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Web EHR Implementation Mistakes to Avoid: A 10-part series

Dr. Lawrence Gordon, the founder and CEO of WRS Health, recently authored a white paper titled, “10 Implementation Mistakes to Avoid: Why Practices Fail,” which is designed to advise medical practices on how to successfully implement web electronic health record (EHR) systems. Today, we will launch a 10-part series that examines each of the 10 most common implementation mistakes. Here is the first segment:

MISTAKE #1: Not Taking the Wheel or Putting Someone Else in the Driver's Seat

John F. Kennedy once said, “Things do not happen. Things are made to happen.” Lack of leadership is one of the most costly mistakes that can derail an implementation. Delegating leadership or divided leadership is equally detrimental. “The leader needs to set the vision for the implementation, truly understand how EHRs will help the organization achieve clinical transformation to greatly improve quality, safety and the patient experience,” said Fred Bazzoli, Senior Director of Communications for the College of Healthcare Information Management Executives (CHIME) and author of “The CIO’s Guide to Implementing EHRs in the HITECH Era.”

It is crucial to understand that EHR implementation is a time intensive pursuit. Yet, because they have an eye fixed on the bottom line and want to implement the EHR as expediently as possible, many physicians assign the decisions for implementation to a staff member who does not necessarily have the perspective of a practice owner or a clinician. Understanding the practice’s goals, direction and strategy is paramount to a successful EHR implementation plan.

When Dorsel Spears, owner and practice manager of Wellness Medical Center in Fredericksburg, Virginia, took the reins to find a new Web EHR to replace a system that was dragging down the practice’s efficiency, she had a clear set of practice goals on her shopping list. One of the goals was to enable the practice staff to check patients in while trying to complete other tasks efficiently. Spears explains that with the new Electronic Health Record, “The schedule is always up front and you are able to check people in and out without having to go away (from the screen). That’s a big difference from our previous EHR. If you check somebody in and if you have to go look at a patient’s account in our current EHR, you still have your schedule there, so if you are at your front desk, you can check someone in quickly and not lose everything. It flows better than our previous EHR. The previous company didn’t believe in work lists,” said Spears.

Spears’ goals also included finding a Web-based EHR which could help the practice to bill more efficiently and accurately. “When I submit this claim I don’t want to have to go all the way back around to the billing, and click to get to the next claim. With our current EHR, I submit the claim, I go to submit another claim and I’m back at my work list. And that is definitely a time saver. Anytime we’ve made a change, the staff said, ‘I can’t believe you are doing this to me.’ When we switched to our current EHR, they said, ‘Now we can get some work done.’”

The office manager, biller, nurse manager, and trusted relatives employed by the practice may be expert at performing their particular functions. However, they may be completely unfamiliar with the implementation process. You cannot take any shortcuts by delegating the leadership role and expect a favorable outcome. Although it’s wise to delegate EHR implementation tasks, don’t succumb to delegating leadership to the wrong person. In a study, entitled, “Adoption of Electronic Medical Records in Family Practice: The Providers’ Perspective,” Amanda L. Terry, PhD, studied six primary care providers in Canada and found that the leadership role is indeed paramount for success.

The final sample was comprised of 30 participants from six practice sites (three urban, two rural, and one small-town practice). Participants included 13 family physicians, 11 other health professionals (including nurses, Medical Assistants) and six administrative staff (receptionists, secretaries). Terry said, “In-house problem-solvers emerged during the EHR implementation and adoption process; these individuals played an important role in addressing day-to-day issues related to the EHR. Their function appeared to be more hands-on, in contrast to physician “champions,” who assume more of a leadership role in EHR implementation. Both roles are seen as important and need to be encouraged. Both the in-house problem-solver and the champion may serve a key role in helping novice users move forward to achieve this stage of EHR adoption.

Implementation leadership rules:

  • Make implementation your number one priority. Although you may be tempted to conduct business as usual and continue with your normal patient load, it is necessary to devote a substantial amount of time for analysis, system set-up and configurations, status meetings, user training and management of that training. Lead the change. Set practice strategy and direction, communicate goals and priorities, assign tasks and ensure adequate completion of those tasks to achieve the desired ends.
  • Communicate early and frequently in order to set the tone for the importance of the project to the practice staff.
  • Lay out the projected steps for the project and the overall vision. Set the strategic vision, setting forth all of your expectations so that your practice understands where the practice is headed in terms of increasing efficiency and quality. If your staff knows what to anticipate, you will have a more successful EHR implementation.”
  • Don’t Delegate Leadership. If you delegate leadership to staff members who are accustomed to using a previous EHR system, there is a tendency that they will focus on what the practice has been doing all along, instead of concentrating on the myriad benefits they can reap in the future with the new EHR. They may not embrace the big picture because they are connected to the older workflow and feel comfortable having already mastered the older systems’ functions. Most people do not embrace change. Their scope of vision and expectations may be limited to their function and the features of the system, instead of the workflow.

Homer L. Chin, M.D., MS, is the Assistant Regional Medical Director for Clinical Information Systems for the Kaiser Permanente Northwest Region and Assistant Professor in Medical Informatics and Clinical Epidemiology at the Oregon Health and Sciences University. Kaiser Permanente Northwest (KPNW) has more than a decade of experience working with EHR implementations. Dr. Chin explains why it is so dangerous to base the implementation on the way things have been conducted in the past.

“The EHR is the ‘great magnifier.’ If an organization already does something very well, then the implementation of information technology will probably further improve its performance in that area. However, if an organization is dysfunctional in an area, then the implementation of an EHR will probably magnify that dysfunction. Identifying and addressing potential areas of organizational dysfunction prior to implementing the Electronic Health Record may improve the overall results of EHR implementation,” said Dr. Chin.