emr go live
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[00:00:00] Welcome back to the Academic Medicine Strategy Podcast. Today, we are gonna talk about EMR go-live. If anybody's lived through one of these, and I mean lived through one of these, you realize it is stressful. But the part of the reason it's stressful is I think we have unrealistic expectations because everybody makes it sound like we're just gonna snap, be able to do our normal amount of cases or procedures or whatever it is that we do these days, clinic visits, and some of the most important thing to know is that your productivity loss in those first ninety days will go down twenty to fifty percent. Just the knowledge of this makes it so that you have realistic expectations and hopefully realistic caseloads and clinic loads and productivity loads. Also, the average time to recover that cost is six months.
So just know this in the implementation phase. Make sure it's built into your system. The other thing is that burnout induction with strong support is still twice as likely as it is without [00:01:00] support. So please make sure you're doing some things to help with health and wellness in this time period.
The other thing is that usability is significantly decreased during this period because we don't know what we're doing yet, and it is normal. So there's a few things that are important. No matter if you're starting from no EHR or you're starting from a different EHR, some of the best things you can do is try and create some common templates and phrases before it even goes live or starts.
And while this sounds great, and everybody I've ever heard of is "That sounds good," usually it takes one dedicated person or one per division who can come up with some of these things so that everybody can work together, and that person should have some dedicated time, ideally, to be able to put this together.
The other thing is that there is great data showing that when you use a smart phrase or a note that is a smart template, expanding it into a full note can take much less time. A single phrase can replace ten minutes of typing or more. So what I [00:02:00] want you to really think about is what's most common. If you need to dictate these into something, dictate them into something.
If you wanna, dictate them into EI and ask them to make you a template or a smart phrase or whatever it is, I strongly recommend doing this. But if you don't have time to do this, what I want you to do is to take some of your old notes and see if you can just use those as templates. And if you don't like the format of your old notes, and I can tell you there's times when I haven't, then start doing your new notes.
The very first patient I did who had complaint X, I just went back through and I said, "Here's all the common questions. I'd wanna ask this every single time," and use that to create the next one or have an administrative person where you can highlight the things or speak it out loud. I can tell you, I just did something with WhisperFlow, and it said that my speaking rate is a hundred and forty-eight words per minute, which apparently is at the high range.
So most people don't have to listen to me at 2X, but I will say that it is more efficient to speak things through, which is why ambient AI can be really useful. The other thing is to really talk about your [00:03:00] volume before you build a schedule. You wanna have that conversation. Nobody wants to be the one who's not doing their share, but once the schedule's built, negotiating against a calendar that already owns you is really hard.
And so in order to be able to document and take care of everybody appropriately, I would really recommend that you start with either some spots that are held for urgence or some double spots for complicated patients. We know the creep is that things are always gonna get added on, so I want you to really think about the fact that you're gonna boost your productivity, but not till that first 90 days are over.
So leave some empty slots or hold some slots if they don't wanna rebuild your template twice. The other thing is there should almost always be an EMR expert, whether that's a super user or some other title, but come to them with specific questions. Instead of asking like, "Hey, do you have any tips or any ideas?"
Get specific about what's getting in the way. "I can't pull in any of my patient-reported outcome measures into my note," or, "How do I find a flow sheet that sh- can show my CPAP findings?" [00:04:00] Or what... You name it. You figure it out. How do I pull in the past medical history? Where do I get a summary for complicated patients?
All those things are now possible with your EMR, and if you can integrate them ahead of time, if your note pulls in all of that past medical history, surgical history, medications, allergies, all of that stuff can make your time so much easier and, quite honestly, can make your note something that's instructional for you.
The other thing is to treat your in-basket like a workflow, not a feed, meaning don't let it run your day. People who get home on time run their in-basket on a schedule. They look at it at the end of the day. They look at it at lunch. They look at it at the beginning of the day, or they have a time set aside.
But it's a mindset shift as much as it's a technical one. Set up some filters and some task routing from day one. If you don't know how to do that, find that super user and then triage messages. Come up with pools so you can automatically send things quickly to the people who'll be answering them, and then get people on your team into your box, whether that's your MA or your nurse or your PA or whoever's helping you.[00:05:00]
And then think about the fact that you should look at this after a couple of weeks and categorize some of these and figure out if there's some reported repeated things that you can do so that you can create some smart phrases or templates for responding to your messages too. Now, the other thing I wanna tell you is to lock in your documentation pattern so it's easier over time.
It matters more than your timing. So physicians who do the same thing every time on the same way find that they are actually outperforming people on their clinic days more than anybody else. So decide that you're gonna document in the room. I really recommend this. If you're like, "Hey, I feel weird in front of the patient," tell them, "I am documenting this so your primary care doctor can get this note right away, or your referring doctor."
And they're gonna appreciate that. You're also gonna be able to talk through the assessment and plan, and you can say, "Hey, I'm gonna talk through this in medical words, and then I'm happy to go through it with you afterwards if you have any questions or any thoughts so that you can understand what I'm saying."
And I will confirm "Hey, is this for Dr. X?" And they'll say, "Yeah, that's the right doctor." "Great. This is my [00:06:00] note to Dr. X." And then I go through the impression and plan. The other thing I find really useful is to put the impression and plan at the top of my notes. So it literally says impression, plan, then there's a line, and it says history of present illness.
I find I spend ninety percent of my time in this space, so that as they're talking or they're answering a question or I'm thinking of something, I can be popping it into my impression and plan. I also have regular impressions and plans set. If I see the same complaint all the time, and there's three options that I usually use, I have all of them in my note, and I delete the two that I'm not using.
Or you can have a dropdown box, but I find dropdown boxes are actually slower than just deleting the ones that aren't important or aren't used for that particular visit. I would also say for high disruption weeks, if you're on call, if you're going back-to-back, whatever it might be, announce your rhythm to your team.
"Hey, I'm gonna do this in the room, and I'm gonna give it a shot. I'm gonna try this outside. I'm gonna give that a try. I want you to dictate this, and I'm gonna dictate that so that you can make sure that everything goes the way you want it to be." No matter what EMR [00:07:00] you're integrating, however, I'm gonna tell you, give yourself a break.
You're gonna feel like you're kinda dumb, and it's kinda dumb because you don't have it figured out, and you were probably pretty facile with whatever system you had before, even if it was paper, because you learned how to optimize yourself to that system. You will learn again. Just give yourself the break.
Give yourself some slots to do that timing in, whether it's blocking things on your schedule or making a shorter schedule, and recognize that there are some very clear things you can do, regular dictation methods, or if you're typing regular templates, regular smart phrases. Try and do some of that stuff ahead of time, and if it doesn't work, do it as a team.
And if you can't do that, go back and use your notes, so you can do it later. The one other thing I'll tell you is if you work with trainees, please tell them to work in your templates. It'll make your life so much easier so you're not reworking and rewriting. And one of the things you can do is give "Here's my handout," or the note I send you or the text I send that says, "Here's how I work with trainees.
Here are my templates. They start with this. Please search for them," or, "These are [00:08:00] my top ten. Please use them." I also recommend that you don't let them go on to the next patient till they've finished the first one so that their documentation delays are not your documentation delays. If you have any great thoughts or tips or tricks, I would love to hear them, so please send them along.
In the meantime If there's anything we can do to help you as you're onboarding your new EMR, we would love to work with you through our department coaching program, which is the Faculty Excellence and Retention Initiative, or we're happy to do some workshops where we talk through some of our best tips and tricks on how to do EMR integration.
It was great talking to you. I look forward to talking to you next week, and please reach out. If you have any tips or tricks that you'd like to share, you can reach me at [email protected]. That's A-M-E-D-S-G.com. Have a great day. "
