Implementation Mistakes

Advice for the AAO-HNS OTO-EXPO, Implementing EMR into an ENT office

I am very smart. I know it all. I am young, brilliant, and able to multitask. My only shortcoming is that I can’t walk on water. Training…I can pick it up on the fly.

A couple of weeks ago I attended the AllMeds User Conference. This happens every two years and gives the offices a chance to share their wide range of emotions, thoughts, and experiences. If you are an AllMeds User, you should go at least once. William Rust, the CEO, and Sherry Hunt, the COO, along with all the people at AllMeds make sure that the event is fun and educational.

Sitting in on the specialty discussion session for ENT, I was reminded of our deployment and the next several years of hell. The opening comment on this blog summarizes the thought processes of an amalgamation of individuals. If you think the opening comments were about you, Carly Simon, may have pegged you right. Some other thought processes that I sensed at the conference:

Why should I know how to do it? I’ve been here forever. My people should know it and take care of it for me. I’ll just modify what I have always done a little.

Hire more people? Not on my watch. Heck we just spent $50,000 on computers and software not including the $20,000 on the IT guy’s labor. The doctors are going to learn how to use this “thing” or we will throw it out.

In 2004 we launched our EMR. At that time we just became a 4 man ENT group. The week that we had the training, one partner was overseas, I was on call, and two partners sat through the complete training. Our staff was new to computers. We had only 1 dust covered OLD pc running Windows 95. The rest of the computers were the green screen dummy terminals from the mid 1980’s provided by the billing company. I remember one of our employees not knowing how to use a mouse.

AllMeds sent their top trainer, Lucy Stephenson (now a VP), and she laid down the laws. I subsequently broke them all (and suffered). She went over what it takes to make an implementation successful and how to reap the full benefits of an EMR. It takes some time to learn, a commitment to change daily processes, and the right people. She introduced the concept of an HIA or health information assistant. In the EMR world there is a great debate over HIAs. I know several EMR vendors who hate to mention the role of HIAs. I know of practices that REFUSE to hire HIAs and are somehow willing to live a miserable existence. If you have an EMR vendor tell you their product is SO WONDERFUL that it does not need an HIA, RUN AWAY. Nothing turns off patients more than a doctor working on a computer screen like someone working behind a fast food restaurant counter. So your ear is draining, would you like fries with that?

I digress. Lucy’s comments about HIAs did not sit well with me or anyone else for that matter. My partners and I did without HIAs for 3 painful, excruciating, gut wrenching, and family wrecking years. Each person found a solution for themselves…often antithetical to EMRs.

ENT Physicians Inc. is a medium sized practice by national standards. But when we started we were small. Regardless of how big or small, we suffered with labor. Finding, hiring, retaining, and managing employees gets harder every year. Even in a bad economy, finding the right workers is not easy. Between 2004 and 2009, we had less than full staffing 70% of the time. Pre EMR days we could hire temps to fill in. Now with EMRs it takes 3 months to get a new employee to speed.

My patient care coordinator, Amy is a young fertile lady. She and I started 3 new practice locations in a span of 3 years all the while, she kept having babies and had to take time off. I ended up working longer hours and saw my personal time spent clicking on keys. Unlike some, I can’t see patients and do paper/computer work simultaneously. I find it rude to patients to be scribbling or working on a computer when they are sharing their problems. I finally figured out how to use express documents and leverage the full power of the EMR. But after all that, I was still spending more time with the computer than with my wife and kids. I went to the AllMeds conference in 2007 to pick up tricks and tips. Karen Zupko talked about the difficulties of the labor market and something stuck in the back of my head. I had a sense that my labor pains were shared in many ways.

I remember the day that Amy got sick at work. This was just before the AllMeds conference. I jokingly said are you pregnant again. A few weeks after the conference, she came to my office terrified that she may have to stop working because..she was pregnant AGAIN! Having invested so many years into her and also because my life was still a hell, I sat down and worked through what my problems were. Our office had never developed a pool of HIAs, health information assistants. For reasons beyond my understanding my partners have no interest in HIAs and would rather live with lower productivity and income. So building a HIA pool would be cost prohibitive if I was the only one using the service. Amy wanted to work but we were unsure of her availability. My former patient care coordinator, Dawn, had been transitioned to managing the Allergy patients. We were going to have her fill in on days that Amy was out. But that fell through when Dawn’s husband got a job in Tennessee. Both Amy and Dawn needed at least part-time work, but could not physically be in the office.

For the next several months I was racing the clock, Amy’s biological clock. Since most HIA’s are women, we needed a solution that created flexibility and mobility. My evenings and weekends were devoted to solving Amy’s, Dawn’s, and my problems. I realized that I had to get real time encrypted work/data to Amy and Dawn regardless of where they were. The closest thing was telemedicine. But in this case, the patient and doctor were not separated. I hired a team of engineers and business processing specialists to help me design a patent pending system to get Amy and Dawn into my examination rooms. By the time Amy delivered her child, we had built our system. Amy and Dawn were among the first of my HIA’s who I call Angels.

Over 3 years after Lucy spoke about implementation and HIAs, I finally got it right. It cost a fortune in time and treasure. But in the process we created the first virtual HIAs, aka Angels. Our challenges have resulted in an opportunity for medical offices throughout the USA to share a common labor pool broken down by specialty and EMRs. ENT offices, and now other specialty offices around the country are joining in to help build nationally standardized virtual labor pools that we call Physicians Angels.

More on this on the next blog.

ENT EMR CCHIT, The skinny on Otolaryngology Software

EMR, electronic medical records, have been a constant at the American Academy of Otolaryngology Annual Meetings since I was a resident. The AAO-HNS has an OTO-Expo (its trade show) at the annual meetings. The OTO-EXPO has seen the number of EMR vendors start with just 1 vendor and climb up to, I believe, a peak of 13. AllMeds EMR has held the consistency spot being there every year for the last decade. NextGen, AllScripts, Greenway, MiSys, and a few others have joined the scene.

AllMeds, Greenway, and Misys have progressed from being small startups to now being sponsors of major events. The AOA, Association of Otolaryngology Administrators, now lists AllMeds as a platinum sponsor, Greenway as a gold sponsor, and Misys as a silver sponsor. The AOA and the AAO-HNSF do not endorse one EMR over the other.

The AAO-HNS has multiple lectures and seminars on practice management systems and electronic medical records. Dr. Tom Upchurch, an otolaryngologist and co-founder of AllMeds, has been a perennial speaker at these events. To his credit, he has maintained his objectivity during these presentations. The first time I heard him talk about EMRs, I realized the pain that we would all be going through. Tom is a visionary and is a mentor to me. He has an interest in what we are trying to build out.

I expect the crowd at AAO-HNS conference in San Diego scheduled for Oct 4 through Oct 7 to be bigger than ever despite the economy. With the stimulus package encouraging IT expenditures, ENTs who have been sitting on the fence will come out in force. Having recently listened to Karen Zupko at a conference extolling the potential government money to be had, and watching the fall in PC prices, the return on investment is so much faster than when we bought ours.

Karen Zupko and her firm Karen Zupko & Associates, KZA for short, have presented at the last several AllMeds user conferences. At each conference she has shown the improving rates of return with EMRs. When she first started advising ENT surgeons, the software choices for Otolaryngologists were minimal. Now there is a plethora and the gaps between them are closing. But every single one of them still has the same problem….the people at small offices like yours and mine who have to run them.

So which EMR did we choose and how did we pick it? We started our review of EMRs in 2002. Having looked over AllMeds, Greenway, Misys, and a dozen others, we picked AllMeds. At that time, AllMeds had the greatest number of ENT users. If I am biased towards AllMeds, it would be out of familiarity. I would love to be able to have all the EMRs available to me on a regular basis to test them out and try them. I called all the software providers to see if they would be willing to provide a fully functioning product for me to keep on our test servers. Only AllMeds, GE, and AllScripts called back. AllMeds was kind enough to give me a second software package to put on teaching/training servers. GE will participate in the Fall. All you other EMR Companies….still waiting for the software to test.

What makes comparisons between EMRs frustrating is that testing is not done in the same fashion that cars are tested. It is easier to spend $50,000 on a luxury vehicle than on an EMR. Test-driving it at a convention floor or even in your own office for 15 minutes does not really tell you how it would work in your daily grind. AllMeds has made it easy for me to let you do a test drive. Contact me and we can make this happen.

Say CCHIT three times fast. As acronyms go, this does not bode well when trying to make a sale. In the early days, EMR users did see sh*t. The software was not robust or interoperable and the hardware was expensive. CCHIT stands for: Certification Commission for Healthcare Information Technology. CCHIT has been a blessing and curse to the EMR world. It has forced EMR vendors to improve aspects of their software, but also raised some onerous demands. CCHIT inhibits and promotes natural selection of EMR companies. If you are an EMR designer with a very novel approach, you may find yourself running up against a wall of standardization. But overall, the goal of CCHIT is to provide buyers/users some degree of security and interoperability. The CCHIT website goes into detail and has volunteering opportunities.

Email me about your EMR purchasing decisions and if you have changed your EMR. AllMeds claims to have a 94% retention rate. We are in our fifth year of using their software. AllMeds nor their competitors have given us reason to change. So I need to hear from those of you with different systems. While this blog is directed toward the ENT community at large, I welcome feedback from doctors of all stripes. Please include any industry affiliations. Lets get the skinny on EMR for otolaryngologists.