- Whether a provider is looking to undergo its first EHR implementation process or is looking for replacement options, putting a new system into an organization takes careful consideration.
Each healthcare organization is different and will have different needs and priorities. Everything from the size of a system to what types of care it specializes in could affect which EHR system is chosen.
Healthcare organizations must realize that an EHR implementation will have large costs up front but will pay off in the long run. Additionally, involving employees at all levels will help ensure a smooth process and finding systems with features that will elevate patient care are also key focal points.
The cost of an EHR implementation
Implementing a new EHR system, whether it is the first one for a provider or is a replacement EHR, will be an expensive process. Healthcare organizations need to be prepared to make an investment, and understand that a properly implemented and utilized system will be beneficial financially in the long run.
For example, Vanderbilt University Medical Center (VUMC) reported in March 2018 that it saw a decrease in operating income in fiscal year 2018 compared to the previous year partly due to its $214 million Epic EHR implementation launch.
VUMC officials explained in an operating expense report that the EHR implementation was successful and that the move should help the organization “yield future efficiencies.”
“However, in the year of implementation increased operating expenses related to implementation caused a reduction in operating income,” officials explained. “The EMR implementation put pressure on clinical volumes in the post-live period although we have achieved net patient services revenue in excess of our budget, the implementation has muted volumes.”
The VUMC operating income was impacted by the EHR implementation, but officials maintained that they had prepared for such a scenario. A large portion of the investment also went toward workforce training on the Epic system.
New York-based Ellenville Regional Hospital CEO Steve Kelley stressed that web-based EHR systems can help organizations save money.
Ellenville switch to a web-based EHR system because of health data exchange issues and care coordination problems, he told EHRIntelligence in a previous interview. The hospital has been using a disparate legacy system, which led to a lack of interoperability between hospital departments.
A web-based EHR system allows for a more unique payment structure that can give healthcare organizations more options, Kelley noted.
“There’s no money down,” said Kelley. “It’s based on collections. On athenahealth, if we decided we didn’t like them anymore, we could give them 90 days’ notice and we walk away with no additional back charges — which are notorious for making it difficult for hospitals to change vendors.”
The importance of employee education, consulting
A lack of staff training during the EHR implementation process can lead to complications with daily operations. Healthcare organizations need to take the time to communicate with staff members at all levels to see what types of features are desired in an EHR system, and then conduct regular training to ensure individuals know how to utilize the EHR properly.
Medical Center Health System (MCHS) found that poor staff training helped lead to issues with its Cerner EHR implementation in early 2018.
System stabilization, revenue cycle management, and workarounds leading to errors and reporting issues caused the most problems with the Cerner system, MCHS President and CEO Rick Napper told Odessa American.
“Then — and probably the biggest issue that typically happens — is training,” he said. “Inadequately training your medical staff is a huge challenge and we are no different than any other organization that says, ‘we got this.’”
“And typically it is several months down the road before you realize you did not do that well enough for your staff,” Napper added. “And I stand before you admitting that we did not do that well enough.”
New Jersey-based Virtua Health System found that active clinician engagement helped the organization in its Epic EHR implementation process.
Over 1,500 health system staff members were invited to attend 80 product demonstrations and scored competing systems on their performance against certain metrics, Virtua Senior Vice President and Chief Information Officer (CIO) Tom Gordon previously told EHRIntelligence.com.
“We looked at two solutions: Epic and Cerner,” said Gordon. “We had a week-long process where we conducted 40 demos apiece — 40 Cerner demos and 40 Epic demos.”
It was also important to not be fully focused on the IT aspect, he added. Involving clinicians throughout the entire process helped ensure clinician health data exchange, EHR usability, and EHR integration needs were met.
“The value of integration was certainly a large part of the conversation,” Gordon explained. “Having a single platform for not just the clinical side, but also the financial piece of the pie.”
Pushing toward improved patient care
The push toward value-based care furthers the importance of providers finding ways to best put the patient first, while still ensuring they are not overburdened themselves.
There are key things to focus on during the EHR implementation process that will help patients remain a top priority.
Conducting EHR usability tests during development and after implementation can simply EHR use, data from Pew Charitable trusts showed.
When all healthcare stakeholders are involved in the implementation process, certain issues that can lead to patient harm such as alert fatigue, over customized EHRs, auto-refresh mix-ups, unclear default settings, and incomplete lab results can be avoided.
“Varied EHR formats and a lack of consistent, intuitive interfaces – combined with EHR customization by health care facilities and lack of post-implementation testing and insufficient clinician training – can lead to errors, some of which may cause serious injuries or even death,” Pew explained.
EHR safety net programs can also be beneficial, helping providers reduce errors in the diagnostic process.
Kaiser Permanente has developed a total 54 EHR safety net programs – collectively called KP SureNet – that utilize electronic clinical surveillance tools to systematically identify and address potential care gaps in clinical settings.
“One of the biggest challenges for any healthcare organization is identifying and addressing potential care gaps such as with medical testing: making sure that the patient understands the results of their tests, that their doctors communicate next steps, that the patient actually gets the test or follow up done, and that there is a system in place that ensures those steps are taken. EHR safety nets can help address these challenges,” Michael Kanter, MD, Medical Director, Quality and Clinical Analysis, Southern California Permanente Medical Group told EHRIntelligence.com.
A culture that promotes patient safety, and does not blame or shame physicians is essential, he added.
“Physicians must be comfortable with the idea that they can report near misses or actual gaps in care and that they may periodically get prompted on a suspected care gap – even if it turns out that it really wasn’t a gap,” Kanter continued. “They need to realize that technology can help them identify care gaps and improve the care they provide to their patients.”