3 lessons learned about adopting EMRs

When you adopt electronic medical records (EMRs), the biggest barrier will be resistance to change, said Melodee Moncrief, BSN, RN, CASC, administrator at Big Creek Surgery Center in Middleburg Heights, OH. Moncrief spoke on EMRs at this year's meeting of the Ambulatory Surgery Center (ASC) Association.

The lack of management commitment can mean death for your implementation plan, Moncrief said. "If you do not have management support — whether it be your management company, your management team, such as your administrator, your director of nursing, your BOM [business office manager] — if you don't have their support in the implementation of doing an EMR, don't waste your time," she said. "You absolutely have to be committed to the program, because it is change."

How should managers convey their commitment? Kenny Bozorgi, MD, CASC, chief operating officer, Magna Health Systems, Chicago, said, "It includes some personal communication from the highest level as to the importance of the project as well as education of staff on the potential benefits and goals of organization as to why conversion to electronic medical record is important to the organization," he said.

Consider these other lessons by Moncrief learned as she implemented EMRs at her new facility:

  • Lesson 1: Buy the equipment that you need.

Ensure you have a good hardware system, Moncrief said, "because the software is only going to work as good your hardware." At her system, their wireless system wasn't strong enough for their flowcharts, which created slow documentation, she said. "The hourglass just kept going around and around, and the nurses were getting very frustrated," Moncrief said. Boosters were added. "Now it works great, and it's fast," she reported.

Put enough tablets or carts (computers on wheels) for your facility and place them at the bedside so that caregivers have immediate access to the EMR, Moncrief said.

"My rule of thumb is one nurse for three patients equals one cart, approximately," she said. For a postoperative care unit [PACU] that's not handling a pediatric case, one nurse equals one cart, Moncrief said. "If you have nurses waiting in line to chart your patients, it's not going to work because then nurses get frustrated and they don't want to use it."

  • Lesson 2: There's no halfway approach.

Don't start with only part of record managed through an EMR, Moncrief advised.

"Do it 100%," she said. "There's no partial implementation because that gives people excuses not to use the system."

  • Lesson 3: Your staff need full concentration to learn the software.

If you center already is open, pay users overtime to train on weekends or evenings, "because you really need to be 100% focused on learning the EMR," Moncrief advises.

Don't have staff try to learn electronic documentation as they're caring for patients, she said. "You're going to miss something that's very important and, here again, you're going to give people an excuse not to use the system," Moncrief said.