When asked where practices make the most errors in using their IT, every expert’s first response mentioned the hiring of the IT person. “Don’t just use a friend of a friend or the husband of one of the physicians,” says Quentin Demmon, network consultant with Jackson Thornton Technologies. “It’s not that they can’t be a relative, but use the same criteria to choose your IT support as for any vendor.”
“Besides checking references, ask them what other medical offices they’ve installed your type of software and hardware in,” says Carrie Gulledge, RHIA, director of electronic health records at MediSys. “And check to see how satisfied that customer is.”
The anecdotes of errors and potential fiascos resulting from lax attention to IT hiring abound. One practice of four physicians using a son-in-law for their IT hadn’t backed up their data in over a year.
“They were just lucky,” Demmon says. “It was set up right, but the son-in-law wasn’t checking the backup, even though he had a monthly agreement with them, so it was blank. If they’d had a hardware failure, it would have been catastrophic. They’d have lost every chart.”
A lack of investment in training when converting to new software ranks a close second on the IT errors list. Practices should budget around 100 hours for training staff and providers, usually remotely and in-office, when implementing a new EHR. “If the physicians are unwilling to do what they have to do to make it happen, then you’ll be worse off than you were before you spent the money,” says Mike Jones, CEO of Clinic Anywhere.
For example, at one small practice, the physician took vacation and passed up training on the new EHR. “The first day, they had 25 patients, and he didn’t complete his daily charting until after 10:00 that night,” says David Gray, managing partner with Southeastern EMR. “He’d had some exposure to a different EHR, so training on this one was not a priority for him. Needless to say, it became a priority.”
Providers also fail to thoroughly research software purchases despite the investment cost. “You’d be amazed how many practices complete a $300,000 purchase, but they won’t buy a $1,000 ticket to go see the software in operation by one of their peers,” Jones says. “They think because all the other specialists have it, it must be good. That’s the lemming way of shopping.”
With hardware purchases, practices tend to choose something spur-of-the-moment because they assume computer brands, models, and operating systems are interchangeable. But they’re not.
“It’s not as easy as opening a box, and your hardware magically works,” Gulledge says. “Listen to your IT person. They’re the ones that know the best fit for your practice and have to support it afterwards. It can save you thousands in support costs.”
Practices have applied that same one-size-fits-all approach to their internet connection and found their workflow grinds to a halt. At one large practice, when they installed a web-based EHR, they neglected to think about the impact on their internet connection.
“They assumed they could have five physicians running remotely to a server that was hosted by a DSL circuit,” Gray says. “The speed was so slow, that on their go-live day, if more than one physician got on to use it, each mouse click created a 30-second delay.”
An out-of-the-box EHR software, no planning on the impact on their workflow, and no training with the physician led one small practice to waste their entire investment in a new EHR. “When the physician was presented with a patient flow that was much different than his normal work environment, he refused to use it,” Gray says. “They spent thousands, and now they’re still running on paper.”
Chart conversion from paper to electronic presents a similar array of costly errors by practices unprepared for the impact. “So many practices regret not doing more back scanning,” Demmon says. “A lot of times, they look at it in terms of accounts receivable and scan in only those patients owing money. But there’s a cost to running two systems simultaneously, especially in time spent waiting for files. And when you think about it, time is what a physician is selling.”
“Before making the transition, providers need to assess what they’re commonly referencing in the charts,” Gulledge says. “Most of the time what they find is they only reference the last six months to a year. Sometimes it’s just the last year of labs or last three office visits.”
The most common suggestion by vendors and IT experts is to learn what’s normal for that particular system. “If everyone else is running fine, but yours is dropping the connection, call your IT person,” Gulledge says.
“And don’t assume it’s the application. It may be that the lead in the walls around your x-ray area interferes with the wireless connection,” says Nancy Ellis vice president of MediSys. “Don’t ever hesitate to call. If there’s a problem, don’t get frustrated. Report the issue, so we can work to solve it.”