June 25, 2014

Advice for Solving ARMC's Electronic Medical Records Problems

As someone with 30 years' experience managing health care IT projects, here are my thoughts on Athens Regional Medical Center's problems.

An Electronic Health Record (EHR) implementation impacts all areas of a hospital. Most staff will use and depend on the information contained in the EHR. An EHR implementation is not something the IT department can accomplish alone.

EHRs are complex enterprise projects requiring buy-in at all levels of an organization, not just the C-suite. To be successful, include Subject Matter Experts (SMEs) from every clinic and department to thoroughly understand the processes and workflows. Engage those with experience implementing the chosen product in a similar environment, model workflows, templates, orders, results, interfaces and reports, then test, fine-tune and test again. Run real patients through the new system (in parallel with the old system) from check-in to discharge to confirm the new product works correctly. Keep the legacy systems in place before decommissioning in case you need to fall back.

Having highly trained staff acting as EHR Subject Matter Experts on each shift in each clinic and department is imperative. EHR SMEs learn the system so thoroughly they are the local go-to person to help other staff members navigate the system, find the correct patient, document the record, enter and review orders, results, prescriptions, procedures, vitals, demographics and resolve most problems.

There must be enough opportunities for training, and all staff should be required to complete job-specific EHR training and show competency before using the live system. Grouping people with similar roles and responsibilities in training sessions is efficient; mixing finance staff with nursing is not. Training all staff to use the relevant modules of the system should be done during the regular shift of the staff being trained, not before or after their normal shift. This requires hiring staff to cover for those in training, and sometimes requires one-on-one training.

If too much attention is placed on the wrong, competing or secondary goal (i.e. complete the project in time to collect federal EHR incentive dollars) as opposed to the primary goal (implement a well-thought-out, comprehensive, efficient EHR with the least amount of disruption), the outcome suffers; staff lose confidence in the new system; and the information necessary to properly treat the patient may not be readily available. If this happens, the project is uphill from there, and reputation suffers.

Those who know the current systems inside (IT staff) and out (medical staff, nurses, technicians, managers, administrators) are very important to the design and successful implementation of the new EHR. These folks know the workflows, processes and procedures, and their input ensures the new systems and processes capture, process and provide accurate information in a timely manner for all staff. The EHR is only a tool to document, organize, analyze and provide the information. If too much talent departs before new systems are thoroughly designed and tested, valuable institutional knowledge is lost, and delays can occur.

My sympathies to patients and staff of ARMC during this trying time.