A couple of weeks ago I was privileged to participate in a discussion panel presented by the Nashville Technology Council whose broad topic was healthcare innovation. I sat on the panel with Steve Little from InfoWorks and Bob Chaput from Clearwater Compliance and the panel was moderated by Travis Gregg from Trinisys. One of the questions that was posed by the audience was: “Why are electronic health records such a challenge to implement?”
This is a timely topic for several reasons, not the least of which is the upcoming Meaningful Use: Stage 2 requirements for eligible providers as well as recent, high-profile electronic health record (“EHR”) implementation struggles. When it came my turn to field that particular question I gave three primary reasons why it is difficult to successfully implement an EHR:
- Pressure from financial incentives. Many people outside of the healthcare or technology industries may not be familiar with CMS’ EHR incentive programs but the billions of dollars available to eligible providers (both hospitals and individual) that meet specific criteria has dramatically impacted the marketplace. Providers are doing their best to capture as many of the incentive dollars as they can in order to off-set the costs associated with implementing an EHR while the vendors are happy to have a government-funded marketing campaign for their software and services. This financial pressure, while certainly pushing some providers in to the electronic age, is causing some to partner with vendors that may not be the best fit while also encouraging new vendors to enter the market place and established vendors to speed up their development cycles. All of this pressure can add up to poor decision making regarding solutions that may not be ready for wide-scale use.
- Immature implementation methodologies. Going hand-in-hand with software that is not ready for prime time, many vendors have looked to further capitalize on government funding by expanding in to implementation services. Likewise, consulting companies around the country are seeing a massive near-term opportunity to build up a healthcare practice helping providers implement their newly-selected EHR solutions. While this may be a standard operating procedure for mature solutions, implementations face great difficulty due to immature (or incomplete) implementation methodologies. Much like yesteryear’s ERP implementations, providers are looking for strong project management leaders driving proven implementation plans but are struggling to find either. This deficiency leads to poorly adopted systems that are not tightly integrated, driving up costs and frustration levels.
- Focusing on the wrong fundamental issue. Often led by the CIO, many EHR implementation struggles are seen being driven primarily by technology issues when, in reality, these are the wrong issues to focus on. The issue that causes many EHR implementations to struggle is that the implementing organization failed to adequately understand the scale of the clinical transformation required to be successful. Medical providers on all levels have been documenting the care they render since they first began as a clinician, but they all tend to do it just a bit different than their colleagues. Even with the advent of evidenced-based medical protocols, providers still like to argue about the “evidence” being used and why their patient falls outside the standard. The real challenge is implementing a system that allows for the “practice” of medicine while also enforcing protocols that the larger organization agrees upon. As simple as this may sound, this is in fact a massive undertaking that is often underestimated.
Electronic health records are absolutely worth-while investments for providers of all shapes and sizes and have the capacity to greatly–and positively–impact patient care. Like most great enterprises, however, there are great risks to bear and long roads to travel to unlock all of the potential rewards. EMR implementations do not have to be as great of a challenge to implement as they often times are but they will not go as smoothly as they could without addressing the three points discussed above.
