Thursday, May 1, 2008

Nuts and Bolts of an IO Implementation

Besides its staff being inexplicably and distractingly attractive, one thing that sets IO Practiceware apart from other electronic health record companies is its commitment to customer service.

Yeah, sure, you've heard the phrase "customer service" more times than you've heard mention of swine flu, or Susan Boyle, or whether Susan Boyle has swine flu, in the past few weeks. But here at IO Practiceware, when we say "customer service," we mean it!

One prime example of just how extensively IO Practiceware's blood, sweat, and streaming river of tears go into supporting its customers is the infamous IO Implementation -- or, as I like to call it, OPERATION: WE DON'T SLEEP, SO YOU CAN.

I participated in my inaugural on-site implementation one week ago at a three-doctor retinal practice in Central Florida and realized that many of you would probably be curious to know what the heck goes on. I have therefore decided to record my experiences in a way that's significantly more illuminating than, say, my ASCRS 2009 Diary, which was purely an exercise in indulgence and irrelevance.

So: if you'd like a play-by-play of what its like transitioning to IO's EMR system, read on!


Preparation: IO Practiceware sends one of its employees down to your practice a week and a half prior to initial training in order to set up and configure your network. This means, basically, IO connects all of your new hardware, makes sure the server and internet connection are functioning. In addition, IO takes all the patient demographics that have been stored in your previous practice management system and converts them into IO's practice management system (though not the clinical portion).

Step One: IO Training. We take a full day to teach the practice management / scheduling portion of the software and two days to teach the clinical. Another half day or so is devoted to the billing portion. We set up a cluster of computers in your practice's waiting room area (or wherever there's room) so that the office staff can learn everything together. (See picture at top.) All of IO's staff, which usually numbers between three and four people, is on hand during these classes to answer any questions that may arise.

Meanwhile, Step Two: Members of the practice note problems or concerns they have, and also begin a log of software preferences -- for example, a working list of "Favorites" (where available in the software) are customized to suit the needs of the specific practice. A good portion of the dialogue about these customizable features occurs during training.

Step Three: IO takes a peek at your pre-existing practice management / scheduling system and converts all upcoming appointments so that you can receive patients, old and new, into the new system as they arrive for their appointments.

Step Four: GO LIVE! This is where things get...hairy, so to speak. But into the fray we venture together, fearless and ready to fight! The most difficult part of "going live" with IO Practiceware's software is the initial workflow disruption. IO Practiceware recommends that practices see somewhere between five to seven patients electronically on the first day. Often, these are patients who are new to the practice -- the reasoning being, it's easier to begin using the clinical software on patients for whom you don't have to cross reference old, paper charts.

There's often a good deal of miscommunication on the first, even second, days of going live. Common questions and points of confusion depend on the practice, but they most often have to do with general anxiety about mistakenly performing redundant tasks -- or, in the effort to eliminate redundancy, neglecting to perform those tasks.

It also takes a day or so for an office staff to get used to the flow of how our practice management system relates to our clinical software -- namely: a patient cannot be seen in the exam room if he or she has not been checked in properly and, conversely, a patient cannot be checked out if his or her clinical chart has not been "closed" in the exam room.

Meanwhile, Step Five: IO looks at your practice's outgoing letter templates and converts them into IO Practiceware; these letters are henceforth generated from the IO exam software.

Meanwhile, Step Six: All patients, old or new, get their picture taken and have their IDs and insurance cards re-scanned into the new system.

Step Seven: IO Practiceware stays at your practice for two weeks after your first "go-live" day. Each day, three or so more patients are seen electronically. The onus of picking and choosing which patients to see electronically becomes transferred from the IO Staff (who have, initially, been the Taskmasters of making sure the practice continue to challenge themselves with the clinical software) to the ophthalmology practice's staff.

Meanwhile, Step Eight: The on-site IO staff keeps a dynamic log of glitches, challenges, and suggestions that present themselves after the first go-live day. We stay late after the last patient is seen to do "clean-up" and to continue to customize the software as best we can.

Step Nine: How to deal with old patient charts? It's really the practice's preference. Many times old billing information is converted so that old procedures and visits are automatically incorporated into the patient's electronic chart. Oftentimes, the office staff will need to take some time to scan old images or chart notes such that they become digital, and accessible through IO's EMR.

Step Ten: Typically, by the time IO Practiceware leaves the transitioning practice, all patients are being seen electronically.

And that, my friends, is a basic play-by-play of an IO Implementation. It is quite an endeavor, and is quite time consuming for the IO Staff. But we feel incredibly strongly that it's most important to get your practice up and running properly, even on the first day, so that you have a working, useful product that will support and enhance your practice.

Any questions? Did I leave something out? Post your comments below.