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4/20/2010
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How To Succeed At Electronic Medical Records

Cultural change, training and communication are key to solid EMR implementations, survey says.

Implementing electronic medical record systems often requires changes to a healthcare provider's management culture, according to a recent survey of hospitals that are far along in their EMR efforts.

Other best practices cited in the report include effective communication, hands-on IT training and flexibility in financing costs associated with digitizing medical records. The report is based on a survey of 28 hospitals that are members of the Premier Healthcare Alliance, a network of 2,300 nonprofit U.S. hospitals and 63,000 other healthcare sites.

A summary of the survey's results, authored by Susan D. DeVore, Premier's president and CEO, and Keith Figlioli, the organization's senior VP of healthcare informatics, was published in the April issue of Health Affairs.

The 28 hospitals that participated in the survey are all have contributed to the Premier Healthcare Alliance's EHR best practices library, a recently established database that documents healthcare providers' experiences in implementing EHR. Drawing from the survey's results the authors concluded that there are several lessons to be learned, including:

  • Cultural changes in healthcare settings are far more challenging than technology issues or budgetary concerns. IT implementations won't be as successful if strong consideration isn't given to managing the unique personalities of the users involved. New health IT systems bring with them sweeping changes that require process and behavior changes from nearly all workers involved. As such, it's important to see the effort as an exercise in change management, not an IT initiative.

  • Communication should start from the project's outset and continue at each stage of the rollout, involving all members of the senior management team using a variety of tools, including e-mail, newsletters and face-to-face meetings.

  • IT management must recruit clinical champions--physicians, nurses, and other clinicians--and involve them in the process from the beginning so them provide input into design, workflow sign-off processes and live support.

  • Hands-on IT training for medical staff is far more effective than classroom-style education.

  • Reporting of quality measures and alerts should be integrated into any implementation effort.

  • A rigorous security program needs to be designed that includes procedures for responding to security incidents, including those that involve handheld devices.

  • Clear policies are needed to document both informal and special forms of communication that may need to be documented in the electronic health record.

  • Budgets should be built to account for the unexpected.

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