WHY EHR IMPLEMENTATIONS GO WRONG The decision to purchase and implement an EHR is a daunting taskFor physician practices, especially for the 80% of the market who work in practices of five doctors or less. Thesepractices are faced with a lack of true technical expertise on staff, over 530 fully certified EHR products to choosefrom and a limited knowledge of how EHR adoption affects key areas of the practice. These affected areas caninclude overall patient volume, profitability, clinical workflow and revenue cycles. With all this in mind, it’s nowonder the failure rate for EHR adoption remains perilously high.In many EHR adoption settings, there are a handful of common reasons why the implementation fails.Understanding these reasons, and how to address them, can lead to more efficient, more successful EHRimplementations.Lack of Engagement Engagement runs two ways within the practice. First, the physician has to be engaged and committedto the reality of the challenges and benefits that EHR adoption will have on their practice. For most practices, thismeans that the primary physician is driving the need for implementation but is not fully responsible for the project. Inmost successful implementations, the practice has designated a project manager and physician “champion.” Once theproject manager and physician champion are selected and engaged they are required to ensure the criticalcomponents are managed and the strategic goals are accomplished. This is vitally important as it provides theopportunity for broader accountability and buy in without the already time burdened physician having to mandate theeffort.Second, the EHR vendor or Value Added Reseller (VAR) must also engage with the entire practice, not just the primaryphysician and the champion of the EHR project. This relates to two areas – understanding the practice’smindset/reasons for adoption and making sure that the entire staff understands the value of, and their role in, theimplementation and full utilization of the software. For example, if the only reason a practice is considering adopting acertified EHR is to receive the ARRA incentive payments, then they are significantly less likely to be committed to thelevel of change that is required to go from paper charts to fully utilizing an EHR. This will put the implementation injeopardy right from the start. Engaging the entire practice will ensure general staff and clinicians are committed to thegoal that use of an EHR will improve patient safety and clinical outcomes. When that goal is realized it generatescompelling motivation to deal with the learning curve and transition issues.
Lack of a Strategic Plan A practice’s strategic plan for EHR adoption should include at least the establishment of goals, timelines,financial expectations and job responsibilities. Having these items clearly defined will help bring clarity to the adoptionprocess, outline everyone’s role and build confidence that the practice can take on this level of operational change.However, an implementation can be completely sabotaged by the lack of a strategic plan. A thorough, well-definedstrategic implementation plan will help ensure all users are prepared and ready to begin using the new EHR software.In addition to what is listed above, the plan should also take into consideration all transition issues, for example thetransferring of data from the paper charts or legacy EHR to the new certified system can create problems if notplanned properly. Another potential negative impact is the possibility of a slowdown in revenue, as fewer than usualpatients should be scheduled during the first “go-live” days. Taking the time to address these components, especiallyestablishing goals, will provide a solid foundation for all the operational changes associated with an implementation.A few examples of goals would include:• Improve patient safety and promote quality of care outcomes.• Increase practice efficiency and profitability.• Participate in Meaningful Use and obtain its incentives.Additionally, all employees should be informed and committed as a team, without this commitment there will beuncertainty and frustrations, which can easily lead to a failed implementation.Inadequate Workflow Assessment An inadequate assessment of patient and clinic workflows will create a barrier to the progress of animplementation. The commitment to evaluate and ultimately purchase an EHR system is the perfect time to addressworkflows within the practice. Focusing on the four main tenets of a healthy physician practice – revenue,profitability, efficient workflow and patient satisfaction – will allow the practice to assess existing workflows andmake unbiased modifications moving forward. This will also allow for the identification of specific areas where an EHRcould provide significant support. Adding the right EHR system can streamline existing processes and help make thepractice more efficient. Being able to credibly select the appropriate EHR systems for the practice starts with ensuringthe practice is operating in as efficient a manner as possible.
Lack of Practice/EHR Alignment Trying to implement an EHR software solution that does not meet the unique needs of the individualpractice is actually doing more harm than good for the practice. Working in collaboration, the findings from a clinicalworkflow assessment effort will layout a roadmap, with milestones, that can help ensure a successful selection of anEHR package but also the determination of a timeline and process for implementation. For example, the manner andclinical approach in which a dermatologist practices medicine is different from an internal medicine physician, whichis different from an oncologist, etc… in the same way that small practices have different challenges and needscompared to large multi-specialty practices. MGMA, (mgma.com) tells us that in a practice with as few as twoclinicians you will likely encounter at least six different charting techniques. All of these considerations, and manyother factors, require an informed comparison between the needs of the office and the features and functionality ofthe EHR software.Access and Quality of Training With any implementation of an EHR system within the physician’s office, one of the primary factors to success is howquickly the staff can become comfortable using the system at full capacity. The faster the practice can get to full utilization of theEHR, the faster they can get back to seeing a full patient load. This has very obvious implications on revenue, profitability, etc. Thekey to shortening that timeline is training. The lack of proper training can have very negative impacts on the success of an EHRimplementation. First, if the proper resources within the practice aren’t well trained they become a roadblock to full utilization.Second, if the proper resources do receive training, but have either lingering questions or the type of training did not fit theindividual, and then they can become a roadblock to full utilization. Many times when looking to cut price, training is an easy lineitem to remove. However, training budgets – and access to different modalities of training, including at least web-based andonsite – must be protected by physician practices. Without it, the timelines to full utilization will lag and the practice will becomemired in underperformance and frustration.When making the choice to select and implement an EHR, a physician practice must be aware that they are manypotential roadblocks to delay and ultimately failure of the implementation. However, the practice can be protected bycompleting a proper assessment of the practice, choosing an internal project champion, working with the selectedvendor to ensure there are a strategic plan as well as ensuring that all staff have access to and complete the amountof training required. To learn more got to http://ehrroadmap.mbmehs.com// Contact firstname.lastname@example.org // (800)236-2498 ext 101