Electronic Health Records: adoption or just implementation?

Posted on: November 27, 2018 by Heather Haugen

The benefits for patients and clinicians of introducing electronic health records (EHR) into healthcare organizations are now well acknowledged. Having ready access to complete, accurate and up-to-date patient information can make major contributions to improving patient safety and quality of care while increasing efficiency and improving day-to-day workflow. Yet, while many organizations prepare thoroughly to make sure these systems are introduced on time and to budget, once the go-live date has passed, there is less focus on gaining full value from the functionality they offer. In short, when it comes to EHR, too many organizations focus solely on implementing new software and fail to ensure that the benefits are fully delivered.

Without sufficient effort post-go-live, the value of EHR systems and any subsequent upgrades may be eroded over time. For example, if user training and adoption are not sustained, existing users may fall back on workarounds and ineffective workflows and new users may receive insufficient training.

In many ways, the real effort only begins at go-live; processes to ensure long-term adoption require a very different set of disciplines to launch. What’s needed is a plan for how changes and improvements will be sustained.

An EHR sustainment plan must address two important areas.

  • How the organization will support end users’ ongoing needs, including communication, education and maintenance of materials and resources
  • How and when metrics will be collected to assess end user adoption and performance.

Power of metrics

One of the differences between a highly effective sustainment plan and a mediocre one is the use of metrics. Consistently measuring users’ knowledge about and confidence in the system creates a barometer for proficiency levels and best practice. Performance metrics are powerful indicators of whether users are improving, maintaining or regressing in their adoption of a new system and of any reversion to old behaviors. Metrics also keep organizations on track if, for any reason, performance does not meet expectations. If these warning signs come early, then organizations can react quickly and proactively to address the

problems and ensure the promised benefits of EHR are realized.

Healthcare organizations’ management teams need to keep in mind that adoption is never static; it is continually either improving or degrading. Let’s consider two different scenarios. In both scenarios, go-live was successful, but specific performance metrics are not meeting expectations.

  • In the first scenario, the system is being used inefficiently. This may be due to inadequate training and subsequently lower user proficiency. Measuring this proficiency enables the organization to identify ‘pockets’ of low proficiency among certain users or departments and ensure they receive the education they need. Once users are proficient, the organization can keep monitoring the performance metrics.
  • The second scenario is less common and more difficult to diagnose: metrics show that users are proficient, but specific performance measurements are still not meeting expectations. In this case, the specific metric needs to be analyzed. Is the right question being asked? Is the right data being collected? Are these relatively small changes or rare occurrences? More time might be needed to achieve certain metrics; throwing quick fixes at a problem too early (instead of staying the course and having confidence that the expected performance will eventually emerge) could be damaging.

An effective sustainment plan requires time, resources and funding – ideally identified during the initial planning and budgeting for EHR. To ensure sustained adoption of EHR, it takes relentless focus on improving quality of care, patient safety and financial outcomes. While investment is certainly required, the returns on that investment will be compelling.

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About Heather Haugen
Chief Science Officer for Digital Health Solutions for Atos and member of the Scientific Community
Dr. Heather Haugen has deep expertise in health information technology and a passion for research and the application of those outcomes to the challenges that currently exist in healthcare. She is the Chief Science Officer for Atos in their Digital Health Solutions division. Prior to her current role, she was the Managing Director of The Breakaway Group, A Xerox Company. She has served in research, development and information systems leadership roles. Her past roles have led to a unique mix of experience, including conducting rigorous research, leading development efforts based on research outcomes, and leading and developing top-performing teams. Haugen has more than 20 years of research experience in both the academic and private sectors. Her research and methodology is published in her latest book, Beyond Implementation: A Prescription for the Adoption of Healthcare Technology, which is the second edition and a National Bestseller. Dr. Haugen holds a faculty position at the University of Colorado Denver- Anschutz Medical Center as the Director of Health Information Technology, where she actively mentors doctoral students and teaches courses. She is also the author of Beyond Implementation: A Prescription for the Adoption of Healthcare Technology.

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