I know I’ve written about ERP and EMR before, but the more I think about the EMR selection and implementation process, the more I see the same issues that are experienced with an ERP implementation.

The one issue that is a bit different about EMR versus ERP is that there are only a small handful of ERP vendors to choose from. However, we have 300-600 to choose from in the EMR world. That’s an important and challenging difference.

However, the similarities to ERP are many. One of the most striking is how the EMR like the ERP is something that’s going to be used and have an effect on the entire organization. As such, the need to manage the participation of multiple stakeholders is so key.

The key to a successful ERP implementation is to have a great project leader.  Someone who is great at working with various departments. They are great listeners who hear and understand each departments needs. Then, they have to be great at making the case for each depaartment’s needs.

The same is true for EMR. You need an EMR implementation champion who is great at listening to all areas of the clinic: nurses, doctors, front desk, billing, medical records, etc. Sometimes this can be done well by a physician lead, but is more likely to be a practice manager, IT support (if they have project management skills), or an outside consultant. 

It’s easy to underestimate the challenge of “herding sheep.” Done right, it can work very well. Done wrong and your clinic is likely going to have the opportunity to try again after the failed EMR implementation.

There are other comparisons worth considering, but this one was striking me today. I’ll be interested to hear stories and experiences from those who have implemented an EMR. Did you have a strong leader to help pacify the different stakeholders in your clinic? 

Much ink has been spilled discussing why physicians are resistant to adopting EMRs.

The thing is, it’s really no mystery.  Researchers have arrived at what seem like sensible answers to the question, including a) problems changing their work habits, b) fear of the unknown and c) struggles with kludgy interfaces.

So, why not take these problems on directly? While we can’t get inside clinicians’ heads and tell them how to think, we can address their issues concretely.

If the anecdotes I hear are accurate, many are pushed into EMR use and forced to do all the adapting, rather than getting the help they need.

So how can we help?

Obviously, physicians and other clinical staffers need access to accessible, intelligent training — ideally, both Web-based and live — as well as easy-to-use documentation that’s written in very simple language.

But that’s not all. While many institutions breeze by this step, IT departments (or consultants) should do everything they can to customize the EMR experience for individual clinicians. (If your EMR is too rigid to allow for this, that’s another story, but let’s pray you have one with some flexibility built in.)

It’s also important to pinpoint what other frustrations clinicians may have. For example, some doctors who type poorly are immensely frustrated by using EMRs, something keyboard-savvy techs might never consider.  A good old-fashioned typing course might work wonders in those cases.

In the rush to deal with the complex technical issues involved in EMR integration, it’s easy to blow by the needs of individual users.  It’s even easier to throw some fragmentary training at clinicians and assume they have a bad attitude if it doesn’t “take.”

The truth is, though, that nobody can afford to be short-sighted about getting users connected to EMRs.  Let’s hope everyone bears this in mind as the main wave of rollouts begins.

Today I have a special shirt made just for HIMSS, thanks to the great people at Enterprise Software Deployment.

If you see me at HIMSS, check out my shirt. It has the top 10 real reasons I’m at HIMSS listed on the back of the shirt. My favorite is #4 Booth babes. I’ll post the full top 10 later tonight.

Also, be sure to check out Enterprise Software Deployment at HIMSS if you need a great EMR consultant or if you’re looking for a position doing EMR consulting. You can find them at Booth #2777.

Here’s their HIMSS exhibitor description:
At ESD, our goal is to ensure successful implementation of a new EHR system or upgrade from start to finish in healthcare organizations around the globe. Our services include Clinical Transformation, Legacy System Support, Training, Supplemental Staff Augmentations, Clinical and System Transformation, as well as education and training in all aspects of Cerner®, Siemens®, Epic®, Eclipsys®, MEDITECH, and McKesson systems.

Thanks for ESD for sponsoring such a cool shirt for me.

Yesterday I was attending a conference that had almost nothing to do with EMR. However, in one of my conversations a young girl told me that her dad was a doctor. She went on to tell me how it is all that her dad can talk about her.  He was trying to convince himself why he should ignore the stimulus money and not do EMR.

Of course, this part isn’t that interesting since I think we all know many doctors who are doing something similar. What was very interesting was that the daughter of this doctor explained how she was trying to convince her dad why he should do EMR. In fact, she suggested that she might have read my EMR site before because she’d done searches to learn more about EMR so that she could convince her doctor father to use an EMR.

This discussion of why you should or shouldn’t use an EMR is really nothing new. My challenge with the discussion is that I’ve seen first hand the benefits of EMR. However, I’ve also heard many stories of EMR implementations which utterly failed.

I don’t know all the answers to this situation, but it is something I want to think about more.

I do think that selecting the right EMR is the first step in the process. The other challenge is finding the right person or people to support your implementation.   Now, how do we simplify and improve those two objectives?

A reader of EMR and HIPAA asked the following interesting question:

I was wondering if you had or heard of anyone coming up with a way to measure if the EHR implementation was successful. Other than “its in!”. Im trying to help some clients define this but cant seem to find anyone who has done this. Im thinking something like:
Were all staff trained prior to go live?
Were project goals achieved? etc

Here’s my response that I hope you’ll find useful as well:
It’s an interesting question. I’d suggest you download my free EMR Selection e-Book.

In the book, I cover the various areas where a practice can get benefit from implementing an EMR. I suggest that each practice evaluate which of the benefits they are looking to achieve with their EMR implementation. Then, it works out nicely that it’s the criteria you can use for selecting an EMR and also for measuring how successful the EMR implementation has been.

That’s how I’d approach measuring the success or failure of an EMR implementation. Of course, you could also add in any unforeseen events (good and bad) that happened during the EMR implementation too.

The real key is to establish a set of goals or expectations for what you want to get out of the EMR implementation so you have a way to evaluate the EMR software and the EMR implementation. Then, it’s good to actually look at this criteria after the implementation to see if you fell short of those goals and what you could do to actually achieve them.

Implementing an EMR is a living, breathing thing. The best EMR implementations are evolving and improving as you continue to roll out more features of an EMR or better utilize the existing features. Not to mention all the new features that an EMR vendor will roll out as they upgrade their software.

I’ve been thinking about the EMR consulting business model for a long time (check out my first post on EMR consulting back on October 27, 2006). My personal career path has taken me a different direction. I do some occasional consulting for people, but it’s not really my core business. Unfortunately, I don’t scale very well.

With that said, I think there’s definitely a business model for a company that does EMR consulting. In fact, today I learned that one of my advertisers and also an EMR consulting company, Enterprise Software Deployment, was ranked #561 out of the 5000 fastest growing companies in America (see press release).

That’s right. I guess EMR consulting is a good enough business that they can use an EMR consulting business to become one of the fast growing American companies. Plus, I agree with the press release that this next year we’re likely to see EMR consulting grow even more.

While I ABHOR EMR sales people who like to call themselves EMR consultants, I think there’s definitely a place in the EMR industry for qualified EMR consultants. In fact, check out this series of EMR consultant posts where I talk about the possible advantages of using an EMR consultant:
Benefits of Using an EMR/EHR Consultant – Selection Process
Benefits of Using an EMR/EHR Consultant – EMR Training
Benefits of Using an EMR/EHR Consultant – Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant – Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant – Improved Clinical Buy-in
NOTE: I wrote all these in early 2008. I don’t think too much has changed since then. Although, there are likely more EMR consultant opportunities.

This weekend I decided to look back at some random posts. Yes, call it my deep dive into the over 800 different EMR blog posts I’ve done on EMR and HIPAA. No sense in good quality posts not being seen.

Lies from Meaningful Use Consultants – Yes, the title is a bit sensational, but I was (and still am) aghast at the amount of misinformation (and lies) that are out there misleading the unsuspecting. Expect this to increase in 2011 as the EMR stimulus money starts rolling out. I’d love to post the first picture of someone getting their EMR stimulus check. Too bad it will be part of their Medicare reimbursement. Word of Caution: Be Careful with what you hear!

Converting Data from Old EMR to New EMR – I loved this email. The way he describes the difficult process of converting data from an old EMR to a new one is spot on. I expect in about 5 years, we’re going to have thousands of more stories like this one.

Plus, the comments on the cultural change of switching EMR software is beautiful to read also. This is something that Allscripts and Eclipsys EMR users are going to have to think about after Allscripts acquisition of Eclipsys.

EMR Backlog – I can’t believe I haven’t written about this for a while. It was such a hot topic back when I wrote this post in August of 2009. It’s still in the back of people’s minds. However, so far I haven’t seen any real major EMR backlog. Have you? We’ll see if that changes once the final Meaningful Use rule is out. Or maybe the checks need to start rolling in first. Either way, I’m not too worried. I think a backlog would be a good thing.

Kathleen Sebelius on The Daily Show with Jon Stewart – Just a little something to make you laugh. I should post more things like this. Maybe Saturday will become the Saturday Funnies. If you have healthcare or technology related jokes let me know on my Contact Us page. I’d love to publish them.

When I wrote my previous post about EMR consultant challenges, I thought it might be valuable to create a list of possible ways to do EMR consulting. This list is just off the top of my head, so please feel free to add other EMR consulting opportunities that exist out there in the comments:

EMR Selection – Consult on selecting the right EMR.
EMR Implementation – Consult on the best way to implement the EMR. Map EMR workflows to their existing paper workflows.
Meaningful Use – Consult a practice on how they can achieve meaningful use and get the EMR stimulus money.
EMR Vendors – Consult EMR vendors on their software, their marketing, etc.
IT Consulting – Consult practices on the right IT infrastructure to support an EMR in their practice.
EMR Review – Review an already implemented EMR and suggest ways that the implementation could be improved.
EMR Training – Train end users on a particular EMR. This often is similar to or included in EMR implementation consulting.
EMR Certification – Consult EMR vendors on preparing for and getting EHR certified (some are even still looking for help with CCHIT Certification).

Ok, what other types of EMR consulting are out there?

Everyone has been touting all the tremendous opportunities that are out there for EMR consultants and healthcare IT people. No doubt, there’s a lot of action right now around EMR. However, I’ve started to see many EMR consultants starting to wonder where the fountain of youthwork is that they heard was coming for EMR consultants.

EMR consultants face a really interesting challenge. The small clinics usually can’t afford the services of a consultant (or feel that they can’t) and the large clinics have their own in house resources and so their reticent to pay an outside EMR consultant to come into their practice. Where does that leave the EMR consultants that heard there’s this amazing need for help with EMR selection and implementation?

Not an easy problem to solve. Plus, there’s an even larger group of providers that still haven’t made the decision and committed the resources needed to implement an EMR. This means that the EMR consultant ends up having to not only sale their EMR consulting services, but also have to sale doctors on EMR.

This doesn’t mean that there aren’t a number of opportunities for people wanting to consult on EMR selection and implementation. It just means that EMR consultants are going to have to be really creative in how they find new customers.

From my experience, it’s going to be all about the relationships and trust that these consultants create with the doctors. As in most business, but particularly in healthcare relationships matter a lot.

Anybody have advice they can give these EMR consultants? It always amazes me how every job is basically a sales job. It’s just what you’re trying to “sale” that changes.

Note: Let’s also not confuse true EMR consultants with EMR salespeople dressed in consultant clothing.

I previously posted about the new head of CCHIT, Karen Bell. Most of you probably know that I’m not a huge fan of CCHIT, but I’ve decided that I’d like to give Dr. Bell some advice for CCHIT. Free consulting. How cool is that? Here we go…

If Dr. Bell really wants to solidify CCHIT’s position in the EHR world she’ll find a way to show that the CCHIT EHR certification improves usability, EMR implementation success, reimbursement, etc. CCHIT has some vague terminology about the “assurances” that CCHIT certification provide. Unfortunately, they end up being empty assurances about things that doctors don’t really value.

I’d be really impressed to see an independent study done on the EMR implementation success of CCHIT certified EHR versus non-certified EHR. Or how about a study comparing the usability of CCHIT certified EHR versus non-certified EHR. Let’s see some real data on assurances that doctors actually care about. Do that and everyone will want a CCHIT certified EHR.

Unfortunately, if you do go this route, you need to be open to the possibility that an independent study would find that CCHIT certified EHR have a higher EMR implementation failure rate or that CCHIT certified EHR are less usable. What would CCHIT do then (besides try to manipulate the study to look the way they want)?

What’s more unfortunate, is that studies like this should have been performed before Congress decided to just include the term “certified EHR” without actually knowing what consequence (good or bad) that term might have on the EHR industry.