Virginia's Centra Health CIO Ben Clark: 6 Lessons Learned From EHR Implementation

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Implementing electronic health record systems can be a daunting task for healthcare organizations, especially if a health system has to connect an EHR system over several hospitals. While the challenges of implementation will vary depending on the specific system or hospital, there are certain universal practices that can aid any organization in adopting this technology. Ben Clark, vice president and CIO of Lynchburg, Va.-based Centra Health, shares six lessons he learned from implementing EHRs in Centra's three hospitals.

1. Leaders' involvement is key.
Success in EHR implementation "starts at the top," Mr. Clark says. He says everyone from the CEO to senior vice presidents to vice presidents should make EHR implementation a priority. "It's not just one email or one note or standing up to one group," he says. "It's preaching day in and day out [as you] build the process that this is important."

2. Funding needs to cover technology and training. Hospitals need to secure funding not only for the software and hardware necessary for EHRs to function, but also for training employees. Mr. Clark says training for Centra's more than 2,400 staff members took roughly six weeks. "It's quite an undertaking, quite an expense to the organization," he says.

3. Scheduled implementation can ensure adequate support.
Centra Health used a scheduled implementation of the EHR systems to provide the necessary support for physicians and employees at each location before moving on to the next. The health system established advanced nursing documentation at its hospitals from 2004-2005. From 2007-2009, the organization adopted computerized physician order entry systems and by 2011 it went live with EHR systems. Centra now aims to install physician documentation. "We did not try to do a 'big bang' or system-wide deployment," Mr. Clark says. "We tested it very well in one location [at a time] where we could support the physicians and staff."

In addition to rolling out the EHR systems slowly across hospitals, Centra went live with EHRs in stages at each hospital to be able to show near-perfect functionality to physicians to gain their buy-in. Mr. Clark says the hospital "preloaded" ancillary departments with the systems so they could practice before physicians needed to connect with them. Then, when physicians went live with the EHRs and ordered a blood test, the lab could be ready without delay. Centra also stationed staff in areas where physicians were working to assist with any issues and make changes quickly. This method helped avoid physicians' frustration and their potential resistance to using the EHR for fear it would decrease their productivity or disrupt their workflow. "In reality, [the EHR] works like that all the time. We just primed the pump a little bit so [physicians] could see that," Mr. Clark says. This technique enabled Centra to achieve approximately 80 percent physician utilization of EHRs.

4. Appropriate staffing can support clinicians' adoption of technology. Mr. Clark says one of the best pieces of advice on EHRs he can give is to "make sure that you are staffed to respond quickly to issues and problems." Responding to physicians' EHR needs immediately is crucial in helping them succeed with EHR adoption, he says. "They're not going to wait around a long time for it to get fixed. You need to do it quickly." Centra helped support physicians through staffing by including their key thought leaders in a clinical informatics team the system created to assist in EHR implementation. In addition to physician thought leaders, the team was comprised of nurses and other staff members. They had daily rounds during which other nurses or physicians could ask the team questions about the EHR.

5. EHRs may cause workflow disruptions. One of the biggest challenges in implementing EHRs was the change in workflows, particularly for nursing, Mr. Clark says. Centra invested in additional training for nurses to help them integrate the EHR in their daily processes. Transitioning to EHRs meant that at least initially, nurses had to work in "two worlds," Mr. Clark says — electronic and paper. "They use the computer for all CPOE orders, yet they still handle some written orders," he says, which can disrupt workflows.

Mr. Clark says the EHR system fits more easily into physicians' workflows because it was built to support their work processes, which helped Centra gain their buy-in. However, adapting to the EHR can pose a problem for physicians who enter electronic orders infrequently. Mr. Clark explains that a physician who only sees two admissions a year may not want to invest the time needed to learn the CPOE product and so will handwrite the orders for the two patients. "Do you force [the physician] to learn to use the product that [he or she] will probably not be safe with because it would be so seldom used?" Mr. Clark asks. At some point however, these types of physicians will have to switch to electronic ordering for the hospital to avoid reimbursement penalties. Mr. Clark says Centra is currently developing strategies to maintain compliance with federal health IT requirements while also ensuring physician satisfaction and patient safety.

6. EHRs require a stable wireless network and a significant amount of hardware. Mr. Clark says one of the surprises when implementing the EHRs was perceived and real problems with the wireless network. "Even though we had what we thought to be a very good wireless network, we still had issues where the network appeared to drop out. This was a combination of access point location, laptop and nursing cart software and battery life. We spent time right off the bat reconfiguring the network side of things and teaching staff how to work in a mobile environment," he says. Some perceived problems with the network required training and not technical solutions. For example, a laptop can lose its connection to the network because the battery is low. "This was a training issue, not a network issue," Mr. Clark says.

Another surprise was the amount of hardware that was necessary for everyone to be able to use the EHR, according to Mr. Clark. He says the most challenging time was 7 a.m. because almost everyone at the hospital does tasks that require the EHR at this time: The physicians do rounds, nurses see patients and give medications, the lab draws blood, etc. "You cannot have too much hardware," Mr. Clark says. "However much you have, it's not enough." To combat this issue, Centra added more hardware for physicians on nursing units, as the nurses were using the existing hardware, and reconfigured some of the nursing stations to accommodate the additional equipment.

Related Articles on EHRs:

HIMSS Responds to Draft Guidance on Testing EHR Usability
Interoperability Group Standardizes Connections for EHRs, Health Information Exchanges

Study: U.S. Patients Need More Control Over EHRs for Healthcare to Gain Their Benefits

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