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Life after EHR

September 24, 2015

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The big day came: go-live for your new EHR system.

Actually, the biggest day came a few months later when a group of physicians collectively decided to complain that the new system inhibits their ability to deliver quality care to patients. They don’t know how to use the system properly; they don’t like how it works; it just takes too much time.  

But the goal of implementing this new system was to make everything easier! What went wrong? More importantly, how can it be fixed?

The largest roadblocks to running an efficient EHR system often point back to complications related to alignment, engagement and communication, key factors for successful clinical adoption. On one side of the equation, the doctors, nurses and other care givers are focused on providing care to patients. On the other side, the IT/IS department is working tirelessly to keep the new system up and running. One of the biggest challenges is overcoming a lack of effective communication. Implementing an EHR system is much more than an IT task. To deploy a functional system, providers and IT/IS personnel need to communicate openly and efficiently before, during and after go-live. IT/IS staff want their providers to have the tools necessary to treat their patients but they cannot properly optimize the system without relevant feedback from providers.

Many care givers argue that while they know their EHR is intended to create positive outcomes, they are often bogged down with entering data that in their view has very little to do with improving patient care. The volume of clinical, billing and regulatory requirements that must be documented in the EHR encourages inappropriate documentation practices such that data integrity is becoming an issue.

Another factor that often gets overlooked with an EHR implementation is culture. Some providers have worked on paper or other electronic systems for so long that the transition to a new and/or different digital format is uncomfortable and intimidating. Workflows must change. Some roles may be substantially modified.  Technology skills must improve. It is imperative to consider the cultural impact of implementing new systems.

A recent report by the Brookings Institution about EHR rollout and meaningful use found that 0% of respondents say that their EHR system has helped cut costs or reduce the burden on staff. ZERO percent! The authors of the Brookings report suggest that the meaningful use program and reporting requirements need to be adjusted to focus on “outcome-oriented performance measures.” Facilities are dedicating a significant amount of time and resources to technical and compliance issues and subsequently diverting already limited resources away from treating patients.

The conclusion is simple: hospitals and healthcare facilities that are implementing new systems must have a team of clinicians who understand both sides of the equation. This team needs to engage and communicate with the IT/IS department, as well as the care givers, to create cultural and technological alignment for all stakeholders. This is how real adoption works.