Thoughts on EHR Difficulties and Failures – #2

The transformational character of introducing an electronic health record (EHR) into an enterprise must be well planned and based on foundational work. Because an integrated environment is so interdependent, the absence of policies coordinating the building of interrelated modules and applications can lead to wasted effort and create rework once the unworkability or excessive cost of supporting the configuration is recognized.


Another aspect of dissipating effort and resources are the adoption of deadlines without having contingency plans that allow for the flexible deployment of the EHR to occur after it has successfully passed testing and user acceptance. Often the deadlines are linked to some other events whose prime focus in not the EHR. Similarly, an organization’s executive management must ensure that the project scope is maintained and vigilantly stop or downgrade unassociated projects or unnecessary scope creep.


Establishing the methods for change management (in the integrated environment), coordination and scheduling of build and testing environments, and establishing a sercurity model for user and application access can lead to signigicant simplification of security maintenance while safeguarding protected health information (PHI). Planning for the vetted release of information to indivuals and other healthcare providers should be addressed as part of the architectural design of the EHR. The trend line is that health information exchange (HIE) is becoming one of the main tentants of ARRA HITECH Meaningful Use requirements.

HIT: not all about IT

Much money is spent on clinical applications and too often we say hospitals have developed isolated silos of information. EHR will hopefully remedy this situation, but frequently the selection and implementation of a new specialty application is conducted with a focus that is too narrow. This results in different groups being dissatisfied and also delivers less than stellar returns on the investment. Clinical applications might have a computer program at their heart but they are hugely multi-dimensional and a successful project needs more focus on the elements often regarded as peripheral.

For example, the implementation of an emergency department information system (EDIS) needs to integrate with the rest of the hospital systems (hospital information system, pharmacy, radiology, lab, respiratory therapy, environmental services, communications, clinical data repository, billing, etc.). This requires planning for, and evaluation of such things as compliance issues, legal aspects, metrics for performance, incorporation of quality initiatives, workflows and workflow redesign, user interfaces, user buy-in, unexpected obstacles, common dictionaries, order sets, formularies, handling referring and primary care physicians, granularity of access, and exchanging data with other facilities. The preceding list illustrates some of the complexity involved when integrating with enterprise applications and the need to lay a solid foundation to ensure outcomes when moving to a new clinical tool.

The old saying of measure twice, cut once applies in this situation. Being prepared with knowledge and commitment will make the IT portion of the implementation that much easier.