Let's not beat around the bush: Implementing an electronic medical records system is expensive, time-consuming and often frustrating. In the end, though, you'll wonder why you waited so long to go paperless.

A little more than half (53.9%) of the 141 ASCs Outpatient Surgery Magazine surveyed have at least partly implemented an EMR. Of the 92 hospitals polled, 86.9% have started down the paperless trail. At my ophthalmic surgical center, we're somewhere in the middle of it all.

Where are we now?

Hospitals now have to use certified EMR technology or face losing out on Medicare and Medicaid incentive payments related to achieving "meaningful use," according to a number of criteria. Being in a use-it-or-lose-it situation, hospitals are getting on the wagon — if they've not already — in force. A healthy 29.3% of hospitals are already at full implementation. Just over a third — 36.3% — say they're "almost there." The rest are just getting started (13.2%) or somewhere in the middle of the process (22%).

Of hospitals at full implementation, the data are telling: just 3.8% have had EMR for more than 10 years. The majority have been up running for less than a year (34.6%) or 1 to 4 years (38.5%), coinciding with the lead up to EMR requirements.

The 53.9% of ASCs that have or are implementing EMR are further along than their hospital counterparts, according to the survey. Nearly three-fourths are fully implemented (47.3%) or "almost there" (25.7%). Just 10.8% are "just getting started," and 16.2% say they're "somewhere in the middle of it all."

As for ASCs that don't yet have EMR, just 35.9% are shopping for a system, and the reason is quite simple: the lack of requirements (and corresponding financial incentives) for surgery centers. Overall, 45.2% of ASC respondents think such regulations and rewards will eventually come into play for their centers.

What Stage Are You at With Your EMR?

Source: Outpatient Surgery Magazine
Reader Survey, January 2013 (141 ASCs, 92 hospitals)

Ask what EMR can do for you
EMR was already in the works when I came on board at my ASC. In addition to the possibility of having to comply with CMS requirements down the road, we wanted to

• decrease the amount of storage space in medical records;
• be able to pull up any record, from any portal, in any of our 3 centers;
• be able to share information with outside parties such as insurance companies and the billing department;
• speed access to patient medical records, scans, diagnostic testing results, surgery information, medication history, allergy information, patient history and the like;
• not be allowed to omit information that might be omitted if documenting by hand;
• be able to point and click on different portals to hasten dictation and documentation, generation of discharge instructions and education materials, etc.;
• be able to quickly compile data for quality assurance and research, networking, analytic comparisons, and other statistical/benchmarking purposes;
• have a universal system for interchangeable information.

It's a long list, but the right EMR system will let you do all of the above, maybe more. Survey respondents report their systems integrate with scheduling software, patient pre-admission software, coding and billing software, other surgical facilities' EMRs, physician office software and health record software for patients.

You can also get integrated with pathology and medication administration software and, in the hospital, there's the ability to integrate inpatient, outpatient and surgical departments. On the integration wish list: patient monitors/vital signs monitors, sterilization records and a cloud-based system. So how do you make sure you get what you want?

WHAT THEY WISH THEY KNEW
Advice From Those Who've Gone Before You

• "Pay more attention to programs that can be shared. Often vendors imply [information from other programs] can be imported when, in reality, it doesn't work," says an administrator from the south. The lesson? Give vendors a list of your current software at the outset, and find out what will work (and what might need upgrading or replacing) before you move forward.
• "Not every [part of the patient record] has a template — you have to program a lot of these things yourself," says a DON from the south. The takeaway: Work with your vendor and IT expert to either develop the templates up front or to learn how to create them when you need them.
• "To do it right, you must be prepared to dedicate much of your life to the project," says Stephanie Diem, RN, BS, administrative director at Washington Square Endoscopy Center in Philadelphia. There's no way around this; just prepare yourself mentally for the undertaking.

Source: Outpatient Surgery Magazine Reader Survey, January 2013

Making the right decision
It's imperative that you shop around and not settle on the first system you see. Even if you end up with that one, it's not time wasted — it's confirmation you're doing the right thing. Your IT department or hired consultant (and you really should have one for a project like this) should have a strong sense of your wants and needs, and should provide input based on those.

Think expansion: Don't choose a system that limits you to your current activities. Someday, you might want to be able to attach surgical video to the electronic patient chart, for example. On the flipside, you want to be able to exclude portals that go in too many directions, making the system user-unfriendly, which usually results in staff not taking advantage of your EMR's good points. You should be able to use those portals if you need them in the future, but turn them off in the meantime.

Approach software demos with a critical eye. A system might look great during the demo, but won't do, in practice, what your facility actually needs. For example, one system might not be able to expand or populate information you want in the electronic record, another might come with too many features, ones that will slow down everyday use. Demos and their accompanying pitches have been fine-tuned and polished. It's the manufacturer's job to sell itself, and your job to be wary.

Finally, I wish I'd visited centers with the software already in place and being used for every procedure, every day. It'd be important to spend several days getting a view of how workflow differs — and doesn't — with full implementation. It's all the better if the end-user you sit down with is willing to share the cons with you, and how they got staff past them.

Advice for the long trudge
We've had a rough start, but are working out the kinks. We have a huge staff (130-plus) and trying to get everyone on board at the same time posed a problem. So we backed off and, instead of going live in all areas, have launched in one area of the center at a time. This not only lets each area become fully comfortable, but also lets IT provide its full attention to a smaller group of users, making the process more manageable.

For example, our front-desk personnel had to familiarize themselves with the demographic and insurance sections. They had to learn how to scan patient information into the EMR. They also have to remember to gather data such as patients' e-mail addresses. We gave them a refresher on HIPAA rules regarding use of this information; we use the e-mails only for appointment reminders and other official communication, such as follow-up discussion, with patients.

Patients like this, so long as you assure them their e-mail addresses won't be sold or used unethically, because it lets them share information quickly, which is important to them. For us, we're able to add the text of the e-mail to the patient chart, which is even better than a one-sentence summary of a phone follow-up.

Another big stumbling block has been the cost. You have to budget carefully once you find the system that best suits your needs. One survey respondent lamented "the total cost of hardware, software, upgrades/maintenance and training" was more than expected when it was finally toted up. Get vendors to quote all pricing — so you don't buy the hardware and find out it doesn't come with the software installed, or you get the software only to find out training costs extra.

The teaching itself is another area where we ran into trouble — some people just don't want to change. As a manager, I find it's important to stay in close contact with those who are using and to give recognition for a job well done. You'll get better growth and sense of ownership with a staff who are rewarded and appreciated on a job well done, than by leaving them in the cold, trying to meet unrealistic expectations. You should also have someone on the ground in each area to lead implementation, survey respondents noted.

"You need someone on staff who is computer-literate enough to work through small glitches and help take the mystery out of the little black boxes, especially for the less computer savvy," says Mark Poulson, RN, MBA, nurse manager at Northside Gastroenterology Endoscopy Center in Indianapolis.

What Does Your EMR Integrate With?

Source: Outpatient Surgery Magazine Reader Survey,
January 2013 (141 ASCs, 92 hospitals)

Embrace and enjoy
My philosophy is that "change is inevitable; growth is optional." When it comes to implementing EMR, you may as well choose to work with it. You might even grow to love it. But don't take my word for it.

"Though sometimes there are more steps to getting something done than what I like, it's more efficient," says Bonnie Smith, RN, CNOR, CPSN, nurse coordinator at Aaronson Plastic Surgery Center in Palm Springs, Calif., which has had EMR for more than 5 years. "There's no more hunting for charts. And we were running out of space for paper charts." The one thing she wishes she'd known about EMR? "How great it is."