INTRODUCTION

The decision to move from paper-based medical records and complex workflow management to an integrated HIS/ophthalmology EMR is a prudent transition to benefit from the advantages it offers, making hay when the high-tech sun shines. While implementing an integrated HIS/EMR solution results in more efficient workflow, a decrease in number of staff who create, index, file, and retrieve manual patient records, and a decrease in time spent to complete clinical tasks such as referrals, lab, and diagnostic orders, the process of implementation might prove to be a sticky wicket without adequate preparation and owning responsibility on your part. It is essential to define clear vendor selection criteria, and have a proper EMR and vendor assessment process to avoid being bogged down in the implementation quagmire.

EMR IS NOT JUST AN EMR TODAY

In the present times all health care providers have undergone practice methodology changes and administrative and management changes as well. This is the age of transformation in many respects.

• The earlier model of home-visiting family doctor has given way to single-physician and general practice or single-specialty clinics. Then the practices were mostly owner driven, with multiple visiting physicians. Hence paper-based patient record keeping helped the owner to have the overall knowledge and control of the hospital management.
• Gradually, multi-specialty hospitals came into existence and grew in number. Their administration was run not by a single owner but by a group of young professional business managers who kept abreast of latest technology developments. These managers brought in EMR for better process management and patient care, informed decision-making, and enhanced revenues.
• Now not only big hospitals but physicians who run clinics on their own also want to go for EMR to ease their administrative as well as workflow burden.
• To go by the latest trend, detailed and accurate data capturing capability of an integrated HIS/EMR is used for smarter business intelligence analytics and outcome prediction.
• More and more hospitals are opting for accreditation to compete in the global field. An HIS/EMR with its exhaustive and accurate documentation capabilities is a boon in complying with the accreditation procedures, which call for regular documentation of the organization-centered process flow and patient-centered care procedure standards.
• With the advent of technology patients are well informed. To meet their demand for quality care and competitive pricing, hospitals are increasingly opting for EMR.
• Streamlining insurance process claim submission has become imperative for hospitals to increase patient numbers and improve collections. EMR plays a major role in accurate data capture for complete claim submission, reducing number of rejections to miniscule percentage.

Hence an integrated HIS/EMR comprehensively takes part in decision making, enhancing clinical reporting, improving workflow management, increasing care coordination, boosting collections, complying regulations, and augmenting patient loyalty. Today an HIS/EMR is no more for electronic medical records documentation and maintenance; it has been further expected to play multiple decisive roles in running a health care service successfully.

KEY DRIVERS TO HIS/EMR/PMS TRANSITION

Digitizing patient medical records is only a starting point for opting an Integrated HIS/EMR/PMS package. The patient record data can launch analytics. They help in predicting outcomes, visualizing results and sharing information aiding in diagnosis and management decision-making. A good HIS/EMR facilitates business intelligence analytics using AI by its data capturing and custom report generating capabilities.

To put it in a nutshell, the following are the major reasons for a hospital or a health care provider to switch over to EMR or upgrade to an integrated HIS/EMR/PMS software solution for their daily operations:

• Digitize patient records
• Optimize billing
• Maximize insurance reimbursement
• Increase productivity
• Improve patient care
• Decrease services cost/overhead
• Deploy predictive analysis in decision-making

PREPARATION AHEAD OF HIS/EMR SELECTION

Once the decision to implement/upgrade HIS/EMR is taken, preparations to that effect need to be put in place prior to actual implementation/upgradation. Though the selection and implementation of a most suitable HIS/EMR is a slippery slope, having a clear-cut plan before selecting the HIS/EMR and vendor will significantly sidestep the rocks on the way.

There are a number of key components that need to be crystallized prior to the initiation of the HIS/EMR selection process, which have the potential to make or break the successful transition to HIS/EMR. These include:

Clarity

Be clear on the high-priority requirements that need to be addressed by the HIS/EMR to make the transition useful and worth the efforts and cost. Differentiate between must-have features (e.g. ophthalmology-specific modules) and nice-to-have features (e.g. HR module).

Goal

Set practical, prudent clinical, productivity and work environmental goals, which will result in tangible outcomes.

Time line

Decide on a time line for selection, negotiation, and implementation of EMR to make it effective in achieving goals.

User consensus

Arrive at a consensus with HODs and end-users as their cooperation and active participation will help in attaining the above criteria and also will result in smooth implementation.

Budget

Freeze the budget based on the size of your practice, the required add-on features, deployment location (cloud based, remote, or on premises), and additional warranty required, among other factors. Always allot an additional 30% for hidden charges or customization requirements for the first year.

Level of automation

Decide on the level and the number of processes to be automated depending on your budget and time line. Keep in mind that achieving 100% automation is a phase-by-phase process, that is, complete automation doesn’t occur at the very first stage of implementation.

Compliance

Finalize which statutory regulations need to be complied in toto, such as HIPAA, HL-7, ICD-10 and NABH standards.

STEP-BY-STEP SELECTION PROCESS

1. Need assessment

Based on the above key considerations, the hospital should prepare a requirement document.

2. Vendors selection

Pick five popular vendors after checking up with other practices that have implemented HIS/EMR and any medical association of which you are a member for HIS/EMR evaluation resources and also after searching online for suitable vendors.

3. Request for information (RFI)

Design a RFI document containing relevant details you need for EMR and vendor evaluation. The said document solicits information about the solutions and services offered by the vendor, vendor’s business profile (support structure, team quality, skill set, experience, domain knowledge, previous experience, financial stability), HIS modules, EMR capability, ophthalmology-specific features, statutory compliance, interoperability, equipment integration capability and interface, data security design, implementation and training methodology, ongoing support services, patient tracking capabilities, warranty and extended warranty details, estimated cost, site visit possibility, and availability for demonstrations, among any other specific details you need.

4. Comparison and short listing

Based on the RFI, compare the vendors and shortlist a minimum of three vendors and call for a proposal from each of them. Insist on detailed proposal covering deliverables in no uncertain terms. The exhaustive the proposal the better is the selection.

5. Demonstrations and site visits

Schedule demonstrations of all three shortlisted vendors and have a face-to-face interaction with each team. Obtain two references of the vendors’ clients where the same HIS/EMR model has been implemented. Contact both references, discuss, and collect their feedback and reviews on the vendor. Make sure you visit their websites too to get another angle, as these days most of the patients rate and review their treatment encounter online. Site visit along with the development office visit is highly recommended.

6. Negotiation

Negotiate for the total cost of EMR inclusive of HIS components. Keep in mind hidden costs such as additional implementation charges, additional customization charges, and support charges while working out the final cost. Arrive at the final cost after taking into account the cost that would be incurred for next three years including AMC, for a reasonable expenditure estimate.

7. Finalization

Finalize the best vendor with a stable financial background, solid project management capability, and proven track record in execution that meets you half way and ready for a long-term partnership. Make certain that the vendor is ready to do some customization to suit your needs, at the same time remember that too many changes will lead to distortion. So it is better to strike a balance.

During the finalization freeze 15 to 20 must-have MIS reports, for example daily, weekly and monthly collection summary, payables and receivables, and patient registration summary so as to confirm no necessary input capture is missed by HIS/EMR while customizing.

GO THE EXTRA MILE

As the saying goes well begun is half done, but the other half of the successful implementation of HIS/EMR rests with you. To put it clearly, 50% of the success depends on your owning the responsibility for implementation and maintenance.

For it not to be a protracted process, the hospital must provide a conducive atmosphere for the vendor to implement HIS/EMR seamlessly, while conceding that the process takes 3 to 4 months to settle down.

The following steps from your side guarantee a successful implementation experience:

• Allocate a dedicated resource or a team to go-between the vendor team and decision-makers and end-users. This will ensure there is no gap in communication on the scope that has been finalized and what is being implemented among all stakeholders. The single-point of contact provides the vendor team clear directions and coordination, in turn ease in implementation.
• Apply the top-down approach, which is highly essential for smooth and stable implementation. It has been found from research that the major impediment for implementation success is user reluctance. The end-users willingness to take HIS/EMR training has to be ensured by dispelling their misconception about productivity disturbances, workflow changes, and level of skills needed to work on HIS/EMR by the decision-makers convincingly.

Management has to take into confidence the end-users by enlightening them about the need for HIS/EMR and the advantages it will bring in the realm of ease of use, productivity, and patient care.

CONCLUSION

Although going for an integrated HIS/ophthalmology EMR in this high-tech era is a wise choice, freezing on select-featured EMR and vendor might prove to be a tricky process. This can be handled by systematic approach. Post selection implementation also holds key for a successful EMR transition.

Joint efforts of both vendor and the customer go a long way in seamless implementation and maintenance. To overcome the initial user reluctance and promote user adaptation, the decision-makers should apply the top-down approach by confidence building measures like organizing training sessions, motivational lectures, practice sessions, etc.

The vendor on their part have to provide pre-requisite training, manuals, training videos and enough hands-on training sessions to boost the confidence of users. Further, the management should own the responsibility of implementation and take an active part by dedicating a team to coordinate with the vendor for the best implementation and maintenance experience.