Tip: Best practices for implementing EHR

Without proper management, an EHR implementation may quickly run off the rails. Health care leaders offer tips for keeping the train on the tracks.

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Developing a detailed plan and including the entire staff are keys to the success of an electronic health record implementation project, according to a group of health care executives who offered tips for successful technology adoption as part of a webinar hosted by the Health Resources and Services Administration.

Terry Hill, executive director of the National Rural Health Resource Center, spoke as part of the presentation, titled Leadership Tips During a Health IT Implementation. He said problems always arise during any health IT project. These issues often include low organizational stability, high emotional stress on the part of staff, and high employee turnover. He said the period immediately following electronic health record (EHR) implementation has been referred to as the "valley of despair," because productivity typically drops and staff members become upset.

Embrace workflow changes

While many organizations may try to avoid this valley entirely, managing a way out of it is what really counts, Hill said. To accomplish this, organizations need to have a clear plan for handling productivity losses before the process of implementing EHR begins. Hill recommended that providers develop strategies for engaging workers in all departments, alerting staff to the fact that success will require a cultural change and redesigning workflows.

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Getting staff members on board with workflow changes may be one of the most difficult aspects of an EHR implementation, but it is also one of the most critical, said Greg Wolverton, chief information officer at Augusta. Ariz.-based White River Rural Health Center. When his organization initially moved to EHRs it preserved existing workflows and processes. Wolverton said that approach "absolutely positively has not worked."

In order for a technology initiative to deliver its desired benefits of improved efficiency and patient care, medical staff need to realize that they will have to change the way they deliver care to make the most effective use of IT systems, according to Wolverton.

Joe Wivoda, CIO at the Duluth, Minn.-based National Rural Health Resource Center, said developing a strategic plan should be the first step in any IT initiative. He said many organizations start implementing EHR simply to chase incentive payments or avoid penalties. But providers who have this motivation typically overlook the effect technology will have on workflow. Failing to plan may lead to major disruptions that are difficult to recover from.

"It's more than just double clicking on ‘set up’ and hitting next until it says ‘finish,’" he said. "There's a lot to this and your organization as a whole needs to be ready for it."

Build in long-term plans for replacing technology

In addition to addressing workflow changes, Wivoda recommended that organizations look at the long-term cost of an EHR system during the planning stage. He said many providers understand licensing costs and implementation fees, but few are aware of the staff costs that come from transferring paper records into electronic systems or that hardware needs to be replaced frequently.

It's like a carnival out there -- it smells good and it looks good, but at the end of the day, it really gets expensive.

Greg Wolverton,
chief information officer,
White River Rural Health Center

Wivoda said the industry best practice is to replace anywhere from one-quarter to one-third of an organization's computers annually. Practices should build this expense into their long-term cost projections.

Educating workers is critical to getting the buy-in necessary to convince clinical staff to change the way they deliver care, the presenters agreed. Wolverton said the majority of his staff did not know what the meaningful use program was when White River initially began rolling out EHRs. Many thought it was just something management had conceived of to get people to do more work, he said.

However, once doctors and nurses understood the goals of EHR implementation, they embraced the system and made use of it in treating patients, Wolverton said.

Hill said when people recognize why they are being asked to do something different they are more likely to follow through on it. When the goals of a technology initiative are clear, people are typically able to handle greater amounts of change.

"People need to understand why we're going through this and why change is actually going to happen," Hill said.

Find the EHR cheerleaders

Wivoda recommended that organizations identify what he called executive champions. These are members of the executive staff who familiarize themselves with all the details of a technology initiative and make themselves available to answer questions from clinical staff. When workers see top management is in favor of a technology project they often get behind it.

Unless providers take into consideration the need for planning, workforce education and workflow adjustment before starting EHR implementation, care quality may suffer and costs may rise due to inefficiencies, the presenters said.

"It's like a carnival out there -- it smells good and it looks good, but at the end of the day it really gets expensive," Wolverton said.

Let us know what you think about the story; email Ed Burns, News Writer or contact @EdBurnsTT on Twitter.

This was first published in September 2012

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