Electronic health records (EHRs) have become an essential – yet overlooked – component of our healthcare system. According to HealthIT.gov, EHRs are digital versions of traditional patient charts and records containing a patient's medical and treatment history. Many people also think of an EHR as the online portal that healthcare professionals and patients use to monitor and manage care, diagnoses and medications.
EHR information is available instantly to healthcare providers, becoming a vital part of aggregating a patient's medical history. These records also provide access to tools used to improve the decision-making process. Effective EHRs automate and streamline the provider process and the workflows needed to drive care.
While EHR systems in healthcare management software often appear seamless and intuitive, implementing a new system is a massive undertaking. Here's a look at EHR system implementation, the top challenges healthcare providers face during the transition and measures to take to smooth the transition.
Why EHR implementations are so complex
According to Leidos Health guidelines on EHR launches – also called go-live events – implementing an EHR system is multifaceted. These events are the culmination of significant investments of time, effort, and money, and their success is measured in staff adoption, financial impact, and patient value.
According to Leidos' "Best Practices for an EHR Go-Live," a smooth EHR implementation requires planning, testing, training and piloting systems before rolling them out. Before going live, the healthcare provider should prepare for all aspects of the implementation, including allowing staff the necessary time and support resources to familiarize themselves with new procedures, applications and expectations.
There are also technical hurdles: IT personnel must thoroughly test all EHR builds to ensure they're complete. This includes checking that all hardware, software and network interfaces are compatible, particularly if there will be a telemedicine element. Backup and downtime procedures must also be in place, and staff will need access credentials.
With so much complexity and variables contributing to a successful EHR launch, it's crucial for hospitals to define the results they expect and mitigate the following critical challenges.
Challenge 1: Budgeting and finding the right partner
EHRs are expensive and time-consuming – two characteristics we can't overstate. Here are some tips for budgeting adequately and finding the right partner vendor:
- Budget adequately and generously. Because of the inherent uncertainty in an EHR rollout, hospitals should consider creating a generous EHR implementation budget that allows for additional or emergency resources. As the Leidos guidance advises, unused funds can always be returned; the true challenge is getting more funding during the system rollout. When creating your budget, the company you choose to partner with to provide go-live support should help you estimate the project's overall costs.
- Remember that you get what you pay for. Along with the need for a flexible budget, hospital leaders must understand that – as in many aspects of both life and business – you often get what you pay for, and the least expensive contractor isn't always the right call. Leidos points out that the company offering the lowest estimate is likely to end up with cost overruns from recruiting and staffing shortages that can jeopardize your go-live date.
- Select your vendor. When you select a vendor to assist with your EHR implementation, Leidos says upfront planning is critical. The guidance recommends you research a potential vendor to ensure the company can handle the job. You should also try to settle on your partner as soon as feasible to boost the chances of a successful implementation. Leidos advises that hospitals issue potential contractors with a detailed timetable and list of needs so that proposals are accurate.
Challenge 2: Communication breakdowns and training
Healthcare providers implementing EHRs must prioritize communication training and critical scheduling. Here are some tips for more fluid communication and successful training:
- Identify all the variables. Effective communication and training starts by identifying all the variables involved in your EHR implementation. For example, you'll need to identify if the EHR you chose prohibits clinicians from working before completing their training.
- Loop in vendor personnel. It's essential to include vendor personnel working on the launch in any training programs, so they understand the healthcare provider's processes and workflows. Training should be conducted as early as possible, so the staff is ready to go by the launch date.
- Align the right players. Leidos stresses the importance of "aligning the right players." This includes ensuring all users have successfully completed training, and creating contingency plans for those who must complete training after the launch. The go-live support team will play a significant role: Leidos says staff members will need to use the system several times with guidance from the go-live support team before they are comfortable with the new system.
- Designate a project leader. Hospitals should designate a project leader to communicate with all stakeholders. This person will be the liaison between C-level executives and tactical project leads. A designated project leader will enable coordination between stakeholders so that the hospital, vendors and contractors can have the right people in place so the necessary level of support is in place for clinical, operational and administrative functions.
- Communicate openly. Communication is also essential to ensure that all requirements are met for incoming support staff. Communication drives timeframe development, which avoids unnecessary implementation delays.
Challenge 3: Contingency planning and leadership support
If there's any certainty about EHR launches, it's that something will go wrong. Inevitably, during the rollout, you'll need to escalate help requests beyond what you planned for with the launch team. Here are some tips for mitigating unforeseen crises:
- Empower the launch staff. Healthcare providers should empower launch staff with the ability to address unforeseen issues. A well-defined escalation plan is essential to quickly address emergencies and to reduce staff's and patients' frustration.
- Conduct resolution planning. Leidos advises that go-live support teams create specific procedures to identify and address technical issues – including problems with both hardware and software. It's crucial to designate someone who is responsible for each problem type and share fixes for known issues. As problems are found, addressed and solved, everyone should be in the loop about the new system.
- Ensure leadership support. Another critical driver to fixing emergencies is leadership support. Implementing EHRs introduces an element of change into stable environments. Since change is hard, leaders must understand that when patients and healthcare professionals accept the new system, the EHR rollout is a success. It's ideal for managers to understand and communicate the new systems' benefits, so users know that support staff is there if any problems arise. It's also crucial users know how to quickly access the support team.
Challenge 4: Workflows
Workflows are essential elements for healthcare professionals to focus on when planning, documenting and communicating information about the EHR implementation. But not all healthcare workflows are the same, with some being more sensitive and critical to patients' well-being.
Here are some of the more complex and challenging workflows to keep in mind.
- Blood banks: Lives depend on blood banks, so your EHR implementation should be sure to address this workflow thoroughly.
- Medication reconciliation: Before an EHR implementation goes live, healthcare institutions must ensure the system can track medications before and after admittance.
- Patient movement: Tracking patients' movements during their hospital stay is critical to ensuring proper care.
- Level of care: Correctly documenting a patient's stages – whether they're in the ER or ICU – is crucial for both medical and administrative reasons and can even affect accurate medical billing.
- Careful transport: How patients are physically transported throughout the facility must be monitored carefully.