AMA self-assessment

Before selecting an HIT product, use this part of the site to help you assess the needs and status of your practice. Understand your workflow, your staff, and your budget.

Carefully consider the following factors for your practice: cost, technical requirements, workflow change, and cultural change. Relate these factors to your practice's specific needs and capabilities.

Cost

• The average cost of EHR is estimated to be $30,000 per physician .
• The average maintenance of EHRs is estimated to cost between $3000 and $15000 per year.
• You may need to pay your staff overtime as they work longer hours during transition.
• You will lose productivity and reduce patient volume while you’re adjusting.
• Customizing your EMR—getting necessary interfacing software for your existing HIT, or customizing templates, may cost you extra.
• Purchasing necessary hardware to support your software is expensive.
• ROI shouldn’t be expected until many months down the line—potentially over a year into your transition.

Providers about to implement HIT need to look carefully at their budgets and plan rigorously for these pitfalls. With careful planning, the cost of HIT won’t outweigh the benefits, but without planning, cost may defeat your efforts.

Technical readiness:

• Be aware of your staff’s level of comfort with technology.
• Make sure that everyone in your practice has done plenty of trainings, run-throughs, and is comfortable with “model” patient encounters.
• Gather information about the new hardware and infrastructure you will need to use HIT effectively (high-speed internet connection, big enough hard-drives and back-up systems, PCs for necessary workstations, etc).
• If you don’t know the first thing about hard-drives and bandwidth, read-up and ask questions. (See our HIT reference section for places to find more information.)
• Make sure you have interrogated your potential vendor! Use their expertise. Take advantage of site-visits, presentations, and trainings.
• Once you have the technology set up, conduct plenty of task “trials,” walk-throughs, and model visits. The more time you spend with your new technology, the easier your transition will be.

Remember to be patient and to be open to learn. You won’t be able to maximize these exciting technologies unless you are comfortable with them!

Workflow analysis:

• Have everyone in your practice make a list of their daily tasks and duties. Have them identify which tasks are annoying or repetitive. Have them rate tasks in complexity.
• Make a master list of everything your practice currently does in a daily, weekly, and monthly manner—use this list to evaluate software.
• Calculate completion times for each task; understand which tasks would be benefited by becoming electronic.
• Identify if new tasks will be required with the new system, and who will take care of these new tasks.
• Create diagrams of how information flows throughout your practice. With an EMR, everyone has access to the patient records simultaneously. How will this change the flow of tasks from person to person? Will some tasks become obsolete?
• Do some “dry run” patient visits. Identify “snags” and slowdowns—walk your charts through each of its handoffs and document where modifications are needed.

Remember: be ready to change the way your practice runs! You’re adopting HIT not to replicate your old methods on a computer, but to make your methods smoother, richer, and more efficient. See our tools section for help with analyzing and designing workflow.

Cultural Change:

• Make sure you have a plan for working with staff and patients.
• Consult your staff about what they need, what they want, and what they are afraid of. Make sure everyone knows their work won’t become obsolete.
• Assign a person to keep tabs on the climate of the office. Check in with this person regularly.
• Train your staff to respond to patient questions, complaints, and concerns. Inform patients about what this technology can do for patient care. Get them excited about the change.
• Make sure everyone in your practice is comfortable enough with your new HIT that you can attend to patients appropriately, without technology getting in the way. This technology should enable care, not interfere with care.
• Make sure that you will plan for ample training and hands-on learning, so that everyone is comfortable with the technology.
• Plan for slowed processes, and be prepared to be patient as adult learners adjust.

At base, switching to HIT gracefully and efficiently requires self-awareness. Understand your workflow. Understand your technical status and the comfort of your staff with technology. Understand how much of a transition will be required, and how you will cope with decreased productivity during adjustment. Understand how you will handle resistance and fear among both providers and support staff. Be willing to change and open to new information. If you spend enough time with the self-assessment stage of this process, your transitional stages will be much easier than if you proceed with a trial-by-fire in mind