Conducting Effective Site Visits

Site visits are a staple of the EHR selection/evaluation process.   Unfortunately, I regularly hear complaints from doctors who have purchased EHRs after seeing them working wonderfully during a site visit, but who later have difficulties in their practices.  Site visits can be a helpful component of EHR selection, but only when used appropriately.

When used as part of an EHR selection process, site visits should occur only after the field of potential EHR products has been reduced to no more than three.  Otherwise, the process drags on too long and loses focus.   Site visits are information gathering tools. Therefore, site visits should be used to collect information on:  1)  the difficulty of implementing a specific EHR product; 2) how the implemented EHR performs in daily use; and 3) how similar one’s practice is to the visited site.  Although most EHR purchasers handle the first two items well, they often fail to do a detailed assessment of practice similarity.

Practice Similarity
At first glance, practice similarity seems like a no-brainer. After all, most would ask, “How many differences can there be between two practices with the same number of providers in the same specialty?”   When it comes to EHR implementation, there may be major differences between practices that on the surface seem to be nearly identical.  Not all differences are equally important.  I will focus of the three mostly likely to cause trouble when overlooked–technical experience, resource access, and personnel.

Technical expertise
Computer geeks are everywhere these days. I am no longer surprised when I meet doctors, nurses, and other healthcare professionals who feel perfectly comfortable tweaking a server, setting up a website, or building databases. Practices that have someone with moderate or advanced technical expertise are able to interact with EHR vendors and consultants more effectively than practices that do not. Such practices may receive more favorable contract terms or better technical support.  In-house technical expertise may also lead to smoother implementations because of the role tech-savvy staff can play in educating and assisting other practice members.  When unsuspecting site visitors, without equivalent in-house expertise,  have comparatively worse implementation experiences, they cannot understand what went wrong.

Resource Access
“Create a detailed implementation budget, then double it,” is a common adage.  It is also good advice. Implementations are often plagued by unexpected expenses. Providers who can easily draw on additional monetary or other resources have an advantage over those who must count every dime or do not have a relative with a computer business.    Resource access may be a touchy topic when visiting a site. However, it is essential information if you are trying to determine if your practice can replicate the host’s implementation success.

Data entry is probably the most common source of consternation for new EHR uses–touch-typists have a much easier time than “two-finger” pickers.  The typing skills of practice members (clinical and administrative) will influence implementation success.

Computer literacy is just as important. Using a computer for e-mail or Facebook is not the same as being computer literate.   EHR software may utilize keyboard shortcuts or other standard operating system features as part of its user interface. If practice members are unfamiliar with these features, then computer literacy training may be required before starting EHR training. Therefore, it is a good idea to conduct  computer literacy assessments for all practice members before EHR selection begins.

With the above in mind, consider adding the following inquiries to your site visit agenda:

  • Ask about the technical backgrounds of all staff at the visited site.
    • Include hobbies as well as formal training. Someone can learn quite a bit tinkering in his/her basement.
    • Be sure to ask about informatics-related training.  (Some may consider technical expertise to refer only to computer hardware or programming skills.)
  • Ask about EHR funding and cash reserves set aside for implementation.
    • Pose detailed questions about budgeting, cost overruns or unexpected expenses.
    • Ask about non-monetary resources (i.e. friends/relatives/business associates who are EHR consultants, IT professionals, informaticists, etc.).
  • Ask about typing skills and computer literacy of all practice members.
    • Inquire about formal assessments of typing skills and computer literacy.
    • Determine if typing proficiency and/or computer literacy is a condition for employment.

Site visits will take you to practices that have successfully implemented the EHR under consideration. Your job is to determine how much your practice has in common with the sites visited. Replicating their success means being as much like them as possible. Do not be afraid to ask questions — even sensitive ones.



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