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Why Do Some Hospitals Successfully Implement EHRs and Others Fail?

Carrie Vaughan, for HealthLeaders Media, November 17, 2009

There are pieces of advice I hear repeatedly when talking with technology executives about implementing electronic health records and why some organizations are successful whereas others struggle. Phrases like "get physician buy in," "allocate more resources for training," and "spend more time planning on the frontend" come to mind. Unfortunately, the advice doesn't always come with strategies on how accomplish it.

Recently, I spoke with Chuck Podesta, senior vice president and chief information officer for Fletcher Allen Health Care, about its conversion to an EHR from Verona, WI-based Epic Systems. He shared the governance structure that the Burlington, VT-based academic medical center established to implement its EHR, which he credits as one of the key factors to their success.

The organization also spent a good deal of time determining "what that project would look like, the resources needed, and the cost associated with it," says Podesta, adding that some organizations spend a lot of time on the RFP process, but not enough time planning how they want the project to unfold.

Prior to its conversion to the EHR, the medical center had a mishmash of systems, Podesta says. Fletcher Allen was a best of breed shop with boutique systems for finance, radiology, and labs. "We had our own home grown clinical data repository--called Maple--that was viewable on the units and it had some clinical information but not a lot and everything else was paper,” he says.

The 562-licensed-bed medical center went live with the first phase of its EHR conversion this past June, which included all of its inpatient clinical applications including the emergency department. Fletcher Allen is tracking metrics linked to clinicians' adoption of the EHR system.

For its computerized physician order entry system, for example, 95% of orders are currently being placed electronically. "We were at about 90% a week out of the gate and we keep moving forward," says Podesta, noting that the system will always have some telephone orders because "it's hard for a physician who is driving a car to access a computer and enter the order."

So what went right?

Podesta says the medical center had the right number of committees and each committee knew what its role was and, just as important, what its role was not. "It was set up in a way that it wasn't too bureaucratic, but had enough meat to it that people felt if they had issues they had a place to take them and they would be worked on and decided on quickly," he says.

Fletcher Allen established three committees: a patient care operations group that was a multidisciplinary group of nurses and physicians focused on workflows at the unit level, a physician advisory council that was instrumental in keeping the physician side of the project moving forward, and a clinical transformation group.

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