Is Stimulus Money Enough?

The other pitfall occurs at the training stage—especially when the project is behind schedule. Management presses for the go-live date and as a result, training schedules are compromised. Organizations give training less time than is needed and assume once users are trained, they will recall the functions they were taught. In fact, most students go into information overload within a few hours because they are taught aspects of the system they may never use. In addition, the class may be held hostage by tangent discussions and business process questions. These slow the class to a crawl, time slips away, and the instructor rushes through the remaining material to finish on time.

In my opinion, another 25% of EMR projects will fail because of these issues. If the project makes it through this stage without too many delays, the organization is usually ready to celebrate success. The project may be a technical success, but it is not an operational one at this point. There is still a 50% failure rate that occurs after go-live.

5. Manage adoption rates of the EMR. This is one of the toughest and most overlooked aspects of the project. In it, hospitals have to confront the natural inertia of an organization to change. The system has been installed properly and users trained, but we just can't get widespread use of the system. There is a vague passive resistance, as well as, users who think "If I just keep my head down, this too will pass." Poor adoption rates ruin the return on investment, and the longer it goes on, the more it erodes the enthusiasm of the early adopters.

Before organizations' celebrate success, they should implement a measurement system that will track usage and publish the results. Build an incentive program that rewards the behavior you want and be sure all members of senior management are visibly behind the effort. This is the single biggest pitfall to a successful implementation—35% of EMR projects will fail because the organization does not effectively manage adoption.

6. Ongoing maintenance and support. Organizational knowledge about information systems has a half life, like a radioactive material. It is most potent within the first few months of implementation and then slowly deteriorates if not renewed. This occurs for two reasons. First, employee turnover slowly reduces knowledge of the systems, especially if the departing employee is expected to train his or her replacement. The second driver involves new releases of the software. Sometimes new releases are not installed so new features are not available. Other times, the organization does not utilize the new features and continues to use the software as it was originally implemented.

Adequate staffing, funding, and new hire training can alleviate the risk of this barrier. In my opinion, the final 15% of EMR projects will fail because of these issues.

So, while the experts weigh in on whether $19 billion is "enough of a stimulus" to get the healthcare industry to adopt electronic medical records, an equally important question is whether the stimulus money is enough. Clearly, it is not. Unless healthcare organizations address some of these basic issues that have plagued them for the past 20 years, EMR adoption will still be spotty at best.