Five steps to electronic health record success: no electronic health record will fulfill its promises if implementation fails. And for a successful implementation, the process must begin internally

Healthcare Financial Management,  Jan, 2005  by Joseph T. Wood, III,  Ralph Aceves

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"This change is afoot. We're all locked on, and we're not going to let go until it gets done."--David Brailer, MD, PhD, national coordinator for health information technology

Because of the high cost and potential financial benefit to the organization, hospital and health system CFOs are increasingly involved in electronic health record systems selection. Unfortunately, many organizations make the mistake of distilling this process down to a simple comparison of features and costs among vendors. The result is often implementation failures. These can be very costly, but worse, they can disrupt the organization and affect patient care quality and safety.

In its July 21 report, The Decade of Health Information Technology: Delivering Consumer-Centric and Information Rich Health Care, HHS addressed the consequences of electronic health record implementation failures: "Implementation failure and partial use of EHRs are commonplace. Even if EHRs are implemented, there is no guarantee that they will be used and therefore lead to value for clinicians, consumers, or payers. Failed EHR implementation dissipates investment capital and leads to cynicism and fear among those who may want to bring their practices into a more modern era."

Electronic health records have the potential to improve financial performance of a hospital in a number of ways. These include reducing head count and eliminating unnecessary retests and duplicated procedures caused by misplaced paperwork. Electronic records can also improve physician productivity by streamlining record-related procedures. They can automate time and human intensive chart distribution processes. They can decrease the "discharged, not final billed" component of A/R significantly and improve coding turnaround time.

Moreover, they can minimize legal and financial risks by improving patient safety. Studies have shown that paper documentation is not available 30 percent of the time during a physician-patient encounter. Having an electronic health record system that supports clinical decision making through data mining improves overall pattern care quality and safety. Timely and accurate patient health information is the basis for improving patient safety. However, no electronic record will fulfill these promises if it is underused or if implementation fails. The key to successful implementation is to proceed from a logical plan that involves all stakeholders in the organization and takes a realistic look at the challenges and expected benefits.

When healthcare leaders look at an electronic record, they must resist the temptation to view it as an entity unto itself. Instead, it is important to take a more organic view and consider how the record will integrate with existing business processes. Likewise, vendor products need to be seen as a means, not an end. Vendors make many promises regarding ease of implementation, long-term costs, and financial benefits of their products. However, to achieve a successful implementation and benefits to the organization, the process must begin internally, not with the vendor.

The following five steps create a path for electronic health record implementation success:

* Define "electronic health record" throughout your organization.

* Set appropriate expectations.

* Choose the technology and your technology partner--wisely.

* Accept and promote process changes.

* Carefully plan the transition from paper-based processes to the final deployment of the record, and implement in phases.

Define "Electronic Health Record"

Many vendors offer some sort of electronic method for storing and disseminating patient health information. Although all may call their products "electronic health records," there can be wide-ranging differences in what various vendors offer. It is therefore important to define what your organization calls an electronic health record. rather than allow vendors to define and impose their own concept based on what they can offer.

An electronic health record can be a different animal to different organizations and to stakeholders with in the same organization, depending on their vision of the ideal use of patient information. Individual views of the electronic record are based on individual responsibilities to the patient and the organization. With the goal of smooth implementation and, thus, improved financial performance, CFOs and other executives must recognize that an electronic record must meet at least a consensus of needs and expectations.

Set Appropriate Expectations

There is a wide range of expectations of how an electronic health record should perform. The issues it is expected to address range from finance to privacy to patient care. CFOs want to know how the record will improve revenue cycle management, affect head count and salary, reduce retests and duplicated procedures, and improve the efficiency of caregivers and other workers in the organization. Coders want to know how it will facilitate the swift completion of their work. Physicians want to know how it will improve patient care, and whether it will make them more productive or simply add complexity to their already overburdened days. Nurses want to know if it will help prevent errors, and whether it will relieve their paperwork burden or simply make things more difficult. And, if they've never used a computer before, they worry about how long it will take to learn.