The document discusses the common pitfalls of electronic medical record (EMR) implementation and how to avoid them. It identifies the top 7 sins as: 1) not obtaining physician buy-in, 2) not defining initial goals, 3) partial commitment to content, 4) not evaluating vendors thoroughly, 5) unrealistic expectations, 6) underestimating costs, and 7) implementing an EMR simultaneously with a practice management system. The key is thorough planning, choosing the right vendor based on product, company stability, and implementation experience, and getting full staff commitment to goals. Case studies show EMRs can increase revenues, reduce costs, and improve quality when implemented successfully.

1. The 7 deadly sins of
EMR implementation
and how to avoid them
Presentation for the Arizona MGMA
By James Muir
NextGen Healthcare Information Systems

2. What is an Electronic
Medical Record (EMR)?
 Definition
– An electronic medical record is a
computer-based patient record (CPR) that
electronically maintains information about
an individual's lifetime health status and
health care.
 Styles
– Text Repositories
– Point of Care

3. Do EMR Implementations
Fail?
 Medical University of South Carolina -
$960,000
 Watson Clinic, FL – $1.8 Million
 Cedar-Sinai, CA - $34 Million

4. Why EMRs Fail
Poor
Implementation &
Planning
32%
Vendor Promiced
More Than They
Could Deliver
22%
Product Sun-setted
Inadequate
Physician Buy-in
15%
12%
Other
3%
Clinic Execs Didn't
Back the System
9%
Non-clinical Staff
Saw No Benefit
7%

5. EMR Graveyard
 Aesculapian
 Alcon
 AVIO
 Azron
 Documed
 Glaxo Healthpointe
 IFA
 CIBA
 Logician Web
 Oceana
 Pearl-MIMS
 Wysemed
Each year nearly 100 vendors enter the EMR
market and nearly 100 vendors fail.

6. How do we successfully
implement an EMR?
 Organize Providers
 Define Goals
 Evaluate Systems
 Resolve Technical Issues
 Implementation

7. Organize Providers
 Form evaluation team
 Appoint leaders /
champions
 Communicate with
entire staff
Organize
Providers
Define Goals
Evaluate
Systems
Resolve Technical
Issues
Implement

8. Define Goals
 Access
 Reduce transcription cost
 Reduce transaction entry cost
Organize
 Coding Compliance
Providers
 Quality of Care
 Reduce malpractice premiums
 Protocol
 Time savings
 Outcomes Management Implement
Define Goals
Evaluate
Systems
Resolve Technical
Issues

9. Evaluate Systems
 Prioritize goals
 Create request for proposal (RFP)
– Contact reference sites
 Consider financial viability
 Narrow vendor scope to 3 or 4
 Review demonstrations
– Be wary of beta software
 Site visits
 Consider vendors
implementation capability
 Final quotation
 Selection
Organize
Providers
Define Goals
Evaluate
Systems
Resolve Technical
Issues
Implement

10. Resolve Technical Issues
 Determine technical
feasibility of interfaces
– A/R system
– Programming
– Real time vs. batch
 Determine scope of interface
– Demographics
– Appointment Scheduling
– Transactions
• Code mapping
 Adopt ‘open’ standards
– HL7
– SQL
– ODBC
Organize
Providers
Define Goals
Evaluate
Systems
Resolve Technical
Issues
Implement

11. Implementation
 Physician buy-in Champion
 Prioritize goals for implementation
– Congruency of goals
– Define timetable
 Pre-define critical elements
– High-payoff – Low-behavior change items first!
– Content / Templates
– Protocols / pathways
– Workflow / process
– User-defined functions
 Networking
– Design
• LAN/WAN issues
• Wireless
– Implementation
– Support
– The hidden cost
 Training
– Define changes in business rules
– Start with Champion
– Staff
– Clinicians
Organize
Providers
Define Goals
Evaluate
Systems
Resolve Technical
Issues
Implement

12. What can go wrong?
 Inadequate clinician commitment
 Inadequate operation staff commitment
 Implementation loses steam
 Incongruency of goals
 Unreasonable timetable
 Inadequate effort towards development of user-defined
elements
 Disregard for operations issues
 Inadequate interfacing issues
 Inadequate networking issues
 Inadequate hardware issues
 Buggy software issues
 Finger pointing between vendors
 Vendor insolvency
 Poor vendor support
 Not enough training

13. What can I do to
prevent this?

14. 3 vital aspects of selecting an EMR vendor
PPrroodduucctt
– HHooww ggoooodd iiss
tthhee pprroodduucctt??
– WWhhaatt iiss tthhee
aarrcchhiitteeccttuurree??
– WWhhaatt iiss tthheeiirr
iinnssttaallll bbaassee??
– AArree tthheeiirr
cclliieennttss hhaappppyy??
– HHaavvee tthheeyy
rreecceeiivveedd aannyy
rreeccooggnniittiioonn??
Product

15. 3 vital aspects of selecting an EMR vendor
Product
CCoommppaannyy
– DDoo tthheeyy kknnooww
hhooww ttoo rruunn aa
ccoommppaannyy??
– AArree tthheeyy
pprrooffiittaabbllee??
– AArree tthheeyy
ggrroowwiinngg??
– WWiillll tthheeyy bbee hheerree
nneexxtt yyeeaarr ttoo
ssuuppppoorrtt uuss??
Company

16. 3 vital aspects of selecting an EMR vendor
Product
Implementation
 IImmpplleemmeennttaattiioonn
– DDoo tthheeyy kknnooww hhooww ttoo
iimmpplleemmeenntt??
– DDoo tthheeyy hhaavvee
eexxppeerriieennccee wwiitthh
ggrroouupp lliikkee oouurrss??
• SSiizzee
• SSppeecciiaallttiieess
• NNeeeeddss
– WWhhaatt aarree oouurr rroolllloouutt
ooppttiioonnss??
– HHaavvee rreecceeiivveedd aannyy
rreeccooggnniittiioonn??
Company

17. 7 Deadly Sins of EMR
Implementation
1. Not Obtaining Physician Buy-in
2. Not Defining Initial Goals (Planning)
3. Partial Commitment to Content
4. Not Evaluating the Financial, Technical &
Implementation Aspects of a Vendor
5. Expecting Too Much – Not Being Practical
6. Underestimating Total Cost / Opportunity
Cost
7. Implementing an EMR at the Same Time as
Practice Management System

18. Upside
 Chart Access
 Better Quality of Care
 Reduction of Costs
 Better & More Consistent Quality of
Chart
 Coding Compliance
 Reduced Liability

19. Case Study - SETMA
 SETMA (South East Texas MMeeddiiccaall AAssssoocciiaatteess))
– 2244 PPrroovviiddeerrss
– 33 LLooccaattiioonnss
 OOppeerraattiioonnaall IImmpprroovveemmeennttss
– EElliimmiinnaatteedd $$334400,,000000 ttrraannssccrriippttiioonn ccoossttss
– RReedduucceedd ssttaaffff ttoo hhaannddllee ppaattiieenntt cchhaarrttss 7766..77%%
• Saving $120,000
– RReedduucceedd aaddmmiinn ssuuppppllyy ccoossttss 8877%%
• Saving $380,000
– RReedduucceedd ttiimmee ttoo eessttaabblliisshh aa cchhaarrtt 8855%%
• Saving $22,000
– RReedduucceedd pphhoonnee iinnqquuiirryy ttiimmee 7733%%
• Saving $103,000
 FFiinnaanncciiaall IImmpprroovveemmeennttss
– IInnccrreeaasseedd cchhaarrggeess 2200%%
• Increase of $2.1 Million
– IImmpprroovveedd ccoolllleeccttiioonnss 3300%%
• Increase of $1.4 Million
– RReedduucceedd CCllaaiimm DDeenniiaallss 2266%%
• Improving revenues $102,000
Case Studies: Access and efficiency & Microsoft Customer Solution:Healthcare Industry
OOppeerraattiioonnaall
OOvveerrhheeaadd
RRRReeeevvvveeeennnnuuuueeee

20. “Teamwork is the ability to work
together toward a common vision,
the ability to direct individual
accomplishment toward the team’s
objectives. It is the fuel that allows
common people to attain
uncommon results.”
-Anonymous

21. Resources
 www.healthcomputing.com
– KLAS
 www.TEPR.com
– Medical Records Institute

22. About Your Speaker
James M Muir
Sales Executive NextGen Healthcare
NextGen Healthcare
Speaker, Author, Educator
jmuir@RCMguy.com
www.linkedin/com/in/puremuir/
• 14+ Years in Healthcare & Billing Service Administration
• BA, Brigham Young University
• Author, 2 books, hundreds of articles including articles for the MGMA
Connexion and Advance For Health Information Executives
• Educator for many organizations including various MGMA chapters and
Metro managers groups.
• Certifications from IBM, 3Com, Miller-Heiman, Franklin Covey and JES.
• Longstanding active participant with MGMA & HFMA