Clinics across Arkansas are still wrestling with the question of when and how to adopt an electronic medical records system. According to the Arkansas Medical Society's director of practice management as well as staff members with two of the state's larger systems, buy-in, support and training are critical to making EMR work – and even then, it's going to be difficult.

 

According to the AMS's Billie Jean Davenport, most in the medical profession realize that the train is on the electronic medical records tracks and that they eventually will have to buy a ticket.

 

But at first it will be a costly ride involving a three- to six-month transition period when they won't be able to manage their usual caseload. "I've had practices say that their productivity was decreased by 50 percent while they were implementing," she said.

 

The NEA Clinic in Jonesboro and Medical Associates of Northwest Arkansas (MANA) have both been rolling out electronic medical records in their multi-site systems for about five years, and they agree that it's been a difficult but worthwhile endeavor. According to Denise Boles, NEA's director of specialty operations, doctors in the system are better able to document care and coordinate with each other, and because it is part of a joint venture with NEA Baptist Memorial Hospital, doctors in emergency rooms have instant access to patient records. John Jordin, MANA's chief operating officer, cited the increased space available when paper records are destroyed, better flow of information, and reduced chances of medical error. "I think once (doctors) get up and get on it and have been on it a while, then they say there's no way they'd want to go back," he said.

 

Despite those advantages, it's not surprising that the medical profession has been one of the last to go digital. Established offices carry rooms full of paper records, many dating back decades. Meanwhile, doctors accustomed to their charts and to projecting an air of confidence must learn entirely new ways of interacting with patients – and they must learn to operate unfamiliar digital equipment that can make them look less than competent. For some, it can seem too much to tackle. "Doctors just want to treat patients and practice medicine," Davenport said. "They'd really rather not worry about the logistics of it."

 

Given those realities, it's critical that any office switching to electronic medical records obtain buy-in from all the staff, which wasn't a problem at the NEA Clinic. Boles said the decision to go digital five years ago was necessitated when staff realized their dictation methods were not HIPPA- compliant, so the clinic began an incremental rollout that started with recorders and handheld tablets that physicians carried into each office. But even without that issue, doctors there knew that they would have to adopt electronic medical records eventually. "I don't think it was a hard decision for the group as a whole because we knew where the future was leading with regard to an electronic health record and knew that we wanted to be on the front end of that rather than on the back end of it," she said.

 

Davenport said that when adopting an electronic medical record system, clinics should think about their goals for the software, what their return on investment will be, and whether they will need to reassign tasks to employees or simply add IT staff. They should ask how their current work flow is set up from the time the patient walks through the door to the time he or she leaves, and then seek to mimic that with the electronic medical records system as best they can.

 

Selecting the software vendor can be daunting, and providers must do their homework before making a purchase. Davenport estimated that there are 60-65 reputable companies, but others have sprung up that provide inferior products. Providers should make sure their purchase includes thorough training and support and doesn't come with hidden costs. Additionally, they should make sure that it complies with regulations to take advantage of upcoming government incentives.

 

The best technology in the world won't be much help – and can even be a hindrance – if users don't know how to take advantage of it, so extensive training of physicians and midlevel providers is critical to making the system work for everyone. Boles said that the clinic found that while information technology staff members were great at managing the system, they weren't always able to communicate that knowledge in a way that applied to a clinical setting, so the clinic created a clinical EMR specialist, a nurse, who trains new providers.

 

No matter how much training is provided, physicians will fumble with the new technology, often in front of patients, so available hands-on support is critical to making the system work. In addition to its information technology staff, the NEA Clinic trained an existing staff member at each site to be a "super-user" who can solve problems on the ground. Candidates for the job were selected by clinic managers and then given incentives to get certified. When super-users can't solve the problem, the IT department can remotely communicate with computers to address issues.

 

According to Jordin, it's hard to say which physicians will do well and which will struggle, though generally the youngest, who have grown up tech-savvy and probably worked with the technology during their hospital residencies, do best. Older physicians tend to do better than might be expected. The ones who struggle most are those ages 45-60, perhaps because they are in the peak years of their practice.

 

As for the records themselves, the NEA Clinic has disposed of paper records by scanning them in as patients presented and then shredding the documents. The key, Boles said, is to index the system very carefully so records can be found rather than simply dumping them into an archive.