EVMR 101: Why & How to Take Your Practice Electronic

The medical record revolution began in 1968, when Dr. Lawrence Weed transformed clinical thinking through his publication of the Problem Oriented Medical Record (and patient SOAP note; see Resources: SOAP Note), still used to this day by veterinarians, veterinary and human nurses, physicians, dentists, and more.¹

His concept was simple—more organized and thorough medical record documentation. Until then, a patient’s record contained little more than a diagnosis and list of treatments. The rest of the record remained in the human mind,^2-4 a bragging right for physicians of the day.

Weed knew we had to do better.

“We’re trying to get across the idea that this record cannot be separated from the caring of that patient,” he said. “This [record] is the practice of medicine. It’s intertwined with it. It determines what you do in the long run. You’re a victim of it or you’re a triumph because of it.”⁴ 

He also knew the revolution’s next phase involved leveraging all the enhancements digitized records provide, later developing one of the earliest known electronic medical record systems.⁵ 

As the human medical world rapidly transitions to digital records, modern veterinary medicine must do the same.⁶ Follow this start-up guide to the whys and hows of Electronic Veterinary Medical Records (EVMRs).

Why Go Electronic?

The third leading killer of humans today is medical errors. The statistics are haunting—medical mistakes account for the equivalent of 2 or more jumbo jets full of people crashing per day in the US alone.⁷

In veterinary medicine, we likely deal in similar statistics but lack the robust reporting capabilities to quantify the numbers. Electronic record adoption has the unique potential to address this unacceptable issue and many more, even if the available offerings are still in a rudimentary state. 

Our industry is transitioning. Workflows are changing, practices are consolidating, care is advancing, and case-sharing among veterinary teams is becoming essential. This all means adopting electronic medical record systems is necessary.

Reasons commonly touted in favor of EVMR include efficiency (eg, record portability, no lost charts), revenue (eg, automated charge capture), patient care (eg, better documentation, remote access), client service (eg, patient portals), medical errors (eg, illegible handwriting), and analytics (eg, accounting, medical).

And this just skims the surface. The better question is Why wouldn’t you go electronic?

Ready to make the transition? Over the past 6 years, I’ve helped take 2 different multispecialty practices nearly paperless. Use the following guide and learn from my mistakes—and successes.

Identify Your Starting Point

First, identify the current starting point of the practice to assess the work and time involved in a transition. In my experience, veterinary practices can be digitally classified 5 ways. 

• The Luddite: Paper everything

• The Apathetic: Paper charts, electronic schedule, and client rolodex

• The Confused: Paper charts with some electronic documentation (medical notes, prescribing)

• The Paperlight: Electronic everything, except treatment sheets

• The Paperless: Electronic everything, including treatment sheets

Timing Decisions

Pick a go-live date and timeline. Depending on your starting point and practice size, consider a 5- to 6-month time frame. Work backward, looking at the practice’s historical ebbs and flows. Ideally, the go-live date will correspond with the slower season.

Month1

Identify the Team

Mission critical is naming the superuser, the leader of the project ultimately responsible for the successful transition, and the transition team. A superuser should be an actual in-the-trenches medical team member, ideally a veterinary nurse. Why? Veterinary nurses often have an unmatched understanding of the entire practice workflow.

Month2

Research Software Options

The team searches the internet and talks to at least 10 other similar-size practices. After narrowing the choices, don’t settle for a demo from software vendors. Demand the software for a period of time to test with the team before making the final decision.

Months3&4

Plan Practice Workflow

With the software chosen, assess current workflow and meticulously plan future workflow. Comb through everything from check-in to check-out. Identify pain points and dream up how they can be fixed by switching to EVMRs. Meet with veterinarians and other key team members. Allow a full challenge of the plan and be open to adjustments, which will help with team buy-in.

Month5

Train the Team

Every team member should attend 1 lecture and 1 hands-on laboratory to be ready for the go-live date. Software vendors will often assist with training. This is also the time to begin transitioning existing paper records to electronic, most often through scanning and importing records. Ask the software vendor to help, because the company may offer tools that make the process more efficient.

Go-Live-Day Tips

The day the switch is flipped, make some minor tweaks to optimize success and lessen the pain. Plan the patient load carefully in the first week, making adjustments such as extending appointment blocks and scheduling extra team members.

Management should work with the medical team during the first week. Have everyone work from the treatment room floor so they can hear concerns firsthand and pitch in. Keep team members engaged by making it fun with contests, prizes, and food. Also, don’t overlook the opportunity to involve (ie, brag to) clients by placing signs announcing you are launching a new computer system to improve client service and patient care.

Finally, remember the workflow should not remain static after the go-live day. If something isn’t working, admit defeat and improve it. 

Change is always hard, but follow this advice and turn your practice into a well-oiled, electronic recordkeeping machine in no time.