More lessons learned in EMR selection and implementation

In a recent Wall Street Journal article on EMRs, a number of best practices were shared. It's always good to publish what other healthcare organizations have learned. It's also good to add commentary on those best practices.

The article rightly put a spotlight on a common complaint: Poor design, or in other words a design that is not patient or physician friendly. There has been a lot of back and forth about this. Like any technology, EMRs and EHRs are evolving. These products are vastly improved over the first-generation products of even five years ago. Every system gets upgraded and improved upon; these products are no different. That said, now that there is a lot of money, legislation and local, regional, state and national attention on health IT, EMR and EHR vendors have to prove a lot of things. This is a good thing. Vendors should look at this as an incredible opportunity to go gangbusters with innovation and grab some serious market share. This is no time for vaporware. The emperor who has no clothes will be chased out of the market.

The best practice associated with complaints of poor design, which includes raising the potential for patient safety risks, is to engage in rigorous due diligence. The market leaders are easy to look into. The newer vendors are riskier but worth taking a look, if only to ensure you left no stone unturned.

One interesting advice from the article was to heavily customize the product to suite clinicians' needs. It wasn’t made explicit, but I'm assuming that vendors should be intimately involved in a collaborative product customization with the clinicians. This is a good piece of advice. Clinicians will need to meet in formal committees and workgroups determine workflow practices before the EMR roadmap is created, and these workgroups should remain intact after go-live, as there are always updates and tweaks.

One caveat: HHS addresses customization in its certification standards. It's not clear if recertification will have to be done when a certified EHR product is customized. Once the final certification rules are released sometime late next month, healthcare systems and vendors will need to see how that impacts them.

Several hospitals have phased in their EMR systems successfully. Big-bang implementations, however, can work. It really depends upon the culture of the healthcare system and the buy-in from stakeholders. I've talked to some healthcare systems that did a pilot test in one department or one hospital before rolling it out, in an effort to address any bugs in the EHR system.

One last best practice is to reduce the workload of clinicians during rollout. One hospital reduced the workload by 50 percent. Can other healthcare systems realistically do this? If you're a healthcare system that has multiple hospitals and can divert patients to your other hospitals, the ability to reduce workload is viable. If you're one hospital, I'm not so sure. But if you can do it, it's easy to see the benefits.

In the end, understanding that there are benefits on many levels should be emphasized throughout the implementation, especially during the high learning curve and rough patches.

Patty Enrado blogs daily at EHRWatch.com. Read the rest of this article here.

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