Gov. Arnold Schwarzenegger signed an executive order in March to accelerate California's efforts to adopt healthcare information technology. Many physicians say his order--an unfunded mandate--is about as welcome as a computer virus.

Even so, the writing appears to be on the wall. Unless you're planning to retire soon, an electronic medical record system will likely be in your future. Preparing for that day needn't send your blood pressure through the roof. It's been done before, and there are tips for making the journey as smooth as possible.

1) Start with a needs assessment.
Include physicians in the practice and the front and back offices. "This is the time for practices to determine what they need--and if they even need an EMR at all," says David A. Ginsberg, president at PrivaPlan Associates Inc., Santa Fe. "Look at your ability to document clinical care electronically and how that documentation will interface with your billing software and diagnostic equipment and how it will challenge and change your overall business operations."

2) Make sure your facility can handle the change.
"Ask and answer this question: 'Are we ready?'" Ginsberg emphasizes. "If the answer isn't 'yes,' an EMR purchase and implementation will fail miserably."
Examine any facilities changes required for EMR readiness. Do you have enough Internet capacity to handle the EMR's additional requirements? Do you have enough electricity in the first place?

Perhaps most importantly, is the office in full compliance with the Health Insurance Portability and Accountability Act? Ginsberg's company is the California Medical Association's official advisor for physicians on both EMRs and HIPAA. "We're underscoring that most practices are woefully short of HIPAA compliance," he says.

3) Make sure your office can handle the change.
"Don't ever put a new computer system on top of bad business practices," Ginsberg says. "It's common for one practice partner to be remiss in reviewing lab results and adding them to patients' charts, for example. If it takes him or her forever now to review them and subsequently file them in the chart, there's no reason to believe the situation will improve with an EMR. It just means the lab results will sit electronically in a queue waiting for the doctor to review them."

4) Don't overestimate your staff's computer literacy.
"Employers may feel staffers know computers because they can use the billing software they've had for 15 years," Ginsberg says. Specific training needs will vary by the expectations placed on the EMR and on the staff's real readiness to use it. But you need to budget time for training. "Count on needing more than you think," he adds. "Whatever amount you think you'll need, double it."

5) Trust the experts.
The Chicago-based Certification Commission for Healthcare Information Technology certifies EMR software used in physicians' practices. "Before purchasing and installing [a system], physicians should familiarize themselves with CCHIT's certification program and they should only consider EHRs that are CCHIT-certified," says C. Sue Reber, the group's communication director. CCHIT's physician guide can be found at www.cchit.org/physicians/buy/Physician+Guide+to+CCHIT+Certification.htm.

6) Consider getting outside help.
Contracted experts can manage a practice's needs assessment and even its EMR installation and operations. "Small to solo groups feel threatened by EMRs, so they hire consultants," Ginsberg says. "But the cost can be too high. And it's important for small practices to learn to perform those tasks. Large organizations can hire someone to run them." Companies like his can also train office managers at smaller practices to manage the assessments internally. Planning ahead is key because there could be a reduction in productivity during the two or three months around installation and implementation of as much as 30 percent to 40 percent, Ginsberg notes.

7) Don't be afraid to wait, if you need to.
If all your ducks aren't in a row as suggested above, you may be better off waiting, notes Tim Pietro, MD, a urologist in Riverside. His two-person group did its homework and decided to hold off on implementing an EMR because the start-up costs were prohibitive, "particularly as we're not sure ultimately who the winners and losers will be among the vendors," he says. "The EMR sector is in a state of flux, and we don't want to link up with the Betamax of EMRs. There are going to be vendor casualties, and some of the companies are going to go by the wayside." Also, he notes, prices will come down over time, adding another advantage to the wait-and-see approach.

8) Stay informed.
Even if you're waiting to go digital, like Dr. Pietro is, make sure you keep tabs on the EMR field. "I've done some preliminary research online and looked at some different systems," Dr. Pietro explains. He also attended one of many seminars on implementing an EMR about a year ago, which, ironically, is where he came to the conclusion that it was better for him to wait. Also, he notes, he gets something across his desk related to EMRs at least once or twice a month.

Dr. Pietro's plan: Revisit the issue in a year, gather information again at that time and, in the meantime, talk to colleagues to learn about their experiences. Within two to five years, he says, he fully expects to be operating an EMR.