Patrick Murfee on Dealing with the Challenges of EMR Implementation

No one said implementing an electronic medical record was going to be easy. Patrick Murfee, director of information technology at Hemphill County Hospital, a small, rural hospital in Canadian, Texas, shares three challenges in the implementation process and how to tackle them.  

Staff members who resist change. The hardest part of implementation, according to Mr. Murfee, is dealing with people who don't want to learn a new and complicated system. "I've been in other industries where we've had to implement systems and software and it's been a lot easier because there less people involved," he says. Especially in the confusing trauma of go-live or the long slog of training, physicians and nurses can get discouraged, frustrated and angry with hospital administration and EMR vendor.

Mr. Murfee recommends a few ways to deal with difficult staff members. First, show them how the EMR will improve their day-to-day lives in the long run, he says. Take time to solicit feedback and find the real root of the problem: Are they just having a bad week, or are they really struggling to keep up with the learning process? If gentle, positive motivation tactics don't work, you may have to take disciplinary action. "You have to show people that if they're going to be in healthcare much longer, this is the way it's going to be," he says. "This is what we need to do to all be working here, and this is what's best for our patients."

Establishing the hospital's processes.
In order to have a smooth and successful implementation, it is essential to understand existing hospital work flows, Mr. Murfee says. "We've spent a lot of time looking at every process, examining the step before it and the step after it. When we have to put everything into the electronic system, we know how to structure it because of that work." Unfortunately, establishing workflows that have been in place for a long time is difficult. Over time, physicians and nurses have become used to the status quo and no longer remember the reasons behind particular hospital practices. "People will say, 'I don't know why it works that way,' so we've had a lot of trouble peeling back the layers and figuring out the variables," Mr. Murfee says.

In order to collect thorough, accurate information, he says that hospitals just have to put in a lot of man hours to test and re-test and ask questions. "I wish there was something a little bit more fancy," he says. "But we struggled with establishing these processes, and we've figured out that to have all this capability, there's a lot of grunt work to be done."

Integrating and interfacing different vendor applications. Especially in smaller, rural hospitals like Hemphill County Hospital, facilities may face challenges integrating and interfacing different applications. If your facility has a smaller budget and you can't afford a system with every feature you need — for example, an application for your pharmacy — you may want to use a "best of breeds" approach, where you select each software application based on its usefulness for your particular needs. This approach is best for hospitals that can't afford a fully integrated system, but it also means more work to integrate each application.

"It's led us to moving a lot of data back and forth and putting a lot of manpower on the technology side," Mr. Murfee says. He says that you can tackle this issue by finding team members who really know your hospital's needs and who can think creatively to tailor the workflows in the software. Again, this challenge can be overcome by really digging in and examining your hospital's traditional practices. "We're doing a lot of things that haven't been done before by our vendors," he says. "That's the positive side."

Read more coverage on healthcare IT:

-CMS Chief Donald Berwick Addresses EMR Regulations
-3 Tips on Successfully Implementing an EMR

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