Implementing an EMR in your practice requires a substantial investment of you and your staff's time, energy and money. You will need to evaluate your current environment and decide what you would like the EMR to help you achieve. This phase will get you ready to evaluate available solutions to find the one that will meet your needs.
After completing a workflow analysis and defining your clinical and business functions, it is time to begin the search for an EMR that meets the needs of the practice. OntarioMD has assembled a list of approved vendors. OntarioMD has tested their products and has verified that they meet specific required functional specifications. To qualify for funding, you must select one of these approved vendors.
Now that you have selected your EMR and vendor, you move on to the implementation. After signing the contract, there will likely be a wait of a few weeks before the start of the implementation. During this time, the vendor sets up your account, assigns and schedules resources, acquires equipment and so on. Similarly, you have work to do. You and your staff will be busy getting the practice ready for the implementation as well.
When the practice has adjusted to the new EMR routines, you can turn your attention to looking for ways to use it to improve patient care and health outcomes and to increase the productivity of your practice. However, it may take some time in order to get sufficient data into the EMR to really begin the process of achieving long term benefits. Also, ensuring that data is captured in a consistent way, and using consistent terminology or coding, is also very important.
OntarioMD has completed a detailed readiness assessment.
The practice has successfully selected an OntarioMD Funding Eligible EMR and signed a contract with the vendor.
The practice has completed the implementation and gone live with the new EMR.
The practice has established sufficient number of electronic medical records and is using the EMR for both clinical and practice management purposes.
OntarioMD has Practice Advisors(PAs) to help physicians and their staff through the entire EMR adoption process. Your PA will give you an initial orientation on the services available to you and provide answers to question and/or concerns you might have. You will also receive an overview of the process and milestones involved in successfully adopting an EMR. This orientation is an important first step in the preparation phase and will help you create your vision and set the goals for the EMR adoption.
Create a Vision
A vision is a statement of what you are trying to achieve in a global sense. What do you want your practice to look like once the EMR is implemented? What do you want improve with an EMR? Patient care? Billing? Patient reminders? Medication management? All of the above? Once you have set out your vision, ensure that everyone in the practice knows what it is and understands it.
Set Goals
Goals are numeric measures that you want to achieve as a result of the EMR implementation. In setting your goals, you may wish to focus on clinical care, office efficiency, responses to external organizations and overall productivity. Specifying the goals will assist in identifying the EMR that best matches your needs. Having goals also helps create and manage the expectations of staff and patients. Later on, the goals provide you with the baseline against which to assess the success of the EMR implementation.
Before planning for the future, it is important to understand how things work in the present and identify potential for improvements.
OntarioMD's On Site Readiness Assessment is a tool for reviewing your entire practice. By conducting this review, you will gain a better understanding of the state of your current operations, the problems to be resolved and the potential for improvements. The readiness assessment focuses on a number of components within the practice: knowledge readiness, technical readiness, operational readiness, functional readiness, resource readiness and internal readiness.
You may also want to look at your past experience with introducing changes to your practice. What did or did not work successfully in those situations? Those previous experiences may serve as a useful guide in formulating your approach to the EMR implementation. If you have existing organizational or procedural problems within your practice, it is better to address and resolve them prior to the EMR installation. EMR is not meant to resolve those types of issues.
Keep in mind the importance of good communications during the preparation phase. The project lead should ensure that all staff and physicians understand what is going on and what to expect. Peer Leaders can also help. They bring their experience from other implementations and, as such, they can provide valuable advice and guidance.
Records Management
Data conversion is a function of records management and an important consideration in any transition from paper to electronic records. The decision as to the amount and type of information to be converted is typically based on the size of the practice, the age of the files and the preferences of the physicians and staff. Some practices choose to convert just the most recent years of data. Others consider the EMR as "Volume 2" of the patient's chart and enter just the key information to begin the new volume.
Workflow Analysis
EMRs affect physician and staff workflow. Workflow covers such aspects as clinical processes, business processes and office operations. Different EMRs manage workflows differently. Some do it better than others particularly the ones that can be customized to match physician preferences. However, all EMRs are effective at reducing paper handling and streamlining processes by removing duplication and repetitive tasks. OntarioMD's Practice Workflow Tool is good tool for looking at the workflow within a practice. Understanding the workflow involves the whole team: physicians, nurses, office managers, and administrative staff. Inadequacies in the workflow should be corrected at this stage, before the EMR implementation. Failing to do so leads to delays, frustration and retraced steps later on. Some of the areas covered by a workflow analysis include:
Privacy and Security Considerations
The privacy and security obligations with an EMR are much the same as those for paper charts. Extra precautions, however, are needed for passwords, access to the system and security of sensitive material. OntarioMD's Privacy and Security Resource Guide and on-line tutorial will help you review your EMR privacy and security provisions.
Training requirements
It is recommended that you start to consider the training needs of the staff already at this stage. OntarioMD's Training Requirements Guide will help you with such a review.
After the completion of the current state assessment and identifying your needs, the next step is to create the adoption plan. OntarioMD has created the Practice EMR Adoption Plan to provide physicians with a checklist of various tasks and activities that should be completed and/or considered to prepare for the implementation of an EMR within a practice. It is critical to have a plan in place to ensure your practice is prepared for the transition by defining required activities, timelines, and assigned resources. It has been shown that having a proper plan in place will lead to a more successful implementation with a minimal loss in productivity.
Committed Leader
As mentioned earlier, having a clearly identified and committed physician lead is essential for a successful introduction of an EMR. This lead person serves as the project manager. The responsibilities include providing the business and clinical expertise, building consensus, communications and other activities required to keep the implementation of the EMR on track. Some practices hire an outside IT specialist on a contract basis to serve as the EMR project manager for the period of the implementation. OntarioMD has a roster of pre-qualified project managers that can be deployed in special situations. Factors influencing this decision include the size and complexity of the practice, the skill sets of the existing staff and the amount time that the existing staff has available to devote to the implementation process.
Governance Structure
It is important to consider the governance structure prior to starting the dialogue with potential EMR vendors. This is especially the case when a group of physicians plan to jointly acquire an EMR. A proper governance structure should clearly address the rights and obligations between the members of the group, with respect to the system and how they eventually will satisfy the terms of the agreement signed with the vendor
An EMR Funding Agreement is signed by the Applicant and by OntarioMD (following submission of a Funding Application and Readiness Assessment).
The Funding Agreement sets out milestones for the selection of an EMR (Vendor Contract Declaration) within six months and a Go-Live Declaration within ten months from signing the Funding Agreement.
For more information on EMR Adoption Program Terms and Conditions* Agreements, timing and grants outlined in this guide applies to physicians enrolled in the New EMR Adopter Funding Program (NA). For details on all other programs, please click here.
Why Have a Process?
Physician offices are bombarded by EMR marketing, sales and promotional material. As with any product, it is important to understand the process that aligns the/each practice's unique requirements with the EMR's functionality. Having a good understanding of these requirements and a preset process for selecting the right product will ultimately save time and money and will produce a better result in the end.
The solution is to create a set of selection criteria developed from the practice assessment and workflow analysis. OntarioMD provides a simple EMR Solution Selection Guide and Workbook that helps physicians to compare different EMR products against a select set of functions.
Creating a Selection Team
We recommend that you create a selection team to investigate, assess and select the EMR product. The team should consist of representatives from both the clinical and non-clinical staff. In smaller offices, the selection team could be comprised of everybody in the office.
The selection team should be intimately aware of the overall EMR vision, the numeric goals and the results of the needs analysis and workflow assessment. As well, the team should possess the business judgment to decide what features are nice-to-haves versus must-haves and the consequences of those decisions.
Types of EMR Service Models
There are two types of EMR service models, the Local Solution (LS) and the Application Service Provider (ASP) model. With the Local Solution, you own and manage the computer server. The server is physically located in a secure spot in your facility with the users accessing it locally, but they can also access remotely from home or another location. You are responsible for the maintenance of the server, software updates, disaster recovery and data security. With the ASP model, the server and all the software resides at the eHealth Ontario data centre. You own the data but not the server or the software. Everything that is outside of your facility is managed for you on a fee-for-service basis. eHealth Ontario looks after the servers disaster recovery, software updates, etc.
When you have completed the preparation work, you are ready to engage with the EMR vendors. Select two or three venders that come closest to meeting your needs and goals.
Vendor Demonstrations
Ask selected vendors to demonstrate their products using demo scripts that you have developed. These demonstrations allow you to see the EMR products in action and to ask specific questions about how they would fulfill your practice needs. Don't be shy! Be ready to ask the vendors as many questions as you see fit. The more information you have, the better you will be able to make an informed decision. Your OntarioMD Practice Advisor can suggest questions to ask and ways to get the most value from the time spent on vendor demonstrations.
Visit Existing Users and Check Vendor References
You can learn a lot from the experience of other practices that have already implemented the same EMR that you are considering. Ask them what they like and what they don't like about the product and vendor support. In addition, ask them about the terms and costs in their vendor contracts. Have them identify what they were able to negotiate and what they couldn't. The EMR vendor and/or your OntarioMD Practice Advisor can refer you to existing users whose practices are similar to your own.
Most vendors have a standard contract outlining the details of their product licensing arrangement. These contracts contain terms and conditions that are designed to protect the vendor. Review all standard contracts to ensure that they address issues that are important to you. Don't be afraid to negotiate terms and conditions or to add clauses. Be guided by what you learned on the site visits. You should also consider seeking advice from a lawyer, accountant and/or IT professional.
Vendor and Physician Checklist (Appendix A)
The Vendor and Physician Checklist (Appendix A) sets out in detail the many tasks to be completed in an EMR implementation. You and your vendor must agree on who is responsible for completing each task. The Vendor and Physician CHecklist (Appendix) forms part of the EMR Agreement between you and the Vendor. The Vendor and Physician Checklist is a requirement for obtaining the Readiness Grant set out in Milestone #2 and the monthly subsidies from the OntarioMD EMR funding process.
Vendor and Physician Checklist(Appendix A)
Training Requirements
The better your training, the smoother and faster your start-up. Consequently, training is an important aspect to specify in the contract. Include such aspects as the level, amount and type of training to be provided, specific staff members to be trained and the training schedule. From an implementation perspective, all staff members need to receive some level of training and the more, the better. Only requesting a minimum of training could perhaps save you a bit of money at the start, but you are running the risk of experience post-implementation problems and additional costs later on. Please review OntarioMD's Training Requirements Guide for assistance on training needs of your staff.
Physician Training Requirements Guide
The Contract
The contract that you sign with the vendor is a legally binding document; therefore, be sure to understand the meaning of each term and negotiate hard. As mentioned before, EMR vendors typically begin the negotiations with their standard agreement and then allow some flexibility. When all points have been settled, take the time that you need to review the final document. Don't feel pressured to sign it right away. Check with your lawyer and Practice Advisor. The Ontario Medical Association also provides legal advice to its members.
The Applicant is expected to select a Funding Eligible EMR and sign a contract with an EMR vendor within six months of signing the EMR Funding Agreement.
Once the Applicant submits a Vendor Contract Declaration accompanied by the Mandatory EMR Funding Eligibility Schedule and the Vendor and Physician Checklist (Appendix A) to OntarioMD, upon approval, the one-time Readiness Grant is paid to the Applicant.
For more information on OntarioMD certified EMR vendors* Agreements, timing and grants outlined in this guide applies to physicians enrolled in the New EMR Adopter Funding Program (NA). For details on all other programs, please click here.
The Applicant is expected to select a Funding Eligible EMR and sign a contract with an EMR vendor within six months of signing the EMR Funding Agreement.
Once the Applicant submits a Vendor Contract Declaration accompanied by Mandatory EMR Funding Eligibility Schedule and the Vendor and Physician Checklist (Appendix A) to OntarioMD, upon approval, the one-time Readiness Grant is paid to the Applicant.
For more information on OntarioMD certified EMR vendors* Agreements, timing and grants outlined in this guide applies to physicians enrolled in the New EMR Adopter Funding Program (NA). For details on all other programs, please click here.
The Readiness Grant for new EMR adopters is: $3,500.
For more information on the EMR Adoption Funding Program* Agreements, timing and grants outlined in this guide applies to physicians enrolled in the New EMR Adopter Funding Program (NA). For details on all other programs, please click here.
The vendor shoulders the primary load for the implementation, but responsibility for several tasks remains with the practice itself. These tasks always seem to take longer than anticipated. So, too, does the training. In order to free up the necessary time, many practices cut back on the number of patient visits during some or all of the implementation period. Some practices schedule the implementation to occur during seasonally slow periods of the year
The practice will be responsible for customizing and personalizing the various data input templates to match the style of the practice. Data conversion is a big task as is the preparation of key documents.
If your office isn't already wired for computers, then there will be a certain amount of disruption as the installers put in the cabling. In addition, to facilitate communications with people outside the practice, you will need to set up an account with an internet service provider and create e-mail addresses for each of your staff. You may also require some changes to your office layout and furniture to accommodate the new equipment.
Once everything has been connected and tested, it is time to Go-Live. As part of your implementation project plan, you would have made certain decisions on the Go-Live process. Did you decide, for example, to go paperless overnight? Alternatively, did you opt for a more staged approach, perhaps one where you continue to use the paper files for historical records but you add no new paper? Whatever your plan may be, the transition to EMR takes some time. Make sure that your goals are realistic.
Most practices have opted for a phased approach for the changeover. For example, they will start with lab tests and, then slowly add in patient education and information sheets. This type of phased approach is less risky for the practice and less stressful for the staff and physicians. Due to the "newness" of the EMR, even some formerly simple tasks may take a little longer until new work habits get ingrained. It takes time to absorb the training and to apply it to the more complex tasks. Therefore, expect some loss of productivity in the early phases of implementation. Be patient and give yourself and others time to adjust to the EMR and to the changes in workflow.
Soon after the implementation (e.g. within the first few days or week), take the time to assess the experience. The goal is to identify what is working well and what needs to be improved. Make a list of items that need attention, assign responsibility for resolving each item (e.g. practice staff, vendor, third party suppliers) and set the target completion date. Some practices hold formal staff meetings for that purpose. Others may simply have staff huddles in the morning before the patients arrive. Either way, good communication is critical. Keep everybody well informed. If problems arise, let the staff know. Tell them what will be done and when. If you don't know, tell them that, too. Good communications goes a long way in setting realistic expectations and reducing frustrations.
Shortly after the Go-Live, your Practice Advisor will help you conduct an Implementation Acceptance Test (IAT) to verify that all tasks set out in the Vendor and Physician Checklist (Appendix A) have been completed as planned.
Within ten months of signing the EMR Funding Agreement, the Applicant needs to undergo acceptance testing (per practice location) of the EMR and start to use it.
The Applicant needs to submit a Go-Live Declaration for each Participating Physician. OntarioMD will work with the applicant to complete the Implementation Acceptance Testing (IAT) Review. Upon approval, OntarioMD will start the 36 monthly subsidies.
* Agreements, timing and grants outlined in this guide applies to physicians enrolled in the New EMR Adopter Funding Program (NA). For details on all other programs, please click here.
Within ten months of signing the EMR Funding Agreement, the Applicant needs to undergo acceptance testing (per practice location) of the EMR and start to use it.
The Applicant needs to submit a Go-Live Declaration for each Participating Physician. OntarioMD will work with the applicant to complete the Implementation Acceptance Testing (IAT) Review. Upon approval, OntarioMD will start the 36 monthly subsidies.
* Agreements, timing and grants outlined in this guide applies to physicians enrolled in the New EMR Adopter Funding Program (NA). For details on all other programs, please click here.
Monthly subsidy represent a total funding of $27,100 or $29,800 depending on choice of Local EMR or Application Service Provider (ASP) option.
The monthly subsidy is $600 for Local EMR products and $675 for Application Service Provider (ASP) EMR products.
For more information on New EMR Adopter Funding Program Terms & Conditions* Agreements, timing and grants outlined in this guide applies to physicians enrolled in the New EMR Adopter Funding Program (NA). For details on all other programs, please click here.
As you begin to use the EMR more and more in your day to day encounters with patients, you may reach a "plateau" in using the functionality within the EMR. It will be important at this stage to begin to understand and to further maximize the functionality within the EMR to really drive benefits to patients and your practice. This "maturing" of the use of the EMR will assist in you in realizing the goals that you set earlier in the EMR planning process.
By regularly assessing your practice's "maturity" level you will be able to identify areas for further quality improvements and to create action plans to address them. This is an iterative process that should be undertaken at regular intervals.
Advanced use of the EMR allows you to realize benefits to patients as well as efficiencies in their practices. Some examples of improvement would be ease of managing drug recalls , checking drug interactions , chronic disease management and preventive care. EMRs can significantly assist in chronic disease management and preventive care, especially in patients with one or more chronic disease conditions. Many EMRs provide specific chronic disease templates, flow sheets, reminders and patient education materials, in order to assist in chronic disease management. Many EMRs allow you to group patients with the same chronic disease conditions in order to plan for particular "campaigns" and/or to undertake mail outs. By improving care to individuals and groups of patients this way also allows for improvements in funding revenues related to improved patient care.
Some questions to ask at this point:
Advanced use of the EMR provides additional data management/query capabilities to predict trends and in managing and reporting from a population health perspective. This is an evolving area with EMRs and will become even more important in measuring health outcomes in the future.
Within 12 months of the Go-Live Declaration milestone, the physician can submit a Performance Recognition Declaration and EMR User Survey to OntarioMD for the one-time Performance Grant.
This requires that each Participating Physician has established electronic medical records for 600 or two-thirds of his or her rostered or active patients, whichever is less.
You can find the EMR user survey here.
* Agreements, timing and grants outlined in this guide applies to physicians enrolled in the New EMR Adopter Funding Program (NA). For details on all other programs, please click here.
Within 12 months of the Go-Live Declaration milestone, the physician can submit a Performance Recognition Declaration and EMR User Survey to OntarioMD for the one-time Performance Grant.
This requires that each participating Physician has established electronic medical records for 600 or two-thirds of his or her rostered or active patients, whichever is less.
You can find the EMR user survey here.
* Agreements, timing and grants outlined in this guide applies to physicians enrolled in the New EMR Adopter Funding Program (NA). For details on all other programs, please click here.
The Performance Grant for new EMR adopters is: $2,000.
For more information on the EMR Adoption Funding Program* Agreements, timing and grants outlined in this guide applies to physicians enrolled in the New EMR Adopter Funding Program (NA). For details on all other programs, please click here.
Data Migration
Data Migration is the process of transferring data between computer systems, such as Electronic Medical Records (EMRs). You may need to do so if you are switching from one EMR to another EMR or if you are migrating data from a custom application to an EMR.
Data migration will reduce the need to enter data manually. However, for data migration to be successful, proper time and effort must be allocated for planning, preparation and for the data transfer itself.
OntarioMD has created the Data Migration Guide to provide physicians with guidelines and a checklist of important tasks to be considered when preparing for data migration.