EHR Implementation Completion and Success
William A. Hyman
Professor Emeritus, Biomedical Engineering
Texas A&M University, w-hyman@tamu.edu
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A recent exchange with a colleague about his institution’s forthcoming EHR replacement project included the notions of when an EHR implementation was “finished”, and determining whether the adoption and implementation has been a “success.” I first asked if EHRs where ever finished, especially given the still evolving Meaningful Use (MU) requirements. In this regard Stage 3 will certainly require new EHR capabilities, so that the product will have to at a minimum be “upgraded”, and in a logistically worst case abandoned and replaced. The colleague’s answer to this was that the implementation was by definition finished when the vendor and consultants, if any, were paid in full. Any work after this would be of necessity a new project, although maybe some additional effort would be covered under a warranty of some kind, if one had been well defined. This issue may be complicated by having multiple outside suppliers including the EHR itself and any interface systems. Such multiple providers invites multiple finger pointing when something doesn’t work.
As for success, I suggested that any measure of success should include all of the multiple audiences, including direct users and others, and that the measurement would be enhanced by defining the attributes of success in advance rather than trying to do so during the assessment, if there was actually going to be a formal assessment in the first place. This suggestion elicited the friendly rejoinder that I was being naïve. The answer I was told was that success would be determined ad hoc by senior management and that when they declared the system was worth the money that had been spent on it, then the implementation would be declared a success. Of course since senior management had committed the money in the first place, they might be biased toward a conclusion that it had been well spent. In addition, senior management probably didn’t deal with the anguish of getting it all to work, although past anguish is–well–in the past. Nor are senior management personnel the actual users of the system which reminds us that one group’s success can be another group’s ongoing frustration.
I suppose another definition of success would be qualifying for Meaningful Use incentive payments, including successfully weathering any audits. While achieving MU is certainly important if you want the incentives, and want to avoid the later reimbursement reductions, success in this regard is actually a limited accomplishment. That is unless you believe that MU is the perfect embodiment of the best use of EHRs.
So after implementation is finished, and success declared, where will you be? For many users the answer apparently is struggling to use the EHR in a way that is reasonably useful and reasonably efficient. And if one were to have the temerity to say that the EHR doesn’t mesh with the existing workflow, they will be told that obviously your workflow is inefficient and out-of-date and that what you need to do is revise it to match the performance (idiosyncrasies) of the EHR. While existing workflow is certainly open to review, it has not been established that EHR driven workflow is superior, other than in the circular argument that since the EHR requires things to be done in a certain way, then doing them in that way must be the best way to use the EHR.
I wished my colleague good luck in his new EHR endeavor.