooked and can cause unforeseen inefficiencies. Hospital systems that proactively tackle staff education, multisite rollouts, and potential partnerships can expect a smooth transition to a new or upgraded EMR with little downtime.
