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Concord Hospital's 10 steps for EHR implementation

Jean DerGurahian

When Concord Hospital wanted to get its medical staff on board with implementing electronic health records (EHRs) and eliminating paper-based orders, leaders decided to play a game. The trivia game, "Stump the Staff," displayed prescriptions written by doctors. Participants were asked to guess what the order was for.

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After going through several prescription orders and seeing how people confused the anti-anxiety drug diazepam with the anti-inflammatory drug Naprosyn when the orders were written out by hand, staff started to get the message, according to Joel Berman, chief medical information officer at the New Hampshire hospital. One of the surgeons with the worst handwriting became the hospital's biggest advocate for a computerized physician order entry, or CPOE system, Berman said. "He couldn't wait."

It's not just about games. Once physicians could see that their handwriting could lead to misinterpretation of orders and possible harm to patients, they were more willing to make changes, Berman said. "We want to make this case in a way that's memorable and palpable."

The message must stick, because physician engagement is a key step in an EHR implementation -- which leads to improvements in patient care, Concord Hospital said.

The hospital presented tips for implementing EHR and meeting meaningful use requirements during the Healthcare Information and Management Systems Society's HIMSS 2011 Annual Conference and Exhibition. Focused on its EHR implementation project since 2004, Concord Hospital has been recognized nationally for its technology efforts.

We have to have a heavy presence of clinical people.

Deane Morrison, CIO, Concord Hospital

What providers have to realize is that the efforts they make toward establishing electronic records and becoming eligible for the EHR Incentive Programs are not short-term projects, said CIO Deane Morrison, who, along with Berman, spoke at HIMSS 2011. They need to treat this project the same as they would any other major investment. "It really needs all the same discipline."

Concord Hospital estimates that it could receive as much as $26 million in incentives by meeting meaningful use criteria. If the hospital decides not to participate, it could face about $15 million in penalties by 2015, Morrison said.

To ensure EHR implementation is done right, Concord Hospital recommends these 10 steps:

  1. Interpret the Health Information Technology for Economic and Clinical Health, or HITECH Act. The standards continue to be refined, but providers have to decide where to focus their efforts, Morrison said. "Draw a line in the sand, take a position and move forward."
  2. Determine the financial impact on your hospital.
  3. Conduct a gap analysis. Track readiness for meeting meaningful use criteria.
  4. Define future capital needs. Remember, there are two more stages of meaningful use on the way. "This is not a one-time spend," Morrison said.
  5. Create a strong governance structure. Staff at all levels should be on board.
  6. Establish a program office. A project of this size needs leadership to oversee the changes in clinical workflow, among the other operational changes that come with an EHR system, according to Morrison: "We have to have a heavy presence of clinical people."
  7. Engage your hospital's physicians. "I can't say enough about this step," Morrison said. "Physicians have to lead this."
  8. Separate each meaningful use requirement into individual projects.
  9. Develop a timeline.
  10. Monitor progress. The governance team should be receiving reports and gauging how well projects are moving forward and meeting set timelines.

Let us know what you think about the story; email Jean DerGurahian, Executive Editor.


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