EHR IMPLEMENTATION:
FACTORS FOR SUCCESS
Tess Settergren, MHA, MA, RN-BC
Director, Clinical Informatics
July 19, 2005
What is EHR? (Brailer, 2005)
“A real-time patient health record with access to
evidence-based decision support tools that can be
used to aid clinicians in decision-making. The
EHR can automate and streamline a clinician's
workflow, ensuring that all clinical information is
communicated. It can also prevent delays in
response that result in gaps in care. The EHR can
also support the collection of data for uses other
than clinical care, such as billing, quality
management, outcome reporting, and public
health disease surveillance and reporting.”
EHR Capabilities (IOM, 2003)
• Longitudinal collection of electronic health
information…pertaining to the health of an individual or
health care provided to an individual…
• Immediate electronic access to personal- and populationlevel information by authorized users
• Provision of knowledge and decision-support that enhance
the quality, safety, and efficiency of patient care
• Support efficient processes for healthcare delivery
EHR Components
• Patient Data (PHI)
– Discrete, structured, sometimes coded
– Textual/other non-structured
– Digitized images, biomedical, other
• Clinical Decision Support
–
–
–
–
Information Displays & Prompts
Rules-based Order Entry (CPOE)
Population-based “Best Practice”
Patient Context-Based
EHR Components
• Clinical Messaging
– Results Management, Referrals, & Other
– Operational Efficiency Beyond WORM
• Personal Health Record
– View Results & Reports; Add Data
– Education & Support Resources
– Clinical Advice & Messaging
• Support of Secondary Data Use
EHR Building Blocks
FUNCTIONAL
BLOCKS
Results
Reporting
& Imaging
Decision
Support
Multidisciplinary
Guidelines
Documentation
QM/UM
Order
Entry
Scheduling
Registration
Coding &
Grouping
Confidentiality and Security
Unique Patient and Provider Identifiers
Scanning
Automated Data
Capture
Data Exploration
and Display Tool
TECHNICAL UNDERPINNINGS
EHR Target: Provider Level
RIGHT
INFORMATION
AT THE
RIGHT
PLACE
Patient
AT
REASONABLE
COST
TO THE
RIGHT
PERSON
AT THE
RIGHT
TIME
Staggers & Leaderman, 2000
EHR “Opportunities”
•
•
•
•
•
Technology & Standards Maturity
HIT Financing
Organizational (Cultural) Readiness
Individual Adoption of Innovation
Data Security & Availability
Transforming Healthcare Delivery
• Installation is hard, and mainly technical
• Implementation is really hard, and mainly organizational
• Transition (lasting change) is incredibly hard and purely
human
• Transformation is a state of profound new personal and
enterprise behavior [which accompanies the strategic
acceptance of information technology]
Cerner Corp
Diffusion of Innovation (Rogers, 1995)
Adoption of Technology
“In my opinion, perhaps the success of a
project is 80% dependent on the
development of social and political
interaction skills of the developer and 20%
or less on the implementation of the
hardware and software technology.”
Reed Gardner, 1998 Davies Symposium
CSFs for Successful Implementation
•
•
•
•
Leadership Vision that Compels Engagement
Commitment to Redesigning Work Processes
Operations-Led IT Strategy: Partnership
Strategic Alignment: Clinical/Operational,
Financial, Customer Service, & Employee
• Organizational Metrics—Integration of Clinical,
Financial, & Quality Measures
• Excellent Technology Products & Service
Dilbert loves technology for the sake of technology. In fact, Dilbert
loves technology more than people. He's got the social skills of a
mousepad and he'd rather surf the Internet than Waikiki (which,
considering the physique he developed after years of sitting in front
of a PC screen, is a blessing).
CSFs for Clinician Adoption
•
•
•
•
•
•
•
•
Engaged & Credible Leaders
Managers Accountable for Success
Data Availability & Flexible Displays
Efficiency & Revenue “Hooks”
“Doing It The Right Way” is Easiest Path
Leverage Nursing Support of Providers
Report Card Transparency
Training, Training, Training; then Optimization
EHR Evolution
EHR Target: Community Level
Interconnected
Clinicians &
Informed Practice
Enabling
Technologies
Personalized
Care
Population
Resource
Efficiencies
Economic
Growth
Care
Quality-Outcomes
Nation-wide EHR Barriers
•
•
•
•
Lack of Payer Incentives
Adoption Issues
High Implementation Failure Rate
Interoperability Capacity Limitations
ONCHIT
• Focus Areas:
– Regional Health Information Organization (RHIO)
Development
– Nationwide Health Information Network (NHIN)
– Driving EHR Adoption
• HIT RFPs: Harmonized Standards, EHR
Certification, NHIN Architecture Prototypes, &
Secure Health Information Exchange
"This 'telephone' has too many
shortcomings to be seriously
considered as a means of
communication. The device is
inherently of no value to us."
--Western Union internal memo, 1876.
"Heavier-than-air flying machines are
impossible."
--Lord Kelvin, President, Royal Society,
1895.
"Airplanes are interesting toys but of
no military value."
--Marechal Ferdinand Foch, Professor of
Strategy, Ecole Superieure de Guerre.
"640K ought to be enough for
anybody."
-- Bill Gates, 1981
GotEHR? ☺
Tess Settergren:
[email protected]
(218) 786-3967