Before delving into an EHR customization project, hospitals and health systems should consider various factors in order to set up their organization for success.
Here, chief medical information officers and clinical informaticists from three U.S. health systems offer their advice for organizations contemplating EHR customization.
Editor's Note: Responses have been lightly edited for clarity and length.
Question: What advice do you have for hospitals looking to implement an EHR customization?
Steve Peters, MD, clinical informaticist and co-chair of the EHR implementation at Mayo Clinic (Rochester, Minn.): Obtain as much data as possible to guide the planning of optimization or customization. Surveys will identify the perceived pain points; objective data such as time to create and finalize a document, time spent in chart review and orders or inbox are also invaluable. With goals and priorities established, you need to leverage the simplest solutions first, like secondary training, configuration and personal settings for efficiency, templates for documentation, favorites for ordering and shortcuts for handling messages. If clinicians are hand-entering notes, a potentially major enhancement is the addition of voice-recognition tools for self-documentation. Only after these steps would I consider true customization — that is, asking for vendor enhancements that might add significant cost and result in non-standard code that requires maintenance and extra work at every upgrade.
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Lauren Koniaris, MD, vice president and CMIO of the Northern Region at Hackensack (N.J.) Meridian Health: Do due diligence and explain to your vendor the need and why it cannot be achieved using existing functionality. Then be prepared to wait while it is discussed and circulated by the vendor in their home office. Finally, you must follow their existing processes regarding how to prioritize these change requests.
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Anthony Dunnigan, MD, vice president and CMIO Maricopa Integrated Health System (Phoenix): I would certainly be aware of what other systems have done, to avoid "reinventing the wheel." One of the biggest benefits of attending the annual user group sessions is to seek out these systems and shorten the development cycle. In some cases we have found what we needed was not truly customization but use of "foundation" technology implemented in a unique way to better meet the strategic needs of users in certain situations.
Also, have an eye toward the future, particularly as the vendors move toward more continual software updates versus annual or biannual large updates, as it may be more difficult to ensure local customizations are not overwritten.
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