The big buzzword in EMR circles is usability. It means choosing an electronic medical records system that's easy to use and effective. Industry observers say a lack of usability may be a significant barrier to the widespread adoption of EMRs. Before you implement a paperless solution at your facility, read this advice from your colleagues who've already taken the plunge.

1. Contract for compliance. While the federal government has set a deadline of 2014 for the widespread adoption of EMRs, it hasn't yet provided definitive requirements for meeting that goal. Any contract with an EMR software vendor should include a clause guaranteeing that it'll keep you compliant in the event of regulatory changes after your implementation. "When new requirements come out — and there are always new requirements — the company will be committed to bringing you up to those standards," says Colleen Heeter, senior vice president of operations design for Nueterra Healthcare, the Leawood, Kan., developer and manager of ASCs and surgical hospitals.

2. Don't let the perfect be the enemy of the good. Aside from initial costs and lost productivity during EMR implementation, a key reason EMR adoption rates have been slower than expected in the United States is a lack of efficiency and usability of the EMRs currently available, says the Healthcare Information and Management Systems Society (HIMSS). "We were on a search for the perfect EMR, but the perfect EMR is not out there," says Rebecca Craig, RN, CNOR, CASC, CPC-H, the CEO of Harmony Surgery Center in Fort Collins, Colo. To find the product that best meets your needs, Ms. Craig recommends judging your options with the help of the HIMSS white paper "Defining and Testing EMR Usability" (www.himss.org/content/files/HIMSS_ DefiningandTestingEMRUsability.pdf), which lists 9 criteria for effective, efficient use, including simplicity, naturalness, consistency, forgiveness and feedback.

3. Creative financing. EMRs aren't cheap. The Fremont (Neb.) Surgical Center spent $150,000 for hardware, software and training on its EMR system, says Administrator Daren Smith, BSN. A big outlay, yes, but one with a 14-month return on investment and one that let the ASC eliminate a full-time chart-assembly position in the business office. "Look at the true cost over 5 years, not just the initial expenses," says Steve Campbell, chief operating officer of Mavicor, an information technology consulting firm in Overland Park, Kan. Ask if software vendors offer monthly leasing or subscription programs. "Vendors know that we're under financial constraints," says Ms. Craig.

4. Paper under glass. Make your EMR look and feel as much like a paper chart as possible, says Mr. Smith. "Our doctors brought us the forms they were used to, we turned them over to the vendor, and they made EMR charts out of them," he says. "We didn't try to adopt (our staff) to the EMR, but to adopt the EMR to them, to their workflow." Plus, he adds, "if it looks and acts like a paper chart, there isn't a whole lot of training necessary."

5. Input from all sides. "The best way to get your staff to give up paper is for them to trust the system," says LaVerne Manos, clinical informatics director for Nueterra. "And the best way to get them to trust the system is to have them help build it." Seek input from physicians, nurses, the business office and every possible user throughout the selection and implementation process. Finding out how they plan to use the technology can help you conform it to their needs.

6. Repetition and mentoring. Before Fremont's EMR system went live, staff drilled for 2 days with the vendor, using the hardware and software in mock cases to prepare for different surgical scenarios. But few physicians showed up for the training classes scheduled for them, says Mr. Smith. So when the system went live, staff members who'd excelled during training were assigned to accompany the physicians throughout their day for the first 6 weeks of use. These "super users" mentored the physicians through the tasks they needed to master. Because the nursing and anesthesia personnel input most of the data into the EMRs, "what (the physicians) had to learn was not mission critical," says Mr. Smith.

7. Start soon. If you aren't already planning your transition to EMRs, you might want to begin now. Plenty of administrators seem to be taking a wait-and-watch approach to healthcare IT, says Mr. Smith, but "you don't want to be one of the centers that are implementing EMRs 6 months before it's due." Software companies have a finite number of staff and resources with which to serve their customers, "and I would hate to be at the end of the line for support," he says. Especially with a deadline looming, and especially since adopting new technology nearly always raises unforeseen issues to resolve.