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Meaningful Health Care Informatics Blog

Aug 5 2010   10:33PM GMT

The top ten steps to do prior to de-installing an EHR

Posted by: RedaChouffani

For many healthcare organizations that have made the commitment to paperless and implemented an electronic health records the road has been challenging.  Some have at some point contemplated the de-installation of the entire system, and others worked through the pain points and found new ways of making work..

Usually in an environment where physicians are making every attempt to not loose focus on providing the patient care needed, it is understandable to see the tensions and frustrations that can come for implementing an EHR.  So, prior to deciding when enough is enough and giving up on an EHR system what are the steps needed to be taken prior to finalizing the de-installation decision.

The top ten steps to do prior to de-installing an EHR:

1.Be objective: One of the most critical steps of identifying if the current EHR investment can be saved would be to identify what exactly is causing the frustration, bottlenecks in workflow or downtime.  Focusing on the situation not the application or vendor will help create specific items that could potentially be resolved through training and simple support calls.

2.Assign a team lead or champion:  Having a person that can be the point of contact to report system problems, an individual who can work with vendors, and a team member that is looking for a way to salvage the EHR installation would be a very helpful step.  This would enable the organization to properly identify tangible and specific system problems that may be causing the sour taste,  and create a positive atmosphere toward making an effort to resolving the challenges of the solution.

3.Get more training if needed:  Many of the vendors are more than happy to assist with additional training when requested.  So, an organization must accept the fact that they may need more training to properly perform certain actions.

4.Talk to your vendor: In most cases the vendors or Project manager that was assigned to you during the implementation stage assumes that you are a happy client when they don’t hear your feedback. And that your sole point of contact with the company is the support line or an individual that changes every time you make the call.  You must make an effort contact the vendor and express your frustration and challenges.  As many vendors, it is important for software companies to keep happy references and reduce if not eliminate bad PR.

5. Discuss your needs with a third party consultant: Unfortunately not all EHR vendors are able to assist in integrating all the different healthcare products to create a comprehensive solution.  Their expertise is usually based solely around their product.  While there are few vendors that do offer a wide spectrum of services that include consulting, interfacing and integration, it is important to seek assistance from consultants that have assisted other organizations identify issues associated with the EHR.

6. Identify the real source of the issues:  On many occasions, clinical staff run into performance issues on the system, and rightfully so, this has a direct impact on patient care, productivity and the bottom line.  But what seems to be a classic case of software issue, sometimes it is simply the infrastructure that may not be meeting the requirements of the solution.  From slow wireless connections, to slow workstations that barely browse the internet,   it is critical to identify the real source of the problem.

7.Involve everyone:  Whether all the vendors agree on the source of the trouble or not, it is critical to get everyone involved.  From IT, to clinical staff, software vendors and management, everyone must work together and be aware of what issues the organization faces.  This can assist in identifying at a much faster rate possible solutions to help.

8.Compare what you have gained thus far:  On many occasions, one would tend to ignore the positives that came out of the EHR.  Thus step would require you to compare your pre-paperless days and identify what you have gained in added efficiencies, collections, or even incentives from using the EHR.

9. Are the health records accessible:  With the enactment of the ARRA in 2009, and the final ruling on meaningful use,  software vendors are now required to use agreed upon interoperability standards.  But unfortunately for practices utilizing systems that may not adhere to the requirements of the Certified EHR,  extracting existing electronic health records in a standardized fashion would be the biggest challenge when considering de-installing the product.  This can be considerably more challenging if the model used is a web based solution.  Of course, no one anticipates needing to extract data from the new and existing EHR  package during the implementation phase, so many of those questions are never addressed upfront.

10.costs associated with the de-install:  The last step that is a must review is the costs that would be associated with the de-installation of the system.  Whether the organization is going back to paper and requiring staff to print all charts and file them as paper,  or simply maintaining the system and enduring more maintenance costs associated with keeping the system intact, the stakeholders must account for those added costs.

In most organizations having to decide if a system is sustainable or not is something that should take serious consideration, analysis and team work.  In some cases things can be corrected through retraining and reevaluating some of the workflows.  But with the steps listed above, it may help reduce de-installations and confusion associated with the process.

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