EHR Implementation Success Story: Dartmouth-Hitchcock

Dartmouth-Hitchcock, with headquarters in Lebanon, N.H., was one of the first institutions to move from a legacy electronic health record system to a new electronic health record system. Dartmouth-Hitchcock was also one of the first to launch an EHR system in all departments, specialties and locations at once.


Despite a unique starting position, "we faced many of the same challenges as other hospitals and health systems" when implementing the EHR system, says Christine Rosenwasser, MD, associate medical director and member of the informatics clinical faculty.

Dartmouth-Hitchcock's EHR successes offer four best practices for other hospitals.

1. Draw EHR programming staff from clinical staff. "We hired nurses, respiratory therapists, medical assistants and others in various clinical roles within Dartmouth-Hitchcock" to help program the EHR system, says Dr. Rosenwasser. These employees were trained extensively to help configure the system.

"It was invaluable for us to have clinical staff who were already familiar with our workflows and experienced in patient care" to be the ones configuring the system, says Dr. Rosenwasser. "Their clinical experience helped us configure the system so that it made sense to clinical staff and physicians, and prevented rework."

"I think that having our own clinical staff configuring our EHR allowed us to do things quickly and accurately the first time," she says.

2. Retain technical employees.
"You want to hang on to qualified programmers and IT managers," says Dr. Rosenwasser. System rollouts are demanding on technical staff, and the extra work put in should be rewarded, she says. Additionally, technical staff members have an institutional knowledge that will be very valuable going forward.

"It's worth the extra resources to pay these folks at or above market," she says, because if they find more lucrative employment elsewhere, "you'll have to hire consultants at twice the price" that probably won't know the hospital's inner workings as well, she says.

3. Prioritize essential EHR features. During the EHR implementation process, Dr. Rosenwasser says that many physicians came forward with requests to have the system mimic their current workflow. She recommends keeping the hospital's overall goals for the EHR system in mind when making these decisions.

"Prioritize safety and quality issues first," she says, "then ACO compatibility issues, then requests from specialists who needs or want a special feature."

When considering a physician's request for a special feature, " look at how will it be used and how will it be beneficial," says Dr. Rosenwasser. "You want to avoid situations where physicians or departments are saying 'we absolutely need this,' and then after the developers spend however many hours on it, it's not even used," she says.

4. Keep the physician champion on long-term. "Continuing to have physician leaders makes a big difference" in the ultimate success of the EHR implementation, says Dr. Rosenwasser. "This person can focus on EHR and what it's doing for both patient and physicians," she says, as the system is adopted and refined. "It's helpful to keep those 'wins' for physicians in their minds," she says.

Dr. Rosenwasser says that it's important to have a physician who is able to not only be a champion for the system, but also be available to listen to questions or concerns, long after the system is officially launched. "If anyone has a risk, quality or workflow issue, they know who to go to," she says.

More Articles on EHR Adoption:

Rural Hawaii County Hits 84% EHR Adoption Rate Through ONC Partnership
RWJF Report: 4 Key Findings on EHR Adoption
Study: Physicians Continue to Use Paper, Computer EHR "Workarounds"

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