Prepare

What does my practice need?

Before you select a health information technology (IT) product, you must first assess the needs and status of your practice. The importance of this step cannot be over stated. Where are you now? Where do you want to be in the future? As you work through these types of questions, always take into account your workflow, your staff and their pain points, and any opportunities and challenges specific to the geographic market in which you practice. The more accurately you can articulate your needs, the more focused and efficient your decision-making will become.

“When I write blogs about [health IT], I just focus on the workforce, focus on the people, and focus on the change management.”
—John D. Halamka, MD, MS, chief information officer, Harvard Medical School; chair, U.S. Healthcare Information Technology Standards Panel; and co-chair, HIT Standards Committee

Is my practice ready to make a technological leap?

Educating yourself about technology is no different than anything else—it’s about knowing where to gather the right information and asking the right questions. This is especially true when assessing your practice’s technical readiness. Although a thorough assessment requires looking closely at your practice and giving careful consideration to many things, it does not have to be a daunting task.

Here are a few first steps:

• Determine what, if any, new hardware and infrastructure you will need to use health IT effectively—high-speed Internet connection, adequate hard-drives and back-up systems, PCs for necessary workstations, etc
• Shop around and speak to different vendors. Get a variety of opinions and feedback on what your needs may or may not be. Take advantage of vendor presentations and trainings.
• Do research of your own. Research vendor reviews on the Internet, specifically KLAS and Black Book rankings. Talk to colleagues using health IT.
• Know your staff’s comfort level with any proposed technology. They’re the ones who will be using the technology you purchase; keep them in mind and involved in the process.

How much should I be prepared to spend?

Determining your technology budget is not always easy. Be sure to take into account things such as maintenance, transition time and potential pitfalls. With careful planning, you can take some of the guess work out of the process.

A few things to keep in mind:

• At the high end, certain electronic health record (EHR) systems can run into tens of thousands of dollars per physician. In some cases, these systems may surpass your needs.
• Maintenance costs such as software updates, minor fixes or hardware upgrades, which often get overlooked in the budget process, may run anywhere from $3,000 to $15,000 per year. 
• You may need to purchase hardware (desktops, laptops, tablet PCs, printers, etc.) to support your new software, and/or incur additional costs to customize your existing health IT to accept and interface successfully with any new software.
• With the proliferation and acceptance of “cloud computing,” incorporating Web-based health IT and EHR technology successfully into your practice is now more cost-effective than ever before.

Why is mapping my practice’s workflow so important?

Diagram and document your workflow as it exists today. Ask everyone in your practice to list their tasks, big and small, that occur daily, weekly, monthly. Identify which of these tasks are indispensible, and which are tedious, repetitive or potentially even expendable. Could any of these tasks easily become electronic? Keep in mind that you’re adopting health IT to make your methods smoother, richer and more efficient, not to replicate your old methods on a computer. Refer to the diagram below for ideas on the types of activities your workflow map should capture.

Typical practice workflows

• Patient registration
• Scheduling
• Patient arrival and rooming
• History-taking
• Examination
• Procedures
• Orders (prescriptions, labs, imaging, etc.) Coding and billing referrals
• Checkout process
• Filing records; documentation
• Between visit care

How can I promote a culture of change at my practice?

Before you select a system, make sure you have a plan for working with staff and patients. Staff buy-in is fundamentally important. Switching to health IT gracefully and efficiently can be done. If you spend enough time preparing, the transition will be much easier. It's important to involve staff in decision-making and to communicate throughout each stage of the health IT adoption process.