A locum clinician can be fully credentialed and still be unable to work at your clinic, because nobody created their EMR account. Or the account exists and can't place orders. Or it can place orders and can't send a controlled substance prescription, because that needs a separate setup step somebody at your clinic has to complete.
Urgent care EMR onboarding for a locum has two parts. The first is access: an account, the right permissions, e-prescribing, and a way to get help when a login fails on a Saturday. The second is familiarity with how your clinic has configured the system. This post is mostly about the first part, because it has to be finished before the shift and it depends on people other than the locum.
Why Locum EMR Onboarding Is Separate From Credentialing
Credentialing establishes that a clinician is qualified and permitted to work for you. It doesn't create a user account. In most clinics the two jobs belong to different people: whoever assembles the locum credentialing file, and whoever administers the EMR, which may be an outside IT company or the vendor's support desk.
Nothing connects the two unless you connect them. A cleared file doesn't open an IT ticket, so EMR access needs its own owner and its own start date.
The exposure is larger in urgent care than in a bigger practice. When a locum is the only prescriber on the shift, there's no colleague at the next workstation to enter an order or pull up a chart while the login gets fixed.
What a Locum's EMR Account Needs Before the First Shift
Their own login. The HIPAA Security Rule requires a unique name or number for identifying and tracking each user. A locum charting under a departed clinician's account, or under a shared "locum" login, defeats that, and it leaves every note and order from the shift attributed to the wrong person.
Permissions that match the role. A physician, NP or PA needs to document, order and prescribe. A locum RN or medical assistant needs a different set, and an account copied from the wrong template will either block their work or give them access they shouldn't have. Tell whoever builds the account which of the six roles it's for.
Ordering pathways. Confirm the account can order labs and imaging through whatever interfaces your clinic uses. An order that fails at the interface can go unnoticed until a result doesn't come back.
E-prescribing. Standard e-prescribing and e-prescribing of controlled substances are set up separately. The second has requirements of its own, which the next section covers.
Billing setup. How a locum's visits are attributed for billing depends on the payer, the clinician type and the arrangement. Don't guess at it in the EMR. Ask your billing team or billing company how the account should be configured before the first claim goes out.
Any second system. If your clinic uses a separate tool for dictation, an ambient scribe, imaging or occupational health, the locum needs an account there too.
E-Prescribing Controlled Substances Takes Extra Setup
Electronic prescribing of controlled substances, usually shortened to EPCS, runs under DEA rules that add steps beyond an ordinary EMR account. Three things have to be in place before a prescriber can sign.
- Identity proofing. Signing credentials can be issued only to a person whose identity has been confirmed.
- A two-factor credential. The prescriber signs with two of three factors: something they know, something they have, something they are. Whatever your EMR uses for the second factor has to be issued to the locum and enrolled.
- Access control set by two people. One person decides who's authorized to sign controlled substance prescriptions and enters them in the system. A DEA registrant then approves that list with their own two-factor credential.
The third step is the one that catches clinics out. If the only DEA registrant who can approve the access list at your clinic is the clinician who's out, EPCS for the locum can't be switched on until someone else with a registration does it. Find out now who that second person is.
How long identity proofing and credential enrollment take depends on your EMR vendor. Ask them, and treat the answer as the lead time for any locum who'll prescribe.
States also run prescription drug monitoring programs, and the rules about registering for them and checking them before prescribing differ by state. Confirm what your state expects of a clinician who's new to it, and whether your EMR's connection to the program works for a new account automatically or needs to be enabled.
Start Locum EMR Access When the Shift Is Confirmed
Open the access request on the day the shift is confirmed. Every item in the last two sections depends on someone outside the exam room, and none of them can be fixed by the locum on arrival.
Send the request with everything the administrator needs in one message: the clinician's name and role, license number, NPI and DEA number where the role has them, shift dates, and the systems they need. A request that's missing one field comes back with a question, and the question can cost a day.
Then test the account before the shift. Ask the locum to log in from home, or have someone at the clinic sign in as a check, and confirm the account can open a chart, place a test order where your system allows it, and reach the e-prescribing screen. A problem found then can still be fixed before the first patient.
Plan for the failure too. If your IT support doesn't work weekends and the locum's first shift is a Saturday, name a person who can reset a password or unlock an account, and put their number in what you send the locum.
What to Show a Locum About Your EMR Configuration
A locum who's used your EMR product elsewhere knows the navigation. They don't know your configuration, because templates, order sets, favorites lists and discharge workflows are built clinic by clinic.
They don't need the whole system. They need the handful of things your clinic has customized:
- Which note templates you use for your highest-volume visit types, and where they are
- How intake from the MA or RN reaches the clinician's note
- Your favorites or shortcut lists for diagnoses and orders
- Where the fields your billing team needs are, so they aren't missed
- How discharge instructions and prescriptions are produced
- How results come back and who's responsible for following up after the locum's last shift
A one-page reference and a short screen recording of one complete encounter cover this better than a manual. The recording is described in the locum orientation post, under EMR orientation. Send both a few days ahead, along with the login.
The reason to bother is arithmetic. If an unfamiliar configuration adds two minutes to each chart and the locum sees thirty patients, that's an hour of the shift spent finding things. An hour is a meaningful share of the provider capacity you scheduled, which is why EMR readiness belongs in the same conversation as urgent care staffing ratios.
Urgent Care Locum EMR Onboarding Checklist
When the shift is confirmed
- Open the EMR access request with the clinician's name, role, identifiers and dates
- State the role so the right permission set is used
- Start EPCS identity proofing and credential enrollment for prescribers
- Confirm who'll approve the EPCS access list
- Ask your billing team how the account should be set up
- Request accounts in any second system the locum will use
A few days before the shift
- Test the login, or have the locum test it and confirm
- Check ordering and e-prescribing on the account
- Send the one-page EMR reference and the encounter recording
- Send the name and number of the person to call for access problems, including on weekends
On the first shift
- Have the locum sign in before the first patient is roomed
- Point out the workstation, printers and any shared devices
- Introduce the MA or RN who knows the system and can answer questions
After the last shift
- Check for unsigned charts and open results, and assign follow-up
- Deactivate the account
- Note anything that failed so the next request avoids it
Turn Off Locum EMR Access When the Assignment Ends
An account that stays active after a locum's last shift gives access to patient records to someone who no longer works at your clinic. The HIPAA Security Rule lists procedures for terminating access when a workforce member's work ends among its workforce security measures.
Make deactivation a step someone owns, with a date. Remove the locum from the EPCS access list at the same time, and close any accounts in second systems.
Ask your EMR vendor how to deactivate an account without deleting it. You want the locum's signed charts to stay attributed to them, and you want to be able to reactivate the same account if they come back. A returning locum whose account can be switched on again skips most of this checklist, which is one practical reason to rebook clinicians who already know your clinic.
This post describes general requirements, and it isn't legal advice. Your compliance lead or attorney can tell you how the HIPAA and DEA rules apply to your clinic.
Rediworks is a self-service marketplace for urgent care locum shifts. Post the clinician type, dates and shift details you need, and open the EMR access request the day the shift is filled. Sign up to post shifts.