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The Five Biggest Mistakes of EHR Implementation

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Mistake"Learn from the mistakes of others. You can't live long enough to make them all yourself."

The above quote by Eleanor Roosevelt is the theme of an excellent article published by ADVANCE and the hope these five facilities had when they opened up to ADVANCE and bravely shared their stories of EHR disasters and downfalls. One facility watched as money drained out of its practice and its patients switched doctors; another made its physicians' workday even more cumbersome than it had been in the paper world; and a third unknowingly put its patients at great risk just by updating its system. In the end, however, all shared one remarkable similarity: They never gave up on their EHRs.

Read their stories and share their experiences. Hopefully you can learn from their mistakes.

Lesson #1: Know your product before go-live
The VAR finally arrived. He had promised to make the practice paperless and fully operational within five days. Without templates, physicians had to start from scratch with each patient rather than being guided with yes/no checkboxes. They were soon moving so slowly that each provider was only able to handle one patient per hour. A few lessons can be taken from this. The importance of training and templates before go-live is one. Being cautious of hyped-up claims is another.
"The VAR used the, 'you could be paperless within a very short time' pitch to entice us into purchasing the product. Doesn't that sound pretty attractive? Well it's not realistic," Barto said. This implementation also taught the vendor a few lessons. Most importantly, every VAR now has to be certified.

Lesson #2: Set a date to leave paper behind
Spending some time in hybrid mode as you transition from paper to the new electronic technology is necessary. Not setting a date to leave paper for good will keep you stranded. With no paperless deadline set, the five physicians at Northwest Family Physicians were finding ways to hold onto paper and scrape by using the EMR at a bare minimum for 7 months -- from May to November 2005. To get them out, the administrative board gave them a deadline -- and an ultimatum.

Lesson #3: Use HIM to understand workflow
Four years ago, Denver Health began a pilot project to implement computerized provider order entry (CPOE), but at go-live, the physicians were learning there was more the CPOE couldn't do than what it could. The CPOE system at Denver Health was making physicians' daily routine even more cumbersome than it had been in the paper world. What the problem all boiled down to was that workflow was completely missing from the equation: The CPOE was treated as an IT project, and HIM -- the department that understands workflow the best -- was completely left out, explained Haugen.

Lesson #4: Start with clean data
As all of the names from the old master patient index (MPI) filtered into the new one, it was acting something like a virus: Everything looked fine on the surface, but was spiraling out of control underneath. Because the new system was configured to have an exact match search, every patient coming in as "Miller, Catherine" one time and "Miller (space) Catherine" another was unknowingly creating a duplicate. Children's Medical Center didn't clean out and unify its MPI data before switching to a new system. The center soon became so inundated with duplicates, physicians were yelling, "We can't find our patients!" Wasted staff time, registration time, delays in the ER, re-ordered X-rays and lab tests when the real tests couldn't be found cost an average of $1,000 per duplicate, totaling "a couple million dollars at best," Just said.

Lesson #5: Scan, don't store
The team reasoned that the EMR should have only the most recent information; old records would simply "muck up" and bog down the database, explained Whitney Gregg, HIM manager. Not to mention, a record that had been inactive for 5 years likely meant one thing: The patient isn't coming back. This sounded reasonable -- until a coincidental event highlighted just how bad this decision was. That same year the HIM department decided it was time to pull out the clinic's old paper charts and store them off site. A physician who wanted an old chart now had to call the off-site vendor, and the vendor had to fax it over. Gregg, HIM manager at St. John's Clinic, was left to handle the aftermath when it became clear the physicians needed the older records much more than expected. Her decision was to either scan, or to keep the paper records in an off-site storage facility obtained only through a fax-retrieval process. Gregg then found a vendor that presented an ideal solution.

 

Get the full article here http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?cc=110980&CP=1 

Last Updated ( Monday, 14 April 2008 00:51 )  

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