When to avoid an EHR customization: Q&A with Golden Valley Memorial Hospital CMIO

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William Dailey, MD, chief medical information officer at Golden Valley Memorial Hospital, shares his advice for EHR customizations and the recent initiative the Clinton, Mo.-based hospital took to enhance its system.

Board certified in family medicine and clinical informatics, Dr. Dailey has a special interest in information technology and pharmacy for physicians. He is a member of the College of Healthcare Information Management Executives, Healthcare Information and Management Systems Society and American College of Healthcare Executives, among others.

Here, Dr. Dailey discusses the potential requirements of an EHR customization and which he recommends avoiding. 

Editor's Note: Responses have been lightly edited for clarity and length.

Question: What is one recent initiative you've taken to customize your EHR system?

Dr. William Dailey: I interpret the term 'EHR customization' as adding functionality that does not currently exist. This may require:

· Programming from the vendor to add new native functionality.
· Implementation of existing functionality not yet implemented locally.
· Add-on software from another vendor to add functionality.
· Custom software/methods to optimize or 'plug in' functionality to the existing EHR structure.

We recently did a Sepsis project, which required implementing an existing functionality net yet implemented locally. This was the typical form of creating governance, gathering stakeholders, creating a project plan and timeline, developing pre- and post- implementation key performance indicators to track effectiveness, implementation, training, post-live monitoring and comparison. We recently went live with the Sepsis Toolkit and anticipate great results.

Q: How did you collaborate with your EHR vendor to implement the Sepsis Toolkit?

WD: Our EHR vendor, Meditech, has a 'cookie-cutter' approach to provide project guidance on these kinds of projects in the form of 'toolkits.' This is particularly important in that every site need not 'reinvent the wheel' to implement commonly needed functionality or to rapidly attack new initiatives.

Q: What advice do you have for other hospitals looking to implement an EHR customization?

WD: I would recommend they avoid the type of customization that requires programming from the vendor to add new native functionality and instead opt to work within the constraints of native functionality. If you decide to go this route, prepare to go down a rabbit hole of defects with every subsequent upgrade and data initiative.  Basically, there is a right way and wrong way of doing an addition to your home. You can end up with something very functional but not pleasing in the long run or you can thoroughly think through the addition and do it right. 

Q: How do you promote innovation among your team members?

WD: I want my team to all be on the lookout for new ways to work toward mission within existing constraints. This can be difficult and requires a multidisciplinary approach to make sure all essential elements are considered. Innovating in silos is much easier than in an integrated environment because you can easily ignore the big picture.

Q: What has been one of your most memorable moments as CMIO?

WD: Watching a team of administrative, technical and clinical people stand shoulder to shoulder to do the right thing for their patients during our EHR implementation project and own every part of it. Seeing that happen was truly inspiring.

To participate in future Becker's Q&As, contact Jackie Drees at jdrees@beckershealthcare.com.

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