Nobody had to ask Oliver Khakmahd, MD, twice to implement an electronic health record (EHR) system in his large, busy nephrology practice—he was ahead of the game by developing his own computerized program for his colleagues at the East Bay Nephrology Group (Oakland, Calif.) and Oakland’s Dialysis Access Center, where he is the medical director.
But for nephrologists who are less enthusiastic or simply overwhelmed by the prospect of converting to online medical records, Dr. Khakmahd outlines why their practices do need to go electronic and how to make that happen.
How big is your nephrology practice?
Dr. Khakmahd: We have 18 nephrologists, two nurse practitioners, and two physician assistants throughout the four offices in our practice, which covers a 35-mile range in the East Bay area of San Francisco. We have more than 900 dialysis patients, 14 dialysis units, two access centers, and five hospitals to cover.
When did you start implementing an EHR system?
Dr. Khakmahd: I have a bioengineering background, so back in 2005 I had developed a chronic kidney disease database that we used to track the patients. And four of our doctors had jumped into that implementation.
Then, when the government started having these regulations about adopting electronic medical record [EMR] systems, we thought about certifying my database by one of the government certifying agencies, but since I was just a one-man operation in terms of developing the software and expanding on it, we decided to go with a proprietary software that I don’t have to keep up with. So in early 2011, to maximize our government incentives, we sent requests for proposals for a certified EMR system that is useful and practical in a nephrology practice.
How did you choose your vendor?
Dr. Khakmahd: We pursued certified technology that is nephrology-practice-friendly and we wanted a superb support team. After multiple demos from different vendors, we decided on Falcon EHR. You need a vendor with a strong backbone and with a support team that does not rest until all the problems are resolved, understands nephrology workflows, and is always available.
How did you prepare in-house?
Dr. Khakmahd: We created a committee of four physicians who were interested in EHR implementation, and we got input from those people, because in a large practice, when you have 18 strong ideas, things may go in the wrong direction and not be productive.
The committee members were not all particularly computer-savvy, but they were from all different areas of our practice and represented different age groups. With that input, we developed a clear-cut project plan with reasonable, measurable goals.
What did following the project plan entail?
Dr. Khakmahd: We started this project in March 2011, and we spent most of our summer reviewing our workflows and our practice processes, redesigning our examrooms so that the computers could easily fit in and not interfere with patient interaction, and creating the templates for different clinics that we offer.
For example, we have erythropoietin, CKD, and transplant clinics, so we designed the templates for the medical records to meet the needs of each. With the help of Falcon EHR support team, we also spent some time converting some of our old system data and demographics into formats compatible with the new system, so we had a ready-to-go system.
We went live on September 12, 2011. We didn’t have much time to meet the [Centers for Medicare & Medicaid Services, or CMS] Meaningful Use] requirements that way, but we had set our goals to meet the requirements in 2011.
I was the physician champion on the team, so I sent weekly reminders and newsletters to keep the users informed about what was happening, and we had adequate support from Falcon, and everybody was engaged in the implementation process.