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Optimize before Go-Live - 3 Ways to Make your EHR Implementation more Successful

By Jenn Bula

To meet federal requirements and not face Meaningful Use penalties many organizations have quickly implemented new Electronic Health Records (EHR) systems (1). Some of these same organizations are not seeing the promised cost and efficiency benefits, which can be attributed to end user adoption challenges and configuration of the new system around broken or inefficient workflows (3). According to HealthIT.gov 96% of all hospitals have in their possession a certified electronic health record (EHR), but only 80% of those hospitals have adopted the basic EHR (2). Let's face it, implementing and adopting the EHR is a daunting and at times overwhelming endeavor. Optimization is built into project plans after go-live with the intention of continuous assessment and improvement objectives. At the heart of these objectives is to see at go-live what works, see what does not work, compile lessons learn, and prioritize the low hanging fruit as well as set up structured resolution processes for the more complex issues. However, research shows hospitals are actually doing remediation and fixing technical flaws and don't have the bandwidth for true optimization (3).    


You and your teams probably already know departments, areas, or workflows which could use some maintenance now. Why configure your shiny brand new EHR around broken or inefficient workflows? Why not start by choosing a few workflows to optimize ahead of time? By choosing to focus on a small number of key areas in parallel with the design phase, adoption of the new workflows begins earlier and ensures the configuration of the new EHR will meet your vision for future state workflows. In addition, optimizing workflows ahead of time can help reduce the work necessary just before go-live to transfer data from the legacy system to the new EHR.  



Acceptance and buy-in to the new EHR can be one of the biggest challenges to implementation. Increasing dissatisfaction with EHRs among clinicians is on the rise as it relates to people training and readiness (4). On the bright side, a literature study by HealthIT.gov showed the top two things organizations did early on to ensure success were to "engage staff at all levels" and "invest in workflow analysis and careful redesign in order to customize and effectively integrate new technology among users" (5). 

Here are three ways to make your EHR implementation more successful: 
  1. Assess your current state appointment schedules for how you want them to work in future state. This is very important in OR, Radiology, and other ancillary areas where legacy systems may have been designed to accommodate certain requirements which will be obsolete with the new EHR. Take a look at your blocks and procedure timeframes and set new policies and procedures ahead of time for staff to become familiar and accept the change before the new system is in place.  
  2. Gauge how efficient your registration and authorization / certification processes are. If your current process requires multiple staff and/or calls to the client to obtain the needed information for authorizations or send out claims, the process is inefficient. Consider if cross training registration, financial counselors, and other staff members to collect the needed information or have alternative workflows in place for the more complicated or private clients. This not only increases patient satisfaction, but reduces labor costs when all the information can be gathered at one time as well as allows for the authorization to be obtained timely. 
  3. Look at current patient hand-off and verbal order workflows and determine how you want these to work in future state. These workflows usually require policy changes that effect everyone from doctors and nurses, to patient transport, to other ancillary groups and are large change management and organizational readiness topics. Starting early with the right people at the table will ensure higher adoption rates as well as make the workflows smoother at go-live with the thoughtful planning ahead of time.  
Implementing an EHR is a big endeavor, but you can make it more successful by engaging providers and staff early and optimizing current workflows for a better designed future state workflows. 

References

1. University of Southern Florida. Federal Mandates for Healthcare: Digital Record Keeping Requirements for Public and Private Healthcare Providers (June 20, 2016).  Accessed on December 22, 2016. http://www.usfhealthonline.com/resources/healthcare/electronic-medical-records-mandate/#.WFyPo-YrLIU

2. Health IT Dashboard. Non-Federal Acute Care Hospital Electronic Health Record Adoption. Accessed on December 22, 2016. https://dashboard.healthit.gov/quickstats/pages/FIG-Hospital-EHR-Adoption.php

3. Healthcare Informatics. What does EMR Optimization Actually Mean? So Much More Than Just Working Out the Kinks (October 29, 2015). Accessed on December 22, 2016. http://www.healthcare-informatics.com/blogs/mark-hagland/what-does-emr-optimization-actually-mean-so-much-more-just-working-out-kinks

4. HIMSS.  EHR Dissatisfaction: A Tech or People Problem (May 6, 2013). Accessed on December 22, 2016. http://www.himss.org/ehr-dissatisfaction-tech-or-people-problem

5. Blavin, Fedric, Ramos, Christal, and Devers, Kelly. Lessons fro the Literature on Electronic Health Record Implementation. Published August 1, 2013. Accessed on December 22, 2016. https://www.healthit.gov/sites/default/files/hit_lessons_learned_lit_review_final_08-01-2013.pdf


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Jenn Bula is a Senior Strategist for MedSys Group and helps build the Advisory Services and Epic Service Line. 

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