Consider usability, compatibility and flexibility for EHR success.
When we opened our ophthalmic ASC in May 2006, our objective was to create a largely paperless facility with information systems integrated into our physicians' practice. Fortunately, we'd gained a familiarity with EHR technology when we implemented a system in the group practice the year before. What we learned is this: Looking for specific qualities in an EHR solution and carefully planning the transition is the best way to avoid many common pitfalls.

Don't deviate from your wish list
Create a wish list of what you want your software to do and don't concede a thing as you begin shopping. Certain things should be non-negotiable. Your system must be user-friendly and adaptable. During product trials, pay close attention to workflows, menus and templates that reflect your specialties, as well as robust reporting and analysis tools that could enable you to better manage your clinical care and patient flow.

Beyond the software interface, you should have specific requirements about the type of vendor with which you want to partner. Customer service and responsive technical support are an absolute. As a busy ophthalmology practice with several satellite locations and a new surgical center about to open, we realized that it would be unacceptable to wait weeks for assistance — a problem we'd faced with previous IT vendors.

Inquire about a vendor's investment into research and development, a potential indicator into whether the company will be around for the long term. In addition, look for vendors who have clinicians on staff collaborating with ongoing product development. We felt, for example, that the presence of an experienced, certified ophthalmic technician among the programmers would produce highly usable solutions with better clinical workflow integration.

Go seamless
To get the most value from your EHRs, it's very important that all of your IT systems work from a single database. To that end, you'll want to ensure that the software you choose is compatible with your previously existing technologies.

Our EHR shares a database with our image management, document management and even our retail sales management systems. This was a must-have consideration for us, because we wanted all of our clinicians to share surgery and office data. As a result, we've created a more complete, more current patient records system without requiring redundant data entry.

Another benefit is that we were able to keep our surgical center's EHR workflow similar to our offices' EHR workflows. To create documentation, we simply started with our office templates and adapted them to the various purposes needed within the surgery center: registration, pre-op, surgery, post-op and discharge. We also added consistent anesthesia processes documentation and related templates.

Can you customize the templates?
Be sure that the system you assemble affords you the flexibility you need for your particular specialty and your facility's way of doing things. Customizable templates for documentation can make an EHR system work well for any surgical specialty.

We took full advantage of our template-driven system to replicate paper charts in such a way that the new workflow seemed familiar to staff and providers. With the right tools, this transition isn't necessarily more difficult than managing paper-based documentation. After the merger of ophthalmology offices that formed our physicians' group practice, we had at least 5 different paper chart methods in play. Consolidating those to a single manual chart was actually more taxing than our transition to EHR.

Build a team, find a leader
To help judge your software choices, and to later help implement the system, put together a broad-based, positive-minded team that truly represents your facility's staff, with an emphasis on the personnel who'll use the system most often. In selecting this committee's members, try to involve people who can inspire others. It takes a certain cheerleader-type personality to make this transition happen, since change can be difficult.

While you need a strong committee, you also need to designate one person to oversee the project. A well-placed coordinator can see seemingly small details and changes — such as an additional field in the patient encounter template and how it may affect reporting later — that might influence what others want to do with the system. Without micromanaging, this project leader can prevent complications due to miscommunication and unintended side effects.

Develop a full plan
Before you buy, and before you begin implementation, evaluate your entire patient workflow and diagram your charting processes. What other equipment, staffing or capability considerations are going to be necessary? Will you use PDAs, tablet PCs, laptops, workstations or a combination of hardware? Who'll manage and maintain documentation for template development? What kind of quality reporting do you want to achieve?

The cost of making things up as you go along can be high. We've heard of cases where physician leaders lost enthusiasm for EHR implementation quickly because they encountered more difficulties than they'd expected. Solid planning will help to prevent this overload.

Plan to train
In addition to budgeting for these ancillary costs, plan ahead to invest in training for your support staff. The people who touch the system the most need to be trained the best. We credit a large part of our EHR success to how well we trained the people who work alongside our providers. You have to train your physicians to use the software, of course, but you get a lot of benefit from a broad-based training that includes your support staff, since then they'll be able to help your physicians learn and keep your workflow moving.

We had the advantage of getting people started with our EHR system as we hired them to our ASC. In an existing facility, it's even more important to communicate before, during and after the transition to explain goals, sustain enthusiasm and gather feedback. Organizationally, the biggest obstacle to the selection and implementation of technology is the failure to address the needs of key individuals, and project pushback is just as likely to come from the computer savvy as it is from the computer illiterate.

Amkai
Amkai Charts
(866) 265-2434
www.amkai.com
Pricing: Priced per OR. About $45,000 for a 2-OR facility with annual subscription rate alternatives available.
FYI: Drives cost savings and efficiencies via clinical data management and full electronic charting, from pre-admission questionnaires through post-operative reports. Automatic alerts to care providers and a computerized physician order entry module boost patient safety.

Cerner Corporation
PowerWorks Surgery Center
(800) 927-1024

Pricing: Priced per OR through a monthly subscription fee.
FYI: Provides a complete operating room information solution. The Business Suite for billing, inventory and office management can provide a substantial upgrade from legacy systems, and the EMR Suite, Anesthesia Suite and Device Connectivity options can help to transform workflows to gain efficiencies. Because PowerWorks is hosted remotely, Cerner handles the IT for you.

gMed
gGastro
(888) 577-8801
www.gmed.com
Pricing: About $12,500 for gGastro Endoscopy Report License, excluding installation, configuration, analysis and hardware.
FYI: Provides GI practices with a solution that thinks like a gastroenterologist. Simple, specialized and flexible, the application is designed to match the workflow, processes and needs of a typical GI office, ensuring staff can quickly document patient evaluation and management encounters.

Medflow
Medflow ASC
(704) 927-9810
www.medflow.com
Pricing: $10,000 per OR, excluding training and implementation services.
FYI: Manages consents, lab tests and surgery plans, and captures electronic signatures for documents through a tablet PC. Cataract planning, IOL calculations and registries are integrated into worksheets, and anesthesia and vital signs monitoring are supported via interfaces. The ASC Dashboard, a patient monitoring tool, lets you review patients in any part of the surgical process.

Mednet
OASIS (Online Ambulatory Surgical Information System)
(866) 968-6638
www.mednetus.com
Pricing: $10,000 1-time license fee (includes 6 concurrent user licenses) and $7,000 annual support and maintenance fee.
FYI: Built for ASC users by ASC users, with the goal of providing a detailed, reasonably priced application. An EHR component manages patient demographics, procedure details, clinical information and document management. Additional modules: scheduling, billing, inventory management and reporting.

NextGen Healthcare Information Systems
NextGen EHR
(215) 657-7010
www.nextgen.com
Pricing: Available through purchase of software licenses or through monthly subscription-based service.
FYI: The NextGen EHR's pre-built clinical templates and workflow for over 25 specialties ensure complete, accurate documentation stored in a standard format. Disease management templates capture discrete data at the point of care to meet clinical reporting guidelines for pay-for-performance programs. And integration with the NextGen product suite enables consistent, real-time clinical and administrative workflow among providers, hospitals and patients.

ProVation Medical, part of Wolters Kluwer Health
ProVation EHR
(612) 313-1500
www.provationmedical.com
Pricing: Varies depending on number of room installations, procedures performed and interfaces selected.
FYI: Designed to meet the patient charting and documentation needs of cost-conscious ASCs. Provides electronic physician, nursing, anesthesia and other documentation abilities combined into a patient-centric system that eliminates the efforts and costs of printing, transcription and chart storage to streamline your workflow.

SourceMedical
Vision EHR
(800) 719-1904
www.sourcemed.net/sourceplus/vision-ehr
Pricing: Varies depending on number of users and options required.
FYI: This single database solution offers a customizable user interface that lets you convert existing forms to an electronic format and make quick changes without interrupting workflow. Offers real-time connectivity and synchronization to the Vision application via a wireless tablet. Supports the importing of high-quality documents, including scanned X-rays and physicians' notes. Search function lets you quickly locate charts to ensure timely completion, fulfill records requests, and support QA processes.

Summit Imaging
EndoManager
(866) 578-5713
www.summitimaging.net
Pricing: $6,000 to $21,000 per room.
FYI: Provides an information solution that a large EMR cannot, says the company. This specialty imaging and reporting software meets and exceeds the needs of clinical users and is HL7 and DICOM compatible. Its tools can transfer all applicable data to any EMR system and can be customized to meet users' demands. Applications are available for endoscopy, pain management and the OR.

Workflow.com
WorkflowEHR
(440) 827-2700
www.workflow.com
Pricing: not disclosed
FYI: Makes it easy to transition from paper to electronic health records by providing an easy-to-use application backed by solid customer support, says the company. HyperForms technology lets you work the same way you do now, with your own scripts, orders and encounter forms on a tablet PC. WorkflowEHR supports providers desiring to use dictation with either Dragon voice recognition or with traditional transcription.

No fear
There's no question about it: Electronic charting is on its way to practically every surgical facility. But don't be intimidated by the prospect of choosing and installing a system. Avoid "analysis paralysis" by trusting in your team members. If you've carefully evaluated your options, thoroughly planned your transition and properly trained your staff, you're well positioned for EHR success.