EHR implementation advice and lessons

The day had finally arrived: September 14, 2010. As I left for work that morning, I told my wife not to expect me for dinner-maybe not even for breakfast the next morning. Who knew what the day would bring? I shut the car door behind me, took a deep breath, and headed for the back entrance of my family practice office.

It was "go-live" day for our electronic health records (EHR) system.

As the largest outpatient practice in our hospital system, we would be the last to take the plunge into the digital age. Not that we wanted to be. We had volunteered to be one of the first practices to go live. But with our 18 providers, the information technology department did not believe it could sail our ship too early. Now, years later, having watched all our sister practices settle in with the new system, having endured multiple launch delays for reasons we didn't completely understand, having experienced what a 41-week pregnant woman must feel, our time finally had come.

IT CAN BE GOOD NOT TO BE FIRST

Turns out, though, that letting the other practices work out the bugs and make the mistakes ahead of us clearly was to our advantage. While we waited, our charts were abstracted. Our plans were laid. Our staff was trained. Our computers were installed. Our stomachs were ulcerated.

When September 14 came, we were ready. Well, as ready as any practice can be with an electronic Category 5 hurricane knocking at your door.

As I marched into the office that morning, I realized why I had to park nearly across town: the Great Invasion had occurred. I now was in occupied territory. A highly trained strike team, probably 30 strong, had descended on our office. It consisted of EHR support staff from the "mother ship," the main hospital.

Stationed at every computer screen, these part-field generals, part-scouts, part-translators, part-grief counselors, part-punching bags stood ready. There was no turning back now.

We didn't just add an EHR system to our family practice; the system created major change in every department and at every level unlike anything that had come before. Processes and approaches to patient care, phone calls, scheduling, lab results, interoffice communication-you name it-had to be retooled.

Posters with dazzlingly complex workflows were constructed with enough arrows and boxes to make any football coach smile. The weight of this metamorphosis had an interesting effect on our staff: older nurses retired in a steady stream in the months before our EHR launch, senior physicians contacted their financial planners to double-check their retirement dates, and those of us in the middle hoped our years playing Tetris would pay off.