Future EHR Users
Implementing an EHR will dramatically change how your organization functions. To derive the full benefits of an EHR, your organization needs to be ready for these changes. A thorough and honest assessment of your organization's readiness should take place before you choose an EHR.
Question 1: Are you ready for an EHR?
Careful consideration must be given to the question of whether your organization is ready for an EHR. An EHR is not a panacea — on its own it cannot solve problems with workflow, efficiency, staff training, or quality. In fact, if such problems exist, implementing an EHR may just make them worse.
Staff Readiness for EHR Implementation: Three independent orthopedic practices recently implemented the same EHR product. Each practice struggled with their implementation because they were unprepared in many respects to move to an EHR. Each of the practices identified the lack of basic computing skills among staff members as a major challenge. Read More »
Before committing to acquisition of an EHR, it is wise to make a careful assessment of your organization's readiness for EHR implementation. If the assessment points to areas where your organization lacks minimum requirements for EHR implementation — such as a lack of basic computer skills among the staff — you can benefit by remedying these deficits before trying to implement an EHR.
Organizational Assessment Tools: The AHRQ National Resource Center for Health IT includes a number of tools that can help you assess organization's readiness for EHR implementation. Interested users can search for such tools in AHRQ's Health IT Survey Compendium. One useful readiness survey is the Primary Care Information Project's Evaluation Provider Survey.
Question 2: Why do you want to implement an EHR?
Setting goals is a critical step in the EHR implementation process. Your organization's goals in implementing an EHR should be clearly stated, and the implementation plan should include strategies for achieving the goals as well as a way to measure your progress towards them.
Setting and Achieving Goals: The Doctor's Office Quality – Information Technology program has developed a useful document on goal setting and AHRQ has developed an HIT Evaluation Guide that can help you determine whether your project is achieving its goals and producing the desired results.
Conflicting Priorities: Regulatory Compliance vs. Clinical Workflow: A large community hospital recently implemented a comprehensive EHR. The hospital's nurses were some of the most vocal critics of the new system. In addition to generally slow response times, the nurses felt that the EHR's admission assessment form was too cumbersome and as a result took too long to fill out completely. The poor design of this form has resulted in many incomplete patient records Read More »
EHR Incentive Programs
The Medicare and Medicaid EHR incentive programs provide financial incentives to health care providers that are able to demonstrate "meaningful use" of certified EHR technologies.
Meaningful Use: CMS provides information about the Federal EHR incentive program
Question 3: How do you select an EHR?
Functionality is only one factor in identifying the right EHR vendor. Other important factors include eligibility for Federal incentive programs, maintenance, support, privacy, ability to link with other systems in the facility, and data ownership. The Office of the National Coordinator for Health Information Technology (ONC) has established Regional Extension Centers across the United States to help health care organizations select, implement, and qualify for Federal EHR incentive programs.
Regional Extension Centers: Find your local ONC Regional Extension Center.
Choose Your EHR Vendor Carefully: Three independent orthopedic practices experienced several unintended consequences after purchasing their EHRs. The practices discovered that they needed to make costly customizations to the systems that were not covered in the original contract Read More »
Question 4: How do you conduct a workflow assessment?
The EHR will not magically improve your processes; in fact, preexisting problems can spread and worsen if they are not addressed prior to implementation. Assessment of your current processes, identification of inefficiencies or safety risks, and redesign of inefficient or unsafe processes should take place before you implement your EHR.
Redesigning Hospital Workflow: A two-hospital health system preparing to implement a new nursing documentation and ordering system assembled an interdisciplinary team to assess their current patient admission processes. They determined that there was significant duplicate documentation in the nurses' workflow. Read More »
Question 5: What are the recommended practices for avoiding unintended consequences of EHR implementation?
As we've emphasized, implementing an EHR is a difficult process that may disrupt your organization's work and upset some colleagues and patients. The following is a list of implementation practices based on expert consensus that should help you avoid EHR-related unintended consequences during EHR implementation
- Project scope is defined, with clear, reasonable, measurable goals.
- Users are well informed and engaged in the implementation.
- Initial milestones should produce early "wins" that will help maintain momentum toward more difficult long-term objectives.
- Plans are detailed but not overly complicated.
- Multiple mechanisms for collecting feedback from users are in place.
- The capacity to analyze and act on user feedback is in place.
- Leaders should work to develop consensus when disagreements arise.
- Use of consultants should be carefully planned with specific objectives before they are employed.
- A critical mass of users must be ready for the implementation.
- A plan for involving clinicians must be developed, followed, and evolved.
- Metrics for success should be determined beforehand and evaluated over time.
- The organization should hire and deploy staff where and when they are most needed.
- Maintenance routines and an environment to support ongoing quality improvement should be established
Source: Ash JS, Stavri Z, Kuperman GJ, et al. Consensus Statement on Considerations for a Successful CPOE Implementation. J Am Med Inform Assoc. 2003; 10: 229-234.
Health IT Journeys: ONC has collected a number of success stories from early adopters of EHRs.
Managing Expectations About How EHR Implementation Will Affect Workflow: Clinicians at a college student health center complained that the introduction of an EHR significantly increased their workload. In particular, physicians and nurse practitioners complained that the additional time they had to spend learning to use the new system combined with the additional burden of documenting patient visits in the EHR reduced their capacity to focus on delivering patient care. Read More »
For additional advice on avoiding unintended consequences and tools for monitoring EHR usage, you may want to consult the next section of this module, for Current EHR users.
In Module III we offer tools and information to better understand and identify unintended consequences. Much of the next module is based on a model of interactive socio-technical analysis (ISTA) developed specifically to understand unintended consequences of EHRs.