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  The Health Record Review
by Jeff Rowe, Editor


Report looks at EHR “early adopters”

The main purpose of ONC’s Beacon Communities program is to provide instructive examples of healthcare organizations that are leading the way in the health IT transition.

But, at least for large providers, a new report from The Commonwealth Fund provides a good look at how nine “early adopters” have already planned, implemented and assessed their respective EHR projects.

Dubbed “Using Electronic Health Records to Improve Quality and Efficiency: The Experiences of Leading Hospitals, the report looks at the experiences of nine large hospitals from the eastern half of the country. Executives looking for a discussion of various implementations problems and solutions will want to read the entire report, but certain themes bear emphasizing.

For example, “Nearly all of the hospitals had intensive, lengthy planning and development phases that involved EHR customization, care process redesign to support use of the EHR, and end-user training. The ‘design, build, validate’ phase took a year or (more often) longer, leading up to a staggered launch at different hospitals and physician practices/ambulatory sites across a health system, generally with a ‘big bang’ implementation (all departments at once) within any one hospital. This kind of ‘big bang’ implementation is often necessary because of the interconnectedness of all systems and departments within a hospital.”

More specifically, “The planning and development period varied among systems and hospitals, but the typical time from the decision to purchase the EHR to implementation was two to three years.”

While the report treats numerous issues providers encounter over the course of shifting to EHRs, two sentences that seem to summarize the entire effort are “All of the hospitals committed significant financial resources toward equipment, software, IT staff, and training. They also kept the new system at the forefront through high-level meetings over months and even years.”

In other words, success is slow in coming and requires extensive planning, consistent support throughout the organization and a clear commitment to training. As one interviewee observed, “If you short-change training, you will bring productivity to a halt.”

As for the return these providers got on their considerable investment of time and resources, “The hospitals report that a major benefit of their EHRs has been the ability to look at patterns in performance data to identify problem areas, thereby facilitating quality improvement efforts and identifying opportunities for process redesign. EHRs enable custom data queries based on any number of parameters. Quality staff, department chairs, quality improvement teams, and individual clinicians are able to independently query the EHR to explore their own questions and test hypotheses.”

Moreover, “The systems have helped promote evidence-based care through standardized electronic order sets, clinical guidelines, and immediate access to medical literature. The systems also help to improve patient safety through features such as automated alerts and reminders and through new predictive analytics that identify potential problems before they become crises.”

However useful this report may be for large providers, to our eyes it inadvertently highlights the likely reason why small providers are lagging behind their larger colleagues. After all, time and resources are arguably the most critical needs in any implementation project, and those are often the ingredients of which small providers have the least.

Policymakers, take note.