1. Sell it and make it work.
The biggest barrier to transitioning to EMRs is resistance to change from the staff and physicians. "You have to get them excited about it," says Melodee Moncrief, RN, BSN, administrator of the Big Creek Surgery Center in Middleburg Heights, Ohio. Look for allies to help you champion the system and its benefits. Nurses who have worked at hospitals may have EMR experience and can help you spread the word and calm the fear of the older nurses. Find a tech-savvy physician to help convince his colleagues that the transition, and the cost of the system, will pay off sooner rather than later.

2. Train EMR gurus.
Appoint a few people to become masters of the system. These EMR gurus will be invaluable during the first weeks of the transition. Station a guru at each computer terminal the first day of using the EMR system. Once the system is up and running, the gurus can answer questions, help troubleshoot the system, report problems to tech support and train new employees. "You'll need a perpetual training system," says Melody Mena, RN, CNOR, managing director of surgical services for Southern Regional Health System and the Surgery Center at Mt. Zion in Clayton County, Ga. At her facility, which switched to EMRs in 2006, supervisors can train a new employee and create a profile and password in as little as 20 minutes.

3. Don't start soft.
When you make the switch, go all out. If possible, eliminate the use of all paper, including information supplied by the patient upon arrival at the facility. This will save time and eliminate information redundancy. With as little paper as possible, you're less likely to have incomplete records, says Ms. Moncrief.

At the Rush Surgicenter in Chicago, the pre-op rooms have laminated printouts of consent forms that patients sign on an electronic tablet. The laminated forms are usually easier for older patients to read, says Barbara Ramsey, RN, MSN, CASC, administrator of the center.

Any paper documents generated during the procedure are scanned and attached to the EMR at the end of each day in the medical records department. Once the case is complete and closed, usually within 30 days of the procedure, the paper documents are shredded, says Ms. Ramsey.

4. Watch how your database grows.
Don't let information get lost in the changeover. Make sure that your EMR system captures all the information that you previously gathered on paper. Work with your EMR system vendor to make sure that you have templates to replace all the paper forms and that the templates have all the necessary fields to enter the information.

Once the system is live, watch the database to see if the proper CPT codes are in the system and in the right place. In the first few weeks, you'll need to do this every evening, says Jan Claybrook, RN, CNOR, CASC, administrative director of the Surgery Center of Lynchburg, Va.

5. Help the physicians, but hold your ground.
Have as many physicians on your side as possible. Let them know that the switch to EMRs is inevitable and will take place on the agreed upon date, says Ms. Mena, who worked with the board of directors at her facility to get the word out about the change.

Don't organize a training session for physicians because most of them won't show up, says Ms. Mena. Teach them one-by-one. Most physicians have Palms, Blackberries or some sort of smart phone, so they won't have too many problems latching on to the concept. It's important to explain, and later show, how easy the system is to use. "If they can use an ATM, they can use our system," says Ms. Mena.

6. The trouble with anesthesia.
Because they often work in several different facilities, anesthesia providers may be less committed to changeover than your staff or physicians of other specialties. Ms. Mena had a handful of challenges from anesthesia providers who were opposed to going paperless and dragged their feet in creating the necessary anesthesia templates for the EMR system. Just before the start date, Ms. Mena cornered one of the partners of the anesthesia group while he was doing a hospital shift and worked with him to create the anesthesia template. Then on the day the system was to go live, the anesthesia providers refused to go paperless and tried to pry open the drawer where the paper anesthesia forms were locked up. In spite of threats to have her fired, Ms. Mena held her ground and anesthesia went paperless. The anesthesia providers are now onboard with the change.

7. Take training seriously.
Allow your staff enough time to get proper training on the system. Don't try and squeeze training into a regular work day because you won't get your staff's full attention. Hold training sessions after work or on the weekends and pay the employees for their time. Do all the training modules and simulations. "If your staff is properly trained, then they're going to accept it," says Ms. Moncrief.

8. Create a backup and maintenance routine.
Take data storage and security seriously. Follow your vendor's instructions for backup and do it assiduously. At the Surgery Center of Lynchburg, data is backed up daily on a tape drive. The next morning, the tape is taken to a safety deposit box at a local bank, says Ms. Claybrook. Daily off-site backup is essential, says Ms. Mena, who paid extra to have a backup server that creates a mirror image of the system. "If the building burns down, you lose only a day."

Because of the nature of computers, plan on spending time and money on continued maintenance of your EMR system, even for a small practice. Have a good relationship with an IT expert, either on-site or through a consulting firm, says Linda Vu, MD, DABO, FRCSC, an ophthalmologist in Monterrey Park, Calif. Dr. Vu's EMR system, with 10 workstations, requires about 10 hours a week of tweaking.

9. Buy enough equipment.
Don't skimp on equipment. The computer terminals where the data are entered can quickly become the bottleneck in the process. At the Surgery Center at Mt. Zion, Ms. Mena purchased one laptop with a touchscreen for each user, which translates to 22 laptops for four operating rooms. Ms. Moncrief calculates one computer cart per three patients (or for each nurse) or a tablet for each bed.

10. Lock up the paper, but don't throw it out.
Once you get settled, you'll notice savings of time and money. At the Surgery Center at Mt. Zion, going paperless halved the workload in the office and reduced the cost of office supplies from $10 per patient to $4 per patient. But keep paper forms for emergencies. If the computer system does go down, you'll notice how long it took to record everything by hand. Your staff and physicians won't know how they ever got anything done without EMRs.

Why wait until 2014?
The federal government has called for electronic health records to be available to all patients by 2014, and most surgical facilities aren't ready. Only 18 percent of ASCs have an EMR system in place, according to a survey published in April by Wolters Kluwer Health. Ready or not, you should at least be thinking about transitioning to EMRs.

Ms. Claybrook spent six years tracking the evolution of various options until she finally purchased an EMR system that she felt was suited for her multi-specialty center. When the system went live in October 2007, her work wasn't over. "For the first couple of months, that's all you think about," says Ms. Claybrook.