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Why Do Some Hospitals Successfully Implement EHRs and Others Fail?

 |  By HealthLeaders Media Staff  
   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.

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.

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