Winners of the HIMSS Analytics Stage 7 Award and a recipient of the HIMSS Nicholas E. Davies Award of Excellence shared some hard lessons learned on their way to achieving a paperless environment and interoperability with other caregivers in the community.
Implementing an electronic medical record system is actually the easy part, says Dave Garets, president and CEO of HIMSS Analytics. Doing something with the EMR system—modifying behavior, documenting improved outcomes, and improving protocols—that is a bit more challenging, he says. Here's a snapshot of some of the lessons learned and best practices shared.
Lesson 1: Plan on more training. Healthcare organizations often underestimate the amount of training that will be required to implement a computerized physician order entry system. Cathy Bruno, vice president and CIO at Eastern Maine Healthcare Systems in Bangor had allocated one month for CPOE support; but she needed to provide that support for three months. In addition, the system still rounds on units that went live a year ago. "It surprised us how long we had to provide CPOE support," says Bruno.
Lesson 2: Don't skimp on back-up systems. NorthShore University HealthSystem quickly learned that a small data center wasn't sufficient back up for their EMR because it prolonged certain care processes. Now the four-hospital system has a more robust back-up system for all of its major clinical components. "We didn't do a great job on the back-up site," says Tom Smith, CIO at the four-hospital Evanston, IL-based system "The complexity and costs of a true redundant center were huge."
Lesson 3: Proprietary systems are not the best approach. Maintaining proprietary systems is expensive and complex. "It is more difficult to do system evolution and keep it up to date. These are not the way to go," says Andrew Wiesenthal, MD, associate executive director for clinical information support with The Permanente Federation. Wiesenthal also advocates taking an integrated approach rather than a "best of breed" approach, which can be hard to upgrade and maintain. "Interfaces with legacy systems are more numerous, complex, and expensive than you think," he says. "We tried to find integrated systems even if one component was not best of breed."
Some additional best practices are:
Change bylaws to make CPOE mandatory. That was a key success factor for both Eastern Maine Healthcare and Northshore.
Appoint a strong project manager. The person will help keep CPOE and EHR initiatives on schedule and moving forward.
Acknowledge how massive the changes are to physicians' workflow. Clinicians will need a lot of training and support during this process. "Clinicians just don't want to be less efficient than they are today," says Wiesenthal.
Focus on the goals that you are trying to accomplish. Organizations shouldn't start this process unless they have clarity about the end game, experts say.
Achieving interoperability by leveraging the stimulus package The key take away message from this session for healthcare providers was start implementing now. Unless you have achieved interoperability you will not get the maximum funds available, says John Halamka, CIO of Harvard Business School and Beth Israel Deaconess Medical Center. "We have to spend now to get all of this money later."
There is about $2 billion available for health information exchanges in the stimulus. A lot of the coordination will be done by the creation of Regional Healthcare IT Extension Centers. The number of the centers is still an unknown—Halamka estimates the centers will range from 10 to 60. It is not clear if the makeup of the centers will be geographical or domain-specific in nature.
Halamka also briefly discussed some of the new HIPAA regulations included in the stimulus law/HITECH. "PHRs are no longer optional," he says. There is a specific requirement to provide the patient with an electronic copy of their health data upon request. In addition, organizations that have a data breach must contact the major news outlet in their region in addition to contacting the patients involved. "I must contact the New York Times about data breaches," says Halamka.
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