The document discusses lessons learned from implementing electronic health record (EHR) systems. It emphasizes that EHR implementations require adequate technology infrastructure, including reliable hardware, software, networking, and disaster recovery plans. The infrastructure must be treated as critically important, as technological problems can cripple an EHR rollout. Specifically, the presentation warns that inadequate infrastructure can lead to EHR systems that are slow, unreliable, and fail to deliver expected benefits. It stresses that the infrastructure should be viewed as a utility and treated with the same importance as other patient care assets when using an EHR.

1. The Obligatory EHR
Implementation “Lessons
Learned” Presentation
Jack L. Shaffer, Jr.
Chief Information Officer
Community Health Network of West Virginia

2. Disclaimer
I’ve been down this road a hundred times with many,
many different IT systems. I have over 20 years of
enterprise IT experience in a variety of industries, so
I’ve seen just about everything.
People in the health care industry think that all of
this stuff is new.
It’s not new. It’s just new to them...and
perhaps YOU.

3. The Three T’s
• Your EHR implementation has a better
chance for success if you organize it into:
– team,
– tactics and
– technology.

4. Team
• Identify one or more EHR champions or don’t
implement.
• Make sure your organization’s senior executive
fully supports the EHR.
• Use an experienced, skilled project manager.
• Utilize sound change management principles.
• Have clear, measurable goals.
• Make sure users share your goals.
• Establish realistic expectations.
• Don’t try to implement an EHR in a
dysfunctional organization.

5. Tactics
• Plan, plan, plan.
• Redesign your workflow.
• Don’t automate processes just because you can;
make sure the automation improves something.
• Design a balanced scanning strategy.
• Consistently enter key data into your new EHR
charts.
• Get data into the EHR electronically when
possible.
• Utilize a phased implementation.

6. Tactics
• Train, train, train.
• Be flexible in your documentation strategy
and allow individual differences in style.
• Lighten your workload when you “go live”
and for a short period afterward.
• Don’t underestimate how much time and
work is involved in becoming “expert” with
an EHR.
• Utilize “power users” at each site.

7. Technology
• Don’t scrimp on your IT infrastructure.
• If you’re a small organization, consider an
application service provider (ASP) model.
• Make sure that your IT personnel do adequate
testing – especially with wireless!
• Utilize expert IT advice when it comes to servers
and networks.
• Make sure your servers and interfaces are
maintained on a daily basis.
• Back up your database at least daily.
• Have a disaster recovery plan and test it.

8. Technology Infrastructure?
• Hardware
– Power/Electricity
– Cable
– Network cards (NIC’s)
– PC’s
– Switches
– Wireless Access Points
– Routers
– Firewalls

9. Technology Infrastructure
• Software
– IOS/Firmware
– Drivers
– Operating Systems
– Applications
• Security
• Antivirus/Spyware prevention

10. Technology Infrastructure Layer
Cake
EHR
Technology
Infrastructure
A failure at a lower layer causes a
failure to all higher layers

11. Why should I care?
• Mission critical information
– Financial / billing information
– Patient information
• Key component in operations
– A technology outage basically stops work
progress
– Processes are too complex to perform
manually

12. Infrastructure and EHR/EMR
• EHR/EMR is a more demanding
application
– Client/Server
– More disk space
– More bandwidth
• Demographic data
• Images
• Telehealth / Telemedicine

13. Infrastructure and EHR/EMR
• EHR/EMR is critical to the treatment of patients
– Clinicians and providers become dependent on the
technology
– Speed of information important
– Reliability is crucial
• Technological problems, such as poorly written
software or inadequate server memory, can
cripple an EHR implementation.

14. Infrastructure and EHR/EMR
• With a poor infrastructure (lower levels of the
layer cake) EHR/EMR could be:
– Slower
– Unreliable
– May not deliver the expected results
• Network & Telecommunications are key –
Especially for ASP
– Reliability a must
– DSL/Cable – Asymmetric up/down speed
• Clinicians and providers will blame the
application – even when it is not the applications
fault.

15. The “Plagues of Pharaoh”
• DSL is evil.
• Fire at Clay, Flood at Lincoln.
• Wireless problems, problems and more
problems.
• Data Center power problems. (I need
more power, Scotty!)
• Tablet Troubles.
• User Interface Issues.
• It all adds up to user frustration.

16. Lessons Learned
• Treat the network as a utility at your own
peril!
• Technology is as key as any other asset
used in patient care when using an
EHR/EMR.

17. Lessons Learned
• Disaster recovery – integrity of data and
the network.
– Broadband loss is prevalent in WV.
– Lots of single points of failure.
– Redundancy is a must.
– Prepare baseline, “if all else fails” backup
plans – i.e. PAPER

18. Infrastructure and EHR/EMR
Just like the NFL – you have to have a
minimum level of equipment before you
are allowed to step on the field –
otherwise you will get hurt.

19. Infrastructure and EHR/EMR
If you do not know where your network equipment is, or
if it looks like this.....
.....then we need to talk.