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Is Stimulus Money Enough?

Bill Mitchell, for HealthLeaders Media, May 12, 2009

Assume for a moment, there will be enough stimulus money to cover the cost of your electronic medical record system. Also assume that you receive the funds prior to your investment, so cost is not an issue. Will your EMR project succeed?

The healthcare industry, has been discussing, testing, and building electronic medical records for 20 years. And yet, the latest study by HHS shows that less than 2% of hospitals have a fully functioning EMR and only 8% to 11% have at least one area fully digital. So, when I see surveys stating 75% of hospitals think cost is the biggest obstacle to implementing an EMR, something doesn't ring true. Until hospitals address all of the barriers, they won't be successful.

Why has success been so elusive? There are six stages to implementing an EMR and each has its own pitfalls. Hospitals can improve the success rate if they recognize the risks at each stage and plan accordingly—especially if the stimulus money reduces the cost barrier.

1. Determine readiness to tackle the EMR. This is a basic planning step, but in practice it's often overlooked. So much time is spent justifying the investment and getting it approved in the budget, no one wants to look back and see if the organization is really ready. Basic issues like prerequisite applications and network capacity will come out in the wash, but other issues lurk in the background. The two biggest are inaccurate or incomplete data and a resistant organizational culture. Both will kill an EMR project if they are not spotted and addressed prior to the implementation.

2. Identify the needed components of an EMR. Everyone has a sense for what a fully digital hospital might look like with every record, test, procedure, image, and file online. But reality is not so clear. The EMR is really a poorly defined term. Vendors and analysts have different definitions for what constitutes an EMR. Too often, the buyer and seller have different definitions and therefore different expectations of what the new system will be able to do. In addition, no one can implement a full EMR at once; the big bang doesn't work. So, the organization must define what components of an EMR have the biggest impact on the hospital and prioritize what will be done first.

3. Select a vendor. There is nothing more basic than contacting vendors, arranging demos, and soliciting user feedback. But how often does the decision come down to vague statements like "either one of these systems will meet our basic needs, but this one seems more cumbersome to use?" This is such a common response that it could be a symptom of a problem—not a conclusion. The evaluation team often sits through canned demonstrations by the vendors, has limited time to devote to the process, and feels ill-equipped to evaluate the systems. In the end, the demonstrations are not easily compared one to the other and do not represent how the system will be used by the hospital. So the team draws conclusions in a very subjective manner.

The solutions to the three barriers above are basic pre-project blocking and tackling. The fundamental problem is that most organizations rush through these steps, which plants the seeds of future failure. In my opinion, 25% of EMR projects fail because of one or more of these three issues.

4. Implementation and training. This is, of course, where many projects fail. In some cases, mistakes in the first three steps come to roost and show themselves here. In others, failures in this stage cause the project to break down. One common pitfall is letting the vendor build the project plan. For example, timelines are governed by the vendor's resource constraints and the project steps are very general or written in complex technical terms. As a result, it is difficult to really know how the project is progressing until it is well behind schedule.

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