Plan with the end in mind. This is good advice in general. But it is particularly true when implementing an Electronic Health Record (EHR) system. The go-live process is a life changing event for a hospital. The sooner you plan, and the more detailed your planning, the more likely you will avoid the perils of a poor implementation that results in decreased adoption and sustainment.
“Ask anyone. EHR rollouts are no walk in the park. They're expensive. They're time consuming. And, for many healthcare organizations, they raise critical safety concerns, can lead to huge budget deficits, C-suite resignations and plummeting staff morale.” ¹
Hospital administrators often underestimate the complexity of EHR implementation, and devote inadequate time and resources to the task as a result.
Take the following steps to choose your implementation strategy.
1) Get Help
Realize that you will learn from the experience and knowledge of others who have implemented EHRs, including peers from provider organizations who had similar perspectives on, and responsibilities in, the process. Look to professional organizations for resources and guidance. Retain consultants and outside implementation professionals who continuously learn from their experience in implementing EHRs.
2) Be Inclusive
Your steering committee should represent your organization’s diversity. Do not emphasize IT over clinicians nor vice versa, for example. They have to go down the path together.
So too, should different providers be represented, such as nurses, physicians, pharmacists and laboratory technicians. As should non-clinicians, like accountants, analysts, billers and schedulers. Include managers and non-managers as well. The front-line, end users who will use the system every day should be involved in every phase, from application choice through implementation and beyond. The process doesn't end with “go-live.” The implementation of an EHR becomes an ongoing day-to-day part of operational life.
Diversify further as you move from your broad steering committee to specific advisory teams. Incorporate nurses from the emergency department, obstetrics/gynecology and pediatrics, for example, when determining how to implement a new system based on work flows. Plan their involvement ahead so that you can maintain care levels by scheduling clinical staff appropriately.
3) Examine Your Options
Don’t be content with sales presentations and marketing brochures. Get demonstrations. Push vendors for case studies and references, specifically from organizations similar to yours whose projects were alike in scope. Schedule site visits—at hospitals you want to see. Vendors often are happy to arrange visits to their best sites. Press for access to one where you can get unvarnished opinions.
Vet vendors’ customization processes. Will they connect their EHR to your legacy systems? If so, what will it cost? And how long will it take? Can the physician group responsible for your largest admission base interface with the vendor’s system? If not, will the vendor help connect them? What is the vendor’s process for upgrades? And what do they cost? These are just a few questions, but the more details you get, the more informed the decision you can make.
4) Plan Your Project
Once you have chosen your system, set out the time line and milestones. Implementations typically take 16 to 24 months, include targets for each. Make them measurable and obtainable, incorporating every phase, from design to go-live.
Choose your go-live method. Will you go all in with a Big Bang? Putting every department and user online at once? Or will you opt instead for a phased-in approach that staggers activations by departments and users? Each type has pros and cons for your organization.
Look at which type of go live works best for your budget, culture and care environment. You may find it more efficient to staff up for one comprehensive push that brings the organization as a whole online quicker than to use a phased approach that requires prolonged support staffing and ties up meeting space, for example. Or, you may go for the phased go-live so that your users can get more personalized support to ease their transition. There is no single right or wrong method.
5) Manage Your Project
Appoint a project manager to manage the deadlines, mitigate the risks and serve as the project’s champion. They must secure and maintain commitments across the organization, from the C-suite to the floor. Hospital executives cannot delegate their way out of the implementation because the end-users will be looking to them for leadership. Similarly, physicians cannot be excluded from the evaluation phase and then told to start using the system that others chose.
Development of a strong, honest and consistent communication plan is imperative. The horror stories are endless! Begin with “why” you are doing this. Remember the bottom line is “the patient in the bed.” Make it a point to discuss efficiency (“ no longer looking for charts”), safety (“up-to-date, real-time diagnostic results available to make on-the-spot care decisions) and communication (“being able to communicate with other providers to reduce and prevent duplicate testing and potential adverse treatment regimens and combinations”). Convey the benefits for each user group similarly, and for your organization as a whole—and reinforce them whenever possible.
Keeping communication clear and processes smooth are essential in successfully implementing an EHR system. Professionals who have been through go-lives before can be invaluable in navigating you through the snake pits, like creating procedures to coordinate lab tests, prescriptions and prescription fulfillment for medications.
Find somebody who can bring a repository of such lessons learned in the industry, and resolve these issues four to six weeks before your go-live. The sooner you start, the better you will finish.
1. Erin McCann. “EHR rollouts gone wrong.” HealthcareIT News. Aug. 1, 2014. http://www.healthcareitnews.com/slideshow/ehr-rollouts-gone-wrong?page=1