Is Your EHR Implementation in Trouble? 10 Things to Check

Electronic health records — they are the wave of the future for all hospitals but a headache for some as well. The Health Information Technology for Economic and Clinical Health Act provides federal incentives to hospitals and physician organizations that are meaningful users of the technology systems, but in the rush to meet the meaningful use stages, providers might be encountering problems during their EHR implementation projects.

So what should providers be evaluating if their EHR projects are hitting snags and speed bumps? Dave Vreeland is a partner at Cumberland Consulting Group, a health IT project management firm that helps healthcare providers with EHR implementation projects. He gives a checklist of 10 things all hospitals should check as they undergo those EHR implementation projects, and he notes that if providers can't answer "yes" to the majority of the following questions, they should be concerned their implementation is in trouble.

1. Is the implementation a top organizational priority or one of many? With so many things grabbing a hospital's attention amidst healthcare reform, including accountable care organizations and health information exchanges, Mr. Vreeland says making EHR implementation the number one priority has to occur in order to avoid problems, especially considering EHRs are the building block for almost any health IT venture.

2. Is the project owned by clinical/operational people or IT? The EHR implementation should be led by operational and clinical leadership in conjunction with IT, not managed by IT alone. "These are not simply technology projects; they are clinical and operational transformation projects that have major technological components," Mr. Vreeland says.

3. Is there a clear project director in charge of the implementation? Similar to structured military exercises, an EHR implementation project should have a defined leader. Projects that involve converting to this type of health record system have a defined beginning and a defined end. Mr. Vreeland says it should be very clear who is in charge to guide the project along.

4. Are the top executives in the organization heavily involved? Top executives should not take a hands-off approach, especially in a project as complicated as one dealing with EHRs, Mr. Vreeland says. Just like a hospital CFO should be involved with a revenue cycle replacement, the hospital CEO, chief medical officer and other executives should take an active role to ensure this health IT system is employed correctly and efficiently. In the end, EHRs will be the future technological foundation for all clinical and operational stakeholders in the health system.

5. Are the clinicians heavily involved? Mr. Vreeland says it is a large error if upper management decides to involve the physicians at a later point. They need to be involved in the EHR workflow discussions, walkthroughs, testing, training and — most importantly — the design of the EHR. He adds that the voluntary medical staff should also be included.

6. Have the following documents been developed for the project?
•    Project charter. This is the broad, overarching document that lays out what exactly the organization is doing relative to the implementation, who is responsible for what tasks and what the time constraints are.
•    Project plan. Elaborating on the project charter, the project plan is more expansive and explains how the organization is going to carry out the EHR implementation tasks.
•   Communication plan. When this large of a task is undertaken, communication can get broken up at times due to several moving parts. Establishing a course of action regarding how to best communicate with each team member can assuage any potential lapses in messaging or contact.
•    Clinician adoption/change management plan. Mr. Vreeland says this document is essential to explain how the healthcare organization is going take the clinical staff through the process of learning the new information system and how EHRs will impact their day-to-day. The chief medical officer plays a big role in informing the development of this document.
•    Project governance organization chart. The hospital CEO plays a big role in executing this plan, articulating why the hospital is using its EHR system and outlining the structure of the entire team who will be working on the project.
•    Project team organization chart. Similar to the communication plan, a flow chart showing who reports to whom is essential to any project, and EHR-based projects are no different, Mr. Vreeland says.

7. Is there a written status report every two weeks?
Mr. Vreeland says if there is no sign of a written status report or no meetings regarding the progress of the EHR project, there is a communication glitch. "It ought to be like clockwork [the status report] comes out every two weeks," he says.

8. Is there regular discussion about how and when to implement mandates and changes to medical staff by-laws? When the EHR is finally installed, the physicians, nurses and other hospital staff will be using it to access and input patient data consistently, but there have to be ground rules regarding how to achieve "advanced clinical functionality," or how the clinical and medical staff will actually use the system, Mr. Vreeland says. The rules of being a physician or any other staff member at that particular hospital will have to be updated to reflect the new changes in patient information access. In general, moving to advanced functionality like CPOE and physician documentation will ultimately require the organization to mandate such use.

9. Has the organization articulated the three main reasons for the implementation? While the federal incentives from the HITECH Act are an impetus for hospitals to implement EHRs, Mr. Vreeland says those incentive dollars shouldn't be the main reasons of the implementation. Installing EHRs is still a workflow project, not a technology project, and the core reasons should be clear and made known to all parties involved. Examples of reasons could include: improved patient care through reduced medical errors, improved efficiencies throughout the organization and improved care quality through the use of the tools and information they provide about what interventions work best.

10. Is there measurable progress each month? If meetings show EHR implementation activities are consistently 90 percent done, action needs to be taken to ensure there is full execution of those activities. "If it's 90 percent done, go finish it," Mr. Vreeland says. "Those project management challenges need to be addressed."

Related Articles on EHRs:

Cloudy With a Chance of EHRs: The Ins and Outs of Cloud Computing
EHR Data Integrity: A Journey, Not a Destination
EHRs: The Starting Point of Healthcare's Future

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