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Keys to Successful Electronic Healthcare Record Implementation

At a recent conference, a vendor remarked wistfully that the process of implementing an electronic health record is only 20% technology and 80% change management, process improvement, and physician engagement. On page 59 of their book, The Executive’s Guide to Electronic Health Records, Chicago: Health Administration Press, 2007, http://www.ache.org/pubs/smaltzoffer.cfm,
Smaltz and Berner quote an article in Computerworld dated November 8, 2004 that states that only 29% of IT projects achieved their envisioned benefits.

Jha et al. wrote that only about 1 in 4 physicians use electronic health records and fewer than 1 in 10 use them as efficiently as possible (Health Affairs 2006:25:496-507). Part of the reason for physician skepticism and resistance is that the benefits of electronic health record implementation accrue indirectly to physicians via ease of data retrieval and improved clinical outcomes. A recent NY Times article “Who Pays for Efficiency,” stated that physicians get only 11% of the savings generated by electronic health records, with the major dividends accruing to payers. (http:www.nytimes.com/2007/06/11/business/businessspecial3/11save.html)
The steep learning curve means increased time making rounds, which is already in scarce supply.

The key to a successful electronic health record implementation process is proactive physician engagement. This process needs to be done with, rather than to, physicians. The authors remind us that the IT department should serve as facilitators for physicians to improve their workflow and that the hospital should compensate physician champions for their time working on the order and decision phase of the electronic health record (p.57). Physician champions should be established clinicians who are well-respected by their colleagues, not techno-geeks.

• Identify the top 20% of physicians, who regardless of their irascibility, account for 80% of admissions or 80% of revenue and approach them well before the go-live date to help them customize the way that they view inpatient data. Show them how to log-in remotely and follow up with them at regular intervals to identify speed bumps, such as problems with interfaces connecting them to laboratory, pharmacy, and radiology systems, which should be resolved with simulation as much as possible prior to the go-live date.
• Allow physician users to go into the “moan zone” initially rather than being defensive or taking their remarks personally. Their comments may be a symptom of pain and emotional overload that will resolve if treated supportively and empathetically.
• Finally, show that you respect physicians’ time by providing assistance when and where they desire it, especially in the early implementation phase, with trainers present at the times physicians make rounds, making sure that there are adequate terminals, so that physicians do not need to wait in line to enter orders and notes. Having the IT staff available periodically when physicians make rounds is an investment rather than a cost of doing business.

Points to remember include:

• Automated, efficient back-end systems in laboratory, pharmacy, and radiology must precede electronic health record implementation
• Involving physicians in improving inefficient care processes prior to implementation is key to successful electronic health record functionality
• Encouraging physicians proactively to customize the way that they view patient data, alerts, and reminders decreases resistance and speeds adoption

©2007 Kenneth H. Cohn, M.D., MBA, FACS

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