How to Survive Your Electronic Health Records (EHR) Project - January 15, 2010
Orlando Florida -- In 2002, Cedars-Sinai Medical Center in Los Angeles launched its new electronic physician order entry system. Three months later, 400 of the hospital’s physicians demanded the software be removed. Later reports cited poor navigation and usability and inadequate user training.
EHR (electronic health records), like any major software project, has to be implemented thoughtfully, with time planned into the schedule for user education, testing, and customization. In a hospital or physician clinic, the 24/7 nature of the operation can make it tempting to do an EHR implementation quickly and hope for minimal disruption to the staff. But an EHR project that is carefully planned with extra time allotted for testing, training, integration, and data migration will usually go more smoothly than rushed projects.
“We start with a series of planning discussions before any work starts,” says Brian J. McCarthy, president and CEO of Sencilo HealthIT Solution, an EHR consultancy. “We create a project charter, goals, objectives, [and a] list of the types of change that have to be endured, the timeline, resources, and assumptions.”
Health History
EHR systems, which include such things as electronic patient charts, physician order entry, doctor’s notes, lab results, and e-prescribing, make it much easier for doctors and other caregivers to see a patient’s health history and to more quickly get records and test results to other providers. They can also improve patient safety by red-flagging potential treatment errors. EHR will also be required software at all hospitals and physicians offices in the next five years.
But EHR also involves drastic changes in work processes, especially for physicians used to writing on paper charts. The systems involve the integration of software and data in various departments throughout the hospital, including admitting, the emergency room, and radiology, as well as with outside labs and clinics, and sometimes with regional health information exchanges. EHR systems are complex, costly, and usually time-consuming to install. According to Hypatia Research’s “ARRA and EHR: What Healthcare Providers Need to Know About the American Recovery and Reinvestment Act and Electronic Health Records,” the cost of EHR software and implementation services for even a small doctors office may reach about $100,000.
Successful Implementation
To better ensure a successful EHR implementation, experts at EHR software companies and consulting firms offer their advice for making the implementation process smoother.
Recruit non-IT staff. EHR systems touch every area of the hospital, not just the IT department. They also usually represent major changes in work processes for the employees, often more than with other enterprise software such as ERP and CRM. Non-IT staff should be involved throughout the project to help spot potential problems with the new workflow or screen navigation and to help with communication and training within their areas.
Workflow, then and now. Putting in a new enterprise application almost always entails changes to employees’ work processes. Hopefully, the new workflows are more efficient than the old ones, but regardless, they’re different and often unwelcome to employees. Have IT and non-IT staff identify the various workflows that will be affected and map out how they will be changed. This will help spotlight problems with the new workflow and give employees a better understanding of how the new system will work.
24-hour support. A hospital treats patients at all hours, so its EHR system has to be available around the clock as well, at least for the first two or three weeks of an implementation. However, not all software vendors expect to provide 24-hour support, so discuss it with the EHR vendor early on and work out a backup plan if need be, advises Cox. She also recommends appointing a triage coordinator to assess how well problems are being handled during the rollout. A daily change meeting to discuss changes to the implementation and any problems is also important, says Cox.
User training. User training often gets low priority, but for EHR systems in particular, user training is critical to adoption. Frustrated users will simply refuse to use the software or use it incorrectly, creating errors. Offer initial training on the product during the last couple of weeks before implementation as well as early in the rollout. To make training more convenient and ensure people retain what they’ve learned, provide multiple types of training, including instructor-led classes, computer-based training via the Web or a CD, and hands-on practice. “Pre-training, post-training, refresher training . . . It’s impossible to train too much,” says Paul O’Toole, senior vice president of operations for Healthland (www.healthland.com), an EHR software maker.
O’Toole recommends getting a group of super users trained on the system early in the process to ensure there are plenty of helpers available to help users navigate the system when it goes live. “They’re the ones that will be hand-in-hand with the docs, making sure they’re comfortable with the EHR,” he says.
Testing. There are multiple moving parts in an EHR system that can go wrong. So testing should occur throughout the implementation as each new function or module is rolled out. O’Toole says that the integration points between different software systems inside and outside the hospital, as well as with medical devices, have to be checked carefully. “You have to make sure the data is flowing properly,” he says.
Data translation is another potential problem area that requires careful checking. After a data conversion, Pam Wostarek, regional implementation manager for EHR software company NextGen (www.nextgen.com), says she has clients do thorough data point reviews and side-by-side comparisons of charts and screens to spot discrepancies.
User acceptance testing is not only a good idea, says McCarthy, but something that should be done more than once. She recommends three cycles of user acceptance testing, with each one followed by a report on the issues the users encountered.
Governance. Any major software system requires constant maintenance after it has been deployed. But if it’s a brand new application such as EHR, there may be no existing group that is tasked with administering it, causing it to be essentially abandoned after the rollout and initial fanfare end.
“One of the biggest mistakes is leaving the product to manage itself, without any governance for how to manage the application,” says Wostarek. “Governance involves assigning committees of individuals to look at content in upcoming releases and upgrades [and] look at changes in workflow [and] at changes in the organization, and ask, ‘Do we need to change anything [in our EHR system]?’”
For more information please call (407) 641-5199 or visit us at: http://www.sencilo.com
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Sencilo HealthIT Solutions is a Florida-based integrator specializing in EHR Cost Cutting storage, security and managed services solutions. Sencilo delivers a comprehensive portfolio of products from best-of-breed hardware and software from multiple manufacturers including Allscripts, VMware, Dell Fujitsu Data Domain, EMC, Hitachi, Symantec, HDS, IBM, Commvault, Xiotech and HP.
Sencilo has offices throughout Florida including: Orlando Lake Mary Daytona, Medical City
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