The incentive money is there to implement EHRs, but most HIM professionals and hospital executives know that deploying the technology is not as simple as pressing a button to go live.
Several industry experts have weighed in on this question: What is the single most important tip you could provide to someone regarding an effective EHR implementation? Their answers, summarized below, are quite telling.
Tip #1: Realize that the EHR will not solve your problems.
"EHRs do not necessarily fix poor processes, but rather, they tend to expose them. Create workflows that depict current scenarios and then revise those workflows once you've implemented the EHR. Use a team approach with IT, HIM, physicians, nurses, and other users of the EHR."
–Jean S. Clark, RHIA, CSHA, service line director for HIM at Roper St. Francis Healthcare in Charleston, SC
"One of the most significant mistakes a provider can make is to implement the EHR so it matches the current practices and workflow. This is a new tool, and providers must map how the business/medical practices must change to increase quality and efficiency before selecting a vendor. This will help them take advantage of the tools the technology has to offer and assist them in finding the right EHR that addresses the specific practice/business needs.
"As an example, one of my clients completed the business process analysis and examined what it needed to improve the practice. In this case, the EMR needed to accommodate sound prescription management, given the client operates a pain clinic. Without the initial assessment, the client would not have necessarily selected an EMR that suited its needs and allowed it to address quality and efficiency.
"The bottom line is it is generally far more important to complete the business analysis rather than jumping right to the implementation phase."
–Chris Apgar, CISSP, president of Apgar & Associates, LLC in Portland, OR
Tip #2: Identify EHR stakeholders and involve them in the implementation process.
"Solicit input from those who you know the EHR will affect."
–Kelly McLendon, RHIA, president of Health Information Xperts in Titusville, FL
"Involve every department that touches a medical record or uses it in any way. Start with the administrators and directors, but be sure to solicit input from end users—especially when you begin to customize the system."
–Donna Walker-Thomas, MBA, RHIA, CPC, CMA, manager of coding and transcription for William W. Backus Hospital in Norwich, CT
"Create a steering committee that represents all end users of the proposed EHR system. The capital and political costs associated with EHR implementation are so substantial that a rush to implement can be extraordinarily expensive and, if done poorly, can sour an entire medical staff to any EHR technology. The planning team should also include experienced technical advisors and legal counsel so that the final implementation plan does not include technical or legal time bombs that go off just before or during cut-over."
-William Roach, Jr., MS, JD and Heidi Echols, McDermott, Will & Emery, LLP in Chicago
Tip #3: Keep it simple with as few systems as possible.
"Our challenge was that we had too many systems. We began our EHR implementation in 1991 by scanning medical records into the electronic patient file (EPF). After that, many other systems have been implemented to create a truly electronic system. Several of the new systems have not been able to feed into the EPF. We have either had to print and scan documents into the EPF or go to that separate system to retrieve records. This is very cumbersome for record requests."
–Phyllis A. Santillanez, RHIA, HIM director for Kaweah Delta Medical Center in Visalia, CA
Tip #4: Remember that communication is essential.
"It is difficult to make sure you keep the necessary players in the loop. As you prepare to move to an EHR, I think it is critical to create a leadership team that is made up of individuals who trust each other and who are ready to communicate the major steps along the way. You need players who are willing to share the good, the bad, and the ugly about the system. Then your team needs to be prepared to problem solve, remain positive, and look for ways to improve processes."
–Betty Lanzrath, MA, RHIA, director of HIM for Newton Medical Center in Newton, KS
"At our facility, we were fortunate enough to have a well-versed vendor lead us in our transition from paper to the EHR. The most advantageous action we took was to consult with every area in the hospital over the course of one week. During that week, we held a 'white board' session during, which a registered health information administrator (RHIA) from the vendor led each department in a discussion of how employees currently accessed the record and how that would change with the EHR.
"The RHIA also conducted a small educational session on how the EHR functioned and pointed out some of the benefits (i.e., more than one person could access information at the same time, workflow or work lists could be triggered off of a document type or admit type, and the current record would be available before discharge).
"This process gave utilization review, coding, nursing managers, clinical and ancillary managers, administration, and physicians a chance to see both current and future benefits of the EHR. It gave our facility buy-in and identified all of our process, policy, and procedure changes up-front so that we would not have to scramble after go-live. The transition was much smoother. At first, the idea of white board sessions seemed to be rather burdensome, but it ended up streamlining and driving all of our workflow at our facility."
–Dawn Osborn, MHS, RHIA, MT, business office IT manager for St. Bernards Medical Center in Jonesboro, AR
Tip #5: Recognize that paper will never disappear completely.
"For some hospitals, scanning will continue to be a permanent or phased portion of the implementation of an EHR. It may be part of downtime procedures when clinicians and other caregivers must use paper. If the clinician/caregiver does not re-enter the information into the EHR, the forms are scanned. Some hospitals may also scan correspondence and records from other hospitals to include in their own permanent record."
–Elaine Lips, RHIA, president and CEO of ELIPSe, Inc. in Los Angeles
Tip #6: Keep usability in mind.
"Effective implementation requires ease of use. All the bells and whistles won't mean much if the users find the system confusing, frustrating, limiting, and slow. Therefore, for implementation to be successful, the end user must be involved in assessing each system's usability during the selection process, including such factors as:
- Logging on and off
- Screen design and information displays and controls
- Navigating within a screen and between screens
- Entering, accessing, and transmitting data
- Integrating with practice managements systems and e-prescribing systems
- Automating the coding process and accuracy
- Connecting with payers, labs, patient portals, etc.
- Assessing functionality of decision support, guidelines, disease management, and other resources
- System user requirements and user options
- System feedback
- System responsiveness
- System speed regarding various functions and user interfaces
"The more intuitive, the better. It's not just what the system can do, but also how it performs each task and how long it takes. Providers must consider these factors if the adoption is to be effective."
–Claudia Tessier, RHIA, president of mHealth Initiative, Inc. in Boston