Electronic Health Records

Why EMR implementation as just an IT project seldom succeeds

I have worked with dozens of hospitals to plan, implement, and optimize their EMR, so I’ve learned a great deal about what creates a successful implementation. I’ve also worked to remediate problems for hospitals that have experienced major difficulties or outright failure with EMR implementation, and have learned important lessons about what can go wrong.

Every major EMR vendor has horror stories about go-lives gone wrong because implementation failure is not about the choice of software or hardware, but about a lack of leadership buy-in, poor governance, absent end-goal development, and difficulty managing diverse constituent perspectives.

Perhaps the biggest source of trouble is the failure of executives to identify the right governance structure at the outset of the project. Too often, they automatically see any project involving technology as an IT project. But an EMR implementation is less about technology than it is about transforming your workflows and processes to be more efficient, more patient-centered, and more information-driven.

When you implement an EMR, your clinical and business staff members have to be fully involved and fully accountable for the results, or you’ll end up with a disaster. Mere buy-in from your clinicians and business staff is not enough. They have to do the actual planning and implementing themselves.

While most healthcare leaders know that EMR implementation is a big process, they often underestimate the extent of the changes that are coming. If you think about ALL the tasks that a nurse does in a shift, and if you understand that you will need to examine each of those tasks to see how the EMR can improve it, and multiply that by every job in the hospital that will use the EMR, you begin to understand the enormous scope of the project.

That’s why EMR implementation is so expensive — it’s not the technology or the software that is the big-ticket item. It’s the time it takes to review your processes, plan the implementation, and train your staff that hits the budget hardest.

Ideally, your EMR implementation team should include leaders from the medical staff, nursing, ancillary departments and business operations, supported by IT. Those leaders should be fully invested and accountable for the success of the project. In turn, they will identify the right staff members to do the detailed planning required. If you give frontline staff the responsibility for planning the implementation, they will know what tasks are important and will make sure those tasks aren’t overlooked.

Unfortunately, when the C-suite starts looking for ways to reduce implementation costs, the front end is where they usually want to cut because it is the most expensive part of the process. This is especially true if they are implementing an EMR just because of meaningful use incentives, not because they want to effect real change.

But the organizations that have chosen that route have ultimately regretted it. Lost charges that reduce revenue, confusion that leads to unnecessary waste, loss of staff productivity, and the cost of starting over and doing it right the second time around end up costing far more than a good process at the front end.

It’s like the old carpenter’s saying, measure twice and cut once. Before you take that cut and implement a new EMR, it is important to make sure that you first have the right team in place, the right external assistance, and commitment from the top.

Later this month, my team will be in Washington, DC, for National Health IT Week, (Sept. 16–20) and will participate in a number of events including the 12th Annual HIMSS Policy Summit. I’m sure that EMR shortcomings and interoperability will be a big topic of discussion, and we can explore together how to better use this tremendous resource to add value to patient care and to the healthcare system as a whole. Check out the event schedule and see how you can get involved.

As managing director and global head of healthcare consulting for Dell, Dr. Cliff Bleustein leads a team of healthcare professionals across management consulting, MEDITECH, Cerner, Epic, McKesson and ICD-10/revenue cycle. Dr. Bleustein helps customers by providing an in-depth understanding of the current problems facing healthcare executives and recommends innovative solutions to prepare for future business needs.

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