How to Plan for a Practice Management System / EHR / EMR Transition

May 12, 2021
by Admin

The best advice you will ever hear ever in life about changing your Practice Management / EMR / EHR System…

? #IndustrySecretAlert?:

Change is hard. Blah blah blah. Something inspirational about how growth only happens outside of your comfort zone.

…OK let’s get real. Changing your PM/EHR/EMR System is one of the most painful things you can/will do in your medical practice. Your staff will not be happy. You will not be happy. Your patients will not be happy.

Honestly, the best advice I can give you…

Don’t let the pain of change management allow you to waiver on the best decision for your practice for a second. If it is the right change, bite the bullet and do it.

Plan it out. Do it carefully. Expect things to go wrong. You won’t be able to plan for it all, but here are a few items to consider for your big change…


1) Give yourself the right timetable for your software transition

Plan on your EMR/EHR/PM wanting 6-8 weeks for launch. Expect 25% of that “training” to be with live data. Like that idiom…you’ll be building the airplane as you fly it or whatever? This means scheduling live with patients. This means learning how the workflow you watched the webinar on interacts with your actual day to day…and finding something new/a question (or seven) every day…for weeks. This means billing with live claims and figuring out what part of your setup is wrong and clogging up your revenue stream/cash flow.

So how do I make this hurt less?

Great question. Practice. Run clinic days with friends of the practice on the weekend. Use test patients (like in the system Dr. Frankenstein). Every single person who works for your practice will use your system…they need to practice too. I don’t care if your aesthetician comes in once/month and they’re barely there so NBD. I don’t care if your surgery scheduler is part-time and they’re going to retire soon so they’ll just use the paper ledger until then. They practice using the system too AND THEY USE THE NEW SYSTEM.

Oh, yeah, that means you too Doc. Guess what happens when you can’t remember squat because you skipped half the implementation calls and/or were eating lunch during the session on “documentation” (who cares right?)…your team has to micromanage the wake of paperwork/activity that you forgot to make and actively retrain you while you’re creating a new wake of stuff. Not fair. Don’t do it. Lead by example and be a system captain or assign one and make time to train with them before you hit clinic.

So what’s my realistic timeline?

8+ Weeks = You’re cool, calm, and collected.

4-8 Weeks = You made it OK…nothing goes off without a hitch, right?

2-4 Weeks = You’re not serious are you? You will have problems…

2 < = You’re nuts. Stop it.


2) Plan your workflow owners

Whether you’re a 2 person show or a 200 seat PEO-backed derm monster biz…you have departments. Front Office, Customer Service, Scheduling, Patient Care Coordination (Sales), Clinical, Medical Assistant Team, Physician Extenders, MDs…every seat has a different workflow. These workflows interact with your system modules such as, but not limited to: Scheduling, Billing, EMR/EHR, MedSpa, ASC, Financial, etc. Find the overlap. Find the interactions. Test them and validate the impacts. Oh yeah…and make sure it is set up appropriately…junk in = junk out…

What does mean?

Have your leaders in each group test each process from each seat in the house. Have them talk after. Walk test examples all the way through. You’ll see bites/chunks in implementation….but not front to back.

For example:

Susie scheduler decides she wants a new Appointment Type for Tissue Expander fills in your breast recon practice, but doesn’t know the full system for setup. She adds it in and starts booking TE fills for 15 minutes, which are half the time of a standard post-op so she can be more efficient with the schedule, which was SO ANNOYING in the old system because they were all 30 minutes and you kept getting mad because you could have seen another cosmetic consult (damned front desk). Great idea Susie! Bad move though. Now we have missed setting up the workflow tied to Appointment Recalls for post-ops (remember these are TE Fills now, not Post Ops) so that if a patient doesn’t show up in 30 days from surgery for that fill, they get don’t get that automatic reminder…so these patients fall off that workflow. Oh and also, the billing team doesn’t know to include the TE Fill Appointment Type in their Schedule QA report so these fall off the billing workflow so no claims get billed out the door (ya ya ya, these aren’t billable visits but you get the point). Oh and your office manager who runs time-based metrics on KPIs for your care regimen just lost all post-op time metrics for your 2-stage reconstructions so now they look 4x as profitable, when you actually just lost 11% this year because the AMA just BSed everyone into thinking they made E/M coding easier when they really just were throwing a shiny object to distract from the drop in conversion factor rate.*

*don’t know what any of that means? You should call us…we can help.

Plan for your clearinghouse cut-over

Let’s play the glossary game…

Clearinghouse = electronic USPS. If you don’t have one and you’re sending paper claims / getting paper EOBs…you better be an out-of-network provider (OON)

Enrollment = you telling your contracted payers where to send/receive data (from a software standpoint)

Old Billing Company = The goombas you used to use

New Billing Company = The guys/gals you just hired

Basically, this is going to suck for your billing team and if they make any mistakes it is going to not be fun for your bank account either.

Enrollment issue = no claims submitted = no money in your bank account.

OR, if you’re lucky…

Enrollment issue = no ERA = no financial integrity.

OK, so what do I do?

Start, at minimum, 30 days ahead of time. KEEP IN MIND: When you change your enrollments, the data comes/goes to/from 1 system (technically there’s more to it than that, but don’t worry about it, the new guys/gals are all over it). This means that the goombas can’t get the payment info anymore so they don’t know what to post where or even that there is a payment. And your patients? They’re going to get maybe two statements with two places to pay and, oh they love that!

In Short: expect to run two systems for at least 2-3 months unless you want to deal with a data transfer.


There’s still more…

  • You’re probably not providing proper training

  • The software training is not good enough (they show you where the buttons are, not what they mean from workflow standpoint for your practice protocol…because they don’t know it)

  • The software training is not good enough (6 hours and a library of snooze videos DOES NOT EQUATE TO HOW HUMANS LEARN)

  • Did I mention the training thing? Humans need months to learn habits/skills/processes. It is a repetitive thing. The system is designed to be imperfect here. Software companies can’t train you every day for three months. They can’t hold your team accountable. You can’t run two systems for months. Rock? , meet hard place ? . So focus on training.

  • Plan for 3-5K+ in medical record export/transition costs (on top of everything else and don’t expect much more than pdf files in a folder structure).

  • Your implementation officer with Software Company XYZ will no longer exist after you launch…Bad news first: support isn’t nearly as good as implementation.

  • Did I mention things will be different and no matter how much of the new you love you’ll be missing that one thing the new system can’t do enough to regret it and you’ll want to buy some plug-in software that resembles the old thing?


I know that was a lot of doom/gloom, but don’t worry! You made the right decision because you carefully thought about the software choice and are certain it is the right choice right?!

In case you need a refresher on that thought process…



Want help? We got this.


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