About half of all electronic medical record implementations fail, and most of those failures stem from poor planning and preparation, said a family physician who spoke at a regional extension center forum for providers in Maine.
Scott Patch, MD, who practices in Yarmouth, Maine, and is part of a multi-specialty medical group called InterMed P.A., has been using an EMR for about five years and considers himself in a “paperless” environment.
When a practice is considering moving to an EMR, he said, the whole organization has to “buy in.”
“One very important thing is to engage everyone in the process,” said Cowan Stark, MD, president of the Martin’s Point Medical Group, based in Portsmouth, N.H. “It’s a very different paradigm for providers. In the days of paper records, (a patient’s chart) was a private thing. Now it is a public event.” 
The hardest part is maintaining good communication during this time, said Patch. He recommends identifying a plan and choosing a “physician champion.”
“There is nothing more powerful” than choosing another doctor for this role, he said, as doctors tend to listen to other doctors.
Another important part of an EMR plan is assessing what a practice does and doesn’t do well, said Patch.
Often a barrier to implementation hinges on what type of capacity or learning curve exists, said Andrew Finnegan, a health insurance specialist with the Centers for Medicare and Medicaid Services’ New England Region, who also spoke at the forum.
For example, he said, something as basic as typing skills can be lacking. He recommended in such cases that providers be offered different ways to deal with this – such as training, scribes, voice recognition or quick text.
 “The EHR represents a fundamental change to the way the office handles the movement of patients and information,” Patch said.
This is where document management comes in.
“Scanning is not the answer to everything,” said Patch, noting that “preloading is more important for productivity; if you favor preloading, it is much more efficient down the road.”
He defined preloading as entering key data about a patient’s medical history – such as medications, allergies and immunizations – into his or her chart before an appointment. He said it's helpful to determine beforehand a list of items that are important to preload.
Stark said that during his practice’s EMR implementation five years ago, they preloaded problem lists, medications lists and allergies. They even came up with a preloading form, he said.
“For us, (preloading) got us up and running,” he said.
Stark added that having a “core amount of data on the record” enabled them to get the information needed to start seeing patients. 
Six months prior to preloading, he said, they began cleaning up paper charts so that information was legible. That ensured that the whole process would run more smoothly.
The session was part of regional forum series being held by The Maine Regional Extension Center, overseen by HealthInfoNet and Quality Counts, a regional healthcare collaborative committed to improving health and healthcare for the people of Maine.