Before the real 'go-live' day in implementation an electronic medical records system (EMR), a practice would be wise to perform an example of the whole process; from check in to check-out. This simulation should actually perform a half day or full day at the clinic. Most practices are also use an electronic practice management (EPM) system, so the simulation day is a great day to also test the EPM and EMR integration, including billing. So, setting aside a Saturday, we listened to some objections, then began to test our plan to look for chinks in the armor.

All hands were needed on deck. With only one or two exceptions, all of the doctors and clinical staff members were to be there. Some other employees volunteered to play the role of patients, and front desk and office personnel were on hand to check these mock patients in and out. Doctors and the other staff members each reported to the place where they would go to begin work on a regular workday, including the surgery facilities.

We tested the different patient scenarios; each mock patient received a sample clinical history and diagnosis, allowing us to simulate the variety of electronic medical records processes, while testing the system in real time. One should stress the overall system by operating all of the equipment at each of the satellite offices all at the same time during the test. This is an excellent way to discover if there are any deficiencies in the overall system. Ask yourself some questions. Do we have adequate bandwidth? Are certain work stations crashing or freezing? Does the WAN handle the workload? Is the network slow or can it handle concurrent connections from all of our locations? Be sure to take note of how the system performs and what scenarios pop up among the staff as they begin to use electronic medical records for the first time.

The simulated workflow should follow the same routine as when working with real patients; this includes all steps, from checking in, to requesting an assistant to walk them to the examination, and on through to check-out. This full workflow simulation will expose problems that may not have been evident during the process of planning. Most practices will discover the new EMR workflow to perform in unexpected ways; simulation day is the right time to learn this - not on the actual go-live day. Remember the surgery center, however, as this area must be able to access patient records. Surgeons should access the EMR to review a mock patient's chart before selecting an intraocular lens, for example.

Post-mortem. Our administrative team met with clinical supervisors at the end of the simulation day to assess the performance of the staff as well as the system. With the exception of some minor technical glitches, the practice received a passing grade. And the physicians all agreed that those dreaded few hours spent indoors on a beautiful sunny day were well worth it, primarily from the standpoint of stress reduction leading up to the actual go-live day.