Transition to a new EMR: first 2 weeks after going live

19Apr2011 & 29Oct2012 This is one of a series of articles about my recent transition to a new EMR that was very popular. The original article from April 2011 was corrupted with my blog migration in the Fall of 2012 but I am happy to have it mostly restored here for people to continue to enjoy and learn from what I put myself through.

I am happy to report that we have survived our first two weeks since our transition from Optimed Software’s Accuro to TeckSoft’s EyeVu. The most important thing to emphasize is that these are both excellent EMR solutions and either one could be ideal for your practice. As I’ve said many times, if there were a perfect EMR system, then everyone would be on that one system. The fact is that just like we all have different learning and teaching styles, we all have different EMR styles and need to find the type that is best for each of us.

In prior articles, I wrote on some of the advantages for me for usability (Glaucoma/EMR: Why I’m switching to yet another EMR system) as well as some of the first steps before going live in deciding how to pull in the old data (Transition to a new EMR: steps before going live similar to the initial transition from paper.) Now that the transition has happened, I am happy to report on how the first two weeks went in case others find this useful or consoling in some way.

1. Don’t forget to decrease patient volume for at least 6 weeks, even if just going from one EMR to another

I really can’t emphasize this point enough. I always lecture about how the time savings by using an EMR are not in the portion where you perform the history and physical examination. Nothing will ever be faster than paper; if you’re lucky, eventually, an EMR can be almost as fast as paper. The time savings with an EMR have to do with retrieving information on future visits, when patients or doctors call, getting lab results into patients’ records, and being able to keep all your information retrievable without having to pull a written record so that the information can be accessed from more than one place at a time.

We were never 100% sure when we were going to go live with our new system but we book patients 6 months in advance. With only 2 days before going live, we still had a 100% full schedule for the next 6 months. To top it off, I had emergency surgery thrown into the middle of the day on our EMR launch date. This meant that any luxury of trying to handle falling behind by working through lunch was thrown out the window. As we scrambled to learn the new EMR, the front desk had to deal with figuring out which patients they could cancel so that we would not be keeping patients waiting unnecessarily. We also had to post signs apologizing for delays as we have moved to a new computer system. Patients were fairly understanding and seem to appreciate that we are leading edge with technology but I still feel horrible for having patients wait longer than their usual 10-15 minutes to get seen.

By the end of the second week, 15Apr2011, we were left twiddling our thumbs at times having postponed 25% of patients each day. We are ready to go back to fully booking our office but this is probably an exception. Most offices really should continue to down book for at least 6 weeks whether they are going from one EMR system to another or making the initial transition from paper.

2. Be ready to make changes on the fly to your EMR

Customizing TeckSoft EyeVu on the fly

Customization is essential in an EMR and be sure you know how to make changes to your drop down lists if possible. With EyeVu, although the ‘widgets’ names are pre-set such as Summary, Pre-Exam, Exam, Diagnosis, there is a lot of customization within each of these. In the days leading up to going live, I did customize the menus by memory for common things I write in my patient encounters. However, when we began to see patients in the flesh, it became apparent that my memory is not what it used to be - but I knew that.

It is important to be well versed in your EMR before going live so that you can handle customization on the fly like we did. If you can’t do that yourself, see the next section - the need for great vendor support.

3. Have great support from your vendor on opening day and beyond

Ideally, a representative from your vendor needs to be on site for you to hold your hands through the crucial getting started phase. In our case, this Montreal based company is thousands of kilometres away. Not only did they never come to Vancouver to do any of the set up; they didn’t come in person to support us on opening day. HOWEVER, they were virtually with us in a big way.

To set up EyeVu, the vendor uploaded a completely virtualized server to our office. They imported our patient data from our prior EMR and ran tests until they matched most of the data with the correct fields in EyeVu. We played around with a test import of that data to learn the system and work on our customization of the widgets before doing the final data import. During this training period, they shared our screens with and TeamViewer while we talked over Skype.

On the day we went live, customer support was ready on Skype the whole day. Most of the help was needed at reception as that section of this EMR is drastically different from any other EMR but from time to time I would Skype in as well with a question. In this modern age, with virtual ‘friends’ on Facebook and Twitter, it makes sense to virtually be helped. But, I can’t help but think that a live presence for both the initial set up and the launch day might have made things a bit less stressful and smoother. Then again, this approach is somewhat like dropping a baby in the swimming pool and making them learn to swim - it works.

Keep following for more articles about the EMR transition. Future topics will include whether we need a fully integrated EMR or if some duties can be shared with other products such as billing and ancillary test viewing. For the time being though, please add your comments as I would like to learn more about your experiences with or fears of EMR systems.