Highlights from CHCN’s EHR Implementation Debriefing Session

By Joann Wong, MPH

CHCN clinics have been busy planning and preparing to transition from paper medical charts by utilizing electronic health records in order to improve delivery of health care to the thousands of patients served by this collection of safety net providers. Such an accomplishment can be an overwhelming and daunting task given the many changes that EHR implementation involves.  Over the past year, several clinics have embarked on various stages of EHR implementation…whether it was first implementing an electronic practice management system (EPM) or piloting EHR system for a couple of providers to full implementation of EHR throughout all clinic sites at their agency.

Lessons learned and tips to those who are still in process of this journey toward EHR implementation were recently discussed at a session called EHR Implementation Debrief: Part 1 – Lessons Learned and Tips from Axis Community Health Center and Part II – An Overview of Experiences from Community Health Clinics.

Axis Community Health Center embarked on piloting their EHR implementation in April 2012 and completed full implementation of the NextGen EHR system throughout all clinics sites by the end of September 2012.   Lifelong Medical Center also completed full EHR implementation at Lifelong Berkeley Primary Care Clinic in July 2012 and then more recently, completed full launch at Lifelong East Oakland clinic.  Some tips and lessons from their EHR launches are highlighted below:

    • Create an “implementation manual” to provide structure and foundation for expectations of clinic staff so they know what to expect and how to prepare – then whole team will be on same page
    • Communicate that initial training is focused on getting through the visits, and that there will be follow-up training to “optimize”
    • Start abstraction process early as possible (minimum 2 months in advance of Go-Live)
    • Communicate plan to providers that metrics would be based on # pts per day, not by hour
      • Then increase number of patients by WEEK (1-2 patients per day per week)
    • Recognize that all providers will have their “hit the wall” moment – natural course of process
      • Around 3 weeks post launch, though varies
      • Increase positive feedback to providers POST Go Live
      • Ex: Ice cream token for providers when they “hit their wall”
    • Subcommittee “Charters” provide a clear description of role/scope of work, time commitment and membership
    • Celebrate and appreciate staff
      • Lunch for all staff post launch
      • Certificates to staff
      • Medals to providers
      • “Pins” given at GO LIVE for each team
    •  Go-Live Support is critical!!!
      • Consider recruiting assistance from other CHCN CHC &  NG Trainer
      • While they may  not have same depth of knowledge of processes, modifications/optimizations to templates/software, still have someone with knowledge of NG EHR system who can provide hands on support
    • Staff Feedback Post Go Live
      • Put in place mechanism for staff to “voice” and be heard regarding their feedback on what issues need to be addressed
    • Sustaining Energy Post Launch
      • Things don’t stop after Go-Live; Sustaining momentum and staff energy, especially core team/leaders in implementation effort is important
    • Post-Launch Support
      • Providers may hit another “wall” and only be up to 80% of their schedules – this is another “wall” that’s related to providers’ capacity and knowledge of using the EHR system.
        • To minimize provider burnout, be flexible to adjust schedules and provide additional support when needed to support providers who may be struggling with using the new EHR system.
        • Ex: Scale back on the schedules for providers who are struggling.
      • Refine some existing assessment tools for providers, provide additional individualized training, and reassess office processes.
    • Reporting/MU attestation
      • Identify criteria based on “lowest hanging fruit”, i.e. patient education
      • Make sure there’s a place within template that captures this data in EHR system
  •  Ergo Assessment: Vendors, like Midmark provided equipment to try and test out for period of time within clinic exam rooms

As staff throughout the CHCN clinics work toward full and complete EHR implementation, their dedication, hard work and tremendous efforts will significantly improve the quality of services and delivery of care to the thousands of patients served across all the agencies. Hats off to a job well done and good luck as you continue your journey to improve delivery of health care through implementation of electronic health records at your agency!