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Why Do Some Hospitals Successfully Implement EHRs and Others Fail?

Carrie Vaughan, for HealthLeaders Media, November 17, 2009

Those three committees report back to a project executive committee that is comprised of senior leaders from across the organization including key physician leaders. The project executive committee is the deciding body. "That is where the buck stopped," says Podesta. "We knew on the PEC committee we were in power to make the decision and once we made the decision that was it."

There are leaders who are on all four committees like the senior vice president of patient care services and the senior quality officer, who were co-executive sponsors of the project, so there is continuity across the committees. In addition, each committee has no more than 12 people on it, says Podesta. The committees meet every other week, and Podesta doesn't foresee these meetings going away any time soon. "We are still dealing with decisions and changes that need to be made to current systems that we are running," he says. "But we'll probably be running these groups for a while. They could just end up becoming part of how we do business."

Podesta's advice for other systems adopting EHRs is two-fold.

  1. Don't make it an IS project. The reporting structure for the implementation of the EHR went up through operations to the senior vice president of patient care services and the senior quality officer. Podesta had an operational responsibility as CIO, but senior leaders wanted to ensure that it was viewed as an organizational initiative not an IS project. "Clinical transformation is not about implementing an Epic EMR," he says.

  2. Carve out time to determine what life looks like after the go live. Organizations go from having a command center, people on the units, and fixing elements as they arise during the go live to a support role, which is a completely different discipline. "It is incredible how quickly you go from implementation to support," Podesta says. "People start using the system and they start thinking how to make it better and before you know it you have 100, 200, 300 enhancements hitting you.” Organizations should determine a way to prioritize and have resources set up for those requests while they are moving onto other phases of the project. Otherwise, it can slow projects down and tarnish what was a great go live, Podesta says. "If you have 500 enhancements, at some point you are not going to get to them in a timely fashion."

The medical center, which has about 200 employed physicians, is currently rolling out the second phase of its implementation--converting its ambulatory sites to an EHR. Its first ambulatory site, a large primary-care practice, will go live tomorrow with the rest of the practice sites coming online by September of 2010. Fletcher Allen has also upgraded its data warehouse system and is rolling out a patient portal this spring that will enable patients to schedule tests, look at a bill, track cholesterol, get lab tests, and send secure e-mails to physicians.


Carrie Vaughan is a senior editor with HealthLeaders magazine. She can be reached at cvaughan@healthleadersmedia.com.

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