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Ten tips for a hospital EHR implementation process

Achieving meaningful use involves implementing electronic health records (EHR) first, then choosing core measures to report to Medicare or Medicaid. On paper, that may seem fairly straightforward. However, getting

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an entire hospital on the same page -- or screen, as it were -- and ready to report on those core measures and prove meaningful use is anything but.

Denni McColm, CIO for Citizens Memorial Healthcare in Bolivar, Mo., helped implement the organization's EHR system in 2003. Project InfoCare is a completely paperless system. Its workflow also connects with the Google Health website for patients' personal health records, thereby meeting a key meaningful use requirement. She is confident that Citizens Memorial is ready for when meaningful use rules are finalized and the first reporting periods begin next year.

For IT leaders still in the throes of their own EHR implementations and on the road to reaping federal incentives, McColm looked back on her experiences during a recent Healthcare Information and Management Systems Society (HIMSS) webinar, and shared 10 tips for making the process go more smoothly. (Citizens Memorial has received a HIMSS Stage 7 Award for EHR adoption; such an organization, according to HIMSS, "support[s] the true sharing and use of patient data that ultimately improves process performance, quality of care, and patient safety.")

•  Pick the right people. Along with what McColm calls a stellar IT staff, Citizens Memorial picked a group of 50 "super users" to test and roll out Project InfoCare.

Physicians and other users go through the five Kübler-Ross stages of grief over the loss of the paper [records] -- first denial, then anger, then bargaining, then depression and then acceptance.

Denni McColm, CIO, Citizens Memorial Healthcare

•  Agree on the "why." One of the implementation team's top goals was to maintain continuity of care for patients while it brought the EHR system online.

•  Evaluate alternatives. You've probably picked an EHR vendor or at least identified one as the best fit for your facility, but look at others "so people don't wonder if there's something else better out there," McColm said.

•  Secure resources up front. Make sure you have all the resources and funding needed to proceed. Having funding for three or four years' worth of EHR implementation costs kept physicians moving forward who otherwise might have been wavering about buying into the project, McColm said. If funding had been dicey or as-yet-to-be-approved, it would have given them reason to doubt the project's eventual success.

•  Plan in detail. Documenting the EHR implementation in advance and following it step by step will make clear to all stakeholders the reasons for the decisions that were made. Include the vendor as well as representatives from all user groups in this process. This part involved two days' worth of hashing out who was going to do what, and when, McColm said.

•  Articulate objectives. Set down your main goals in a vision statement, and repeat them over and over to yourselves and to staff who are learning the system. For instance, one of Citizens Memorial's chief objectives -- identified by patients -- was to have patients provide their information only once; in other words, they wouldn't have to repeat it when they moved to a different part of the facility. Building the EHR implementation to accommodate that goal involved constant reminders, but the payoff is that now, patients can schedule appointments with any of the hospital's providers from any location in its facilities.

•  Communicate constantly with physicians. Solicit their input on processes throughout the implementation. At Citizens Memorial, that meant opening lines of communication so doctors could offer feedback at all hours of the day and through various means, such as email and phone.

•  Involve the pharmacy. Don't make this department an afterthought, even though you might be spending a lot of energy on achieving physician buy-in.

•  Consider phasing in the EHR implementation. Some experts and CIOs advocate a "big bang" approach to switching from paper records to an EHR system, but McColm's facility used a hybrid paper-electronic workflow for a while. This gave staffers a chance to get used to the electronic medical records system; when it came time to flip the switch on the paperless workflow, go-live was a "nonevent" for the physicians, she said.

•  Provide continued support. Seven years after going live, Citizens Memorial still staffs a physician resource room near the medical-surgical unit with an information systems specialist or a super user to help docs or other EHR users who have questions about or problems with the system.

"Expect it to be hard," McColm said. "Physicians and other users, too, go through the five Kübler-Ross stages of grief over the loss of the paper [records] -- first denial, then anger, then bargaining, then depression and then acceptance. When a physician gets to the bargaining stage and starts bargaining, that's a hard stage to be in. Just know that it will move on. We don't want them to get to depression, but that's right before acceptance."

Let us know what you think about the story; email Don Fluckinger, Features Writer.

This was first published in October 2010

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