E-medical record projects aren't for the faint of heart. The conviction of a strong leadership team and a solid vision of the project's goals are keys to successful deployments. Just ask the folks involved with the EMR rollout at Fletcher Allen Health Care in Vermont.Fletcher Allen decided to take a big-bang approach to its EMR and other related hospital clinical systems. That meant getting the EMR deployment at the organization's 500-plus bed medical center completed quickly rather than taking piecemeal strategy that can drag out for several years.

The $60 million project recently completed its first and biggest phase after a 15-month planning and implementation process. That phase, including the deployment of e-medical record software from Epic for inpatients, emergency department, physician documentation, and pharmacy system, went live in June. Those systems replace what were mostly manual, paper-based record keeping.

When that first phase of the project went live, so did electronic clinical documentation even though special templates for specialists writing notes digitally hadn't yet been completed.

"We went live with just a few templates for clinical documentation, but we still got them writing notes in the system," said Anne Ireland, an R.N and clinical architect for the project. "Some organizations would have stuggled with this, we moved forward."

Many times, a healthcare organization will waste a lot of time at the end of projects and missing deadlines trying to make everything perfect, said Fletcher Allen CIO Chuck Podesta. "A lot of organizations spend a lot of time on the last 10% of a project tweaking," he said. And much of that tweaking is unncessary, or can be done after a project is live, he said.

The next two smaller phases of Fletcher Allen's EMR project, includes the rollout of Epic e-health record systems for the Fletcher Allen's ambulatory doctors and a data warehouse for performance and outcome reporting, is expected to be done by end of 2010.

A big part of Fletcher Allen plan was making sure that leaders were on the same page about vision. "From the beginning, this wasn't viewed as an IS project," said Podesta. The project was billed as an initiative to improve patient quality of care.

To drive that point home, Ireland often took along with her an IV pole as a physical reminder about patients whenever she attended Fletcher Allen meetings about the EMR initiative. The various committees and groups involved with the projects included members representing all clinical departments. For instance, there were nurses on groups involved with design as well the committee overseeing governance.

Doctors, nurses and clinical staff were free to air their concerns, frustrations and complaints to the various groups and committees representing all facets of the organization. And those concerns were discussed by Fletcher Allen's leaders.

While there were forums for discussing concerns and opposition to plans, Fletcher Allen's leadership team weren't swayed from the project's mission to improving patient quality of care. "We'll get you an answer, but it might not be one you want to hear," said Podesta about leadership's response to dissenters.

"It's easy to stumble when there's dissent and questioning," said Donna Schmidt, a partner with CSC, which provided consulting, IT design, building, testing and other services to Fletcher Allen during the project. Fletcher Allen's leadership "stayed above the fray and said 'we're going to go,'" said Schmidt.

"When the first physician says, 'I'm taking my business elsewhere,' how leadership confronts that challenge matters greatly" in EMR rollouts, she said. "The whole focus was on the quality of patient care--improving workflow to take care of the patient in the best way." she said. That was the bottom line message sent throughout the organization, she said.

In addition to its academic medical center, non-profit Fletcher Allen Health Care, which employs a workforce of 6,900, also operates 30 other healthcare facilities in Vermont. The EMR will be operational throughout those centers, as well as for the 750 doctors whose practices are affiliated with Fletcher Allen.

In the months to come, there will likely be lots of other healthcare providers taking a faster, big-bang approach to e-medical record deployments as time ticks away towards 2011, when the federal government's $20 billion rewards program for the "meaningful use" of health IT kicks in.

Hopefully, tough leadership with solid, committed vision will help those healthcare organzations, too.

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