Technology Feature - August 2005
By John Lubrano
Last month, we discussed the basic software paradigms and techniques to help you cull one to three alternatives from the array of electronic health record (EHR) products currently on the market.
We did not discuss sales demonstrations because there's little value in having a product demonstration until you've narrowed the field to a few products. And, secondly, software sales representatives are very good at selling their product. They can sell a nickel for a dime. Therefore, scheduling product demonstrations is one of the last steps you should take.
Watching sales representatives demonstrate their product is analogous to being shown a new home. The software you see will be fully developed and contain a substantial patient database. All functionality, all templates, all customization, all interfaces will be built in. It will appear that the software does everything quickly and easily.
How can you get a more realistic view of the software and place the odds more in your favor?
1. Use your own clinical case studies.
Do not allow the sales representative to follow a canned presentation. Prepare clinical case studies beforehand and ask the sales representative to demonstrate the software using your scenarios. This will give a more accurate reflection of the software's capabilities and ease of use for your practice.
2. Evaluate intensively.
Have all product demonstrations on the same day or over a two-day period. Schedule about two to two-and-a-half hours for each demonstration. It will be a long day, but well worth it. These side-by-side demonstrations are important and the best way to make an accurate comparison among products.
3. Evaluate the product, not the person.
Eliminate the sales representative from your mind during the demonstration. Do not allow his or her appearance, likeability, or proficiency with the software to cloud your judgment. Focus on the product in relation to what you want it to do.
Is it a product I can learn to use?
Is it a product I like to look at?
Is it a product I think I can become proficient at using?
Does it meet the requirements of my vision?
4. Test it.
The only way to learn to use software is to use it, i.e., by controlling the keyboard and mouse yourself. Many software vendors have a remote server with their software and sales demonstration database. Ask for a username and password that allow you to log in and "play" with the software on your own time. Many software companies will allow this type of demonstration for a limited time.
So you've followed the suggestions and, combined with your own judgment, have found a product that will work for your practice. Now you're ready to install and implement it. You can do everything correctly, but if the implementation is botched, you can have a bad experience. If you are worried about throwing money down the drain, this is where it can happen.
Many good products are available. However, your success with any EHR software is directly proportional to the time you invest in it. The forms, templates, patient database, etc ., will not be there when the product is delivered. You will have to develop all of those things on your own, which requires a lot of work. Physicians who invest the time to develop the templates, use the product intensively, and identify areas of concern will reap the rewards of their investment faster.
Learn the software, use it, and invest time in customizing your templates as fast as possible.
Filling the Implementation Gap
The implementation phase is perhaps the most crucial step of the entire EHR process. Unmanaged implementations often fall short of expectations.
There is a huge "implementation gap" after the software is installed. You may never actually see your salesperson again. Software vendors assume you are happy if you are not complaining. The reality may, in fact, be that you are struggling and doing your best to simply learn it on your own.
So assign an implementer. This can be someone already on your staff ( not your office manager who is too busy doing other things), someone you hire as an employee for a limited time (six to eight months), or an outside consultant. This person should:
- Have a finger on the pulse of the practice and always know what software was supposed to be delivered, what is yet to be delivered, and the timetable for delivery;
- Solicit feedback from physicians and staff;
- Keep a running list of things that work and don't work and things that have to be done, and communicate with the software vendor about when problems will be addressed; and
- Coordinate interfaces with medical equipment, third-party software vendors, or third-party services such as laboratories.
Software vendors highlight training as the key to successful implementation. Training is important but it must be effective.
Effective training recognizes that:
- People's attention span and ability to retain information is very short (two to three hours) when it comes to any type of software;
- Software is best learned by actually using the software unassisted; and
- End users must be self-reliant after the training ends.
Effective training involves either a classroom setting with computers or intensive on-site training sessions with subsequent follow-up sessions.
Train intensively, have the trainer leave, use the software for one or two weeks, develop a list of questions, and then call the software developer to address these questions. This tends to be more effective than having trainers onsite for several weeks as some vendors will propose.
Unlike other functions within your practice that can be delegated to others, you must take ownership of EHR evaluation, selection, and implementation. In the end, you will be alone with a patient in an exam room. You must be able to use the system effectively to document the encounter. There's no escaping that this will require a lot of your time.
Next month, I will discuss the rewards for your efforts.
John Lubrano is the founder and owner of Protis I.T. Solutions. For eight years, Protis has provided information technology consulting and support for professional service firms in Texas. Mr. Lubrano specializes in office automation and EHR deployment for medical practices and works exclusively with TMA Physician Services as its technology expert.
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