Electronic Health Records

HRSA webinar focuses on rural health EHR tips

Among the biggest misconceptions of EHR implementation is that it requires only IT specialists to be leading the way. While the IT role is important, speakers in the Health Resources and Services Administration (HRSA)’s “Leadership Tips During a Health IT Implementation” webcast last Friday contended that EHR leadership shouldn’t be limited to just IT experts.

Terry Hill, CEO of National Rural Health Resource Center, Joe Wivoda, CIO at the National Rural Health Resource Center and Greg Wolverton, CIO of White River Rural Health Center, were a few of the presenters and have a wide range of EHR implementation advice to offer. Much of this experience has obviously been in rural settings, where the need for collaboration is even more pronounced than bigger healthcare providers.

Hill said that bringing in EHR software is always about the leadership for rural providers. There’s no exact formula in implementing EHR, but one ingredient for success appears to be complete, unqualified support of CEO and executive team, according to hill.

“What we’ve seen with really good implementation from hospitals and clinics, it has to do with leadership,” he said. “Managing change becomes the primary leadership challenge as we’re bringing in EHR. Change is increasing at an exponential rate, it continues to go faster and faster. How we assimilate and manage it becomes the key to the application of EHR.”

In discussing how to combat this change with education and awareness and prepare them for what’s ahead, Hill said that you have to ask what do we really want to accomplish in transitioning to EHR.

“[It shouldn’t be] just getting incentive money, not just to have providers using computers – it really is about greater goal of patient safety and efficiency,” Hill said. “And we need to plan out that transition stage – it’s not going to happen overnight.”

He also offered these lessons that early adopters learned after adoption:

- Engage leadership early on

- Medical staff engaged quickly as well

- Strategic planning is crucial

- Ready everyone for culture change

- Pay attention to process redesign

- Focus on networking and collaboration

- Remember to keep an eye on back-end support


Wivoda’s talk revolved around total cost of ownership (TCO) for EHR and the importance of project management. EHR adoption should involve a readiness assessment – the EHR leadership staff needs to know how ready the whole organization is to fully implement an EHR, because Wivoda said it’s more than just double-clicking in the software setup and hitting next until it says “finished”.

“Many people adopt and don’t realize the efficiency of it,” Wivoda said. “There has to be continual improvement.”

TCO is often misunderstood because of all the moving parts. Wivoda maintained that it’s easy to understand licensing costs and implementation fees, but often people aren’t going in with a complete understanding of what those recurring costs are. Examples of this are annual maintenance fees, computer hardware refreshes and staff costs. He said he often asks customers where they think they will see EHR savings. Customers expect to decrease transcription costs and while they may be able to save on transcription, but they may see increases in other areas.

“You will not get savings without doing a major effort in workflow and productivity improvements,” he said.

Wivoda said that project management is also misjudged – the CEO doesn’t need to manage project. You just need a manager that engages staff and is involved.

Changing culture

Wolverton is currently working on his fifth EHR deployment and wonders why IT people are so often selected to manage a project. He said that having a great project manager is the key, not technical expertise.

“In my experience, the best people on teams are often least technically-savvy,” he said. “We started using middle management [for EHR deployment], but ended up pulling people from the people on the field who had their feet in the ground.”

Part of this culture change is engaging patients – the focus has been on providers, but it should be on patients too. Wolverton believes there needs to be a shift toward patient management.

The next HRSA podcast will be September 18, 1 p.m. EST: “Overview of the Meaningful Use Stage 2 Final Rule for Safety Net Providers” (Register here)

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