One thing often forgotten in major projects such as an EMR implementation within a medical practice: the impact the change has on the staff. Do you think they're prepared for the significant change of moving from paper record-keeping to electronic? How much training will it take to get your employees using the system proficiently, and who needs to know what? The staff's perceptions and use of the system are key in the measure of overall effectiveness and success. It's important to put people first.

Most medical practices, and ophthalmologists in particular, have a majority of staff involved in data input using basic writing and typing skills. When converting your EPM to NextGen from Medical Manager, we went from a DOS keyboard-stroke data entry system to a mouse-driven, Windows-based menu. This may at first seem a minor difference, but it proved a somewhat stressful change for office staff who had enjoyed comfort with doing things in a specific way. After transitioning over to the new system files started disappearing mysteriously, and printouts were popping up at remote offices miles and miles away. It certainly took a bit of time to hone in on the system and how to use it properly.

When preparing our technical staff to implement the EMR module, we established a computer classroom for teaching computer basics. When transitioning over to our new EPM, we switched a few employees into the classroom at a time, there giving them a basic skill set assessment and a bit of training. There they had the chance to use their new skill set by calling up patients to verify their appointment time and information, then entering it into the database. This also helped to make the training time more valuable, as we were able to enter the data and confirm the upcoming schedule information.

When the training was completed, the staff person should have a basic understanding of Windows terminology, including: maximize, minimize, restore, task bar, start menu, tool bar. Because the EPM/EMR system doesn't exist in isolation, users should also understand basic computer skills including: media, drives, files, folders, defaults, paths, and logging out.

An EMR system has its own set of functions and terminology. Staff members will have to be able to tell the difference between images and active images, distinguish between templates, tell fields from data grids, and pop-ups and pick-lists. It's best when your employees have an interest and want to develop it. Some of the details of your staff members' aptitudes and experience can be determined in short assesment quizzes or interviews.

In addition, now is the time to put your security policy for computers and the EPM/EMR system into practice. What are the password requirements? With what frequency will they be updated? What security hardware will be used, if any? What are the consequences for violating policy? How long will an inactive computer remain idle before and automatic timed log-out? Who will maintain security policy? In this day of HIPAA regulations, maintaining EMR system security for patient data must be continually instilled into staff procedure for implementation.