Is your healthcare organization recovering from a poor EHR implementation?
There have been rumors from hospital leaders and Congressional committees about the Veterans Administration (VA) hospitals’ implementation of the Cerner Corporation electronic health record (EHR) replacing the VistA EHR. The $ 10 million EHR review has been controversial since the phased rollout began in Spokane, Washington. One report noted that months after commissioning, fewer users knew how to operate the system well.
From an outside computer scientist’s perspective, such frustration can be multifactorial. Typical problems are compounded by COVID-19 hospital restrictions on normal hospital operations. However, many of these problems could have been mitigated by offering more in-person expert support to hospital staff with the support of virtual technical assistance.
Due to system failures, the US Congress has halted the process of implementing Cerner in VA hospitals. Policymakers want concrete answers about why problems encountered were not planned for, why training was inadequate, and problems with software functionality. Critics also question the decision to award the EHR contract to Cerner rather than rival Epic Systems.
Prior to COVID-19, I participated in a Cerner deployment at Department of Defense (DOD) hospitals in Washington. At the time, I saw numerous challenges, the most worrisome being the integration of the workflow with the new system. That challenge is likely to be seen in VA hospitals that are going through this transition. The question here is how a healthcare system can navigate through disappointment and emerge more resilient. I recommend that my clients use the following five Ess to correct a failed implementation.
Evaluation. Leadership needs a full assessment of what is causing the challenges in question. The hospital has to evaluate the workflows so that the system can be adapted to the needs of the department.
Remove. This is the most challenging part of the process. First, leaders must eliminate infighting that can lead to dysfunctions and animosity between work groups. Focus on the inner dynamics. I suggest a team building session involving critical leaders from all specialties and departments, not just doctors and nurses. It should also include everyone with access to the EHR, including staff such as chaplains and dietitians.
Second, eliminate waste from the process. Process waste is ideas or tasks carried over from old systems that staff still feel the need to complete. It can also include inefficiencies learned by the team when they are not properly trained in the new system.
Engage. Involve the clinical team with the IT team. These two groups must communicate the problems to be solved based on priority while maintaining patient safety.
Make sure all hospital staff are fully informed in plain language that ensures transparency. The less jargon the better. Workers must understand their role and, at the same time, feel valuable; This promotes cohesion within the organization and each team.
Indignation. Invest in what the team needs to make an implementation a success. If they need more in-person support, please provide it; If they need to get out of their regular schedule for system training, budget for time. EHR systems are expensive, but if employees don’t use them properly, money is wasted.
Experience. Potentially errors and failures will occur; maximize learning from other organizations that have implemented in the past or learn from the challenges you have faced with your implementation. It is essential to learn from your mistakes and successes.
Failed EHR implementations are costly, demoralizing, and intimidating. However, they can be corrected, and often faster than many believe.
Afua Aning is a medical computer scientist.
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