The decision to purchase and implement an EHR is a daunting task

For physician practices, especially for the 80% of the market who work in practices of five doctors or less. These practices are faced with a lack of true technical expertise on staff, over 530 fully certified EHR products to choose from and a limited knowledge of how EHR adoption affects key areas of the practice. These affected areas can include overall patient volume, profitability, clinical workflow and revenue cycles. With all this in mind, it’s no wonder the failure rate for EHR adoption remains perilously high.

In many EHR adoption settings, there are a handful of common reasons why the implementation fails. Understanding these reasons, and how to address them, can lead to more efficient, more successful EHR implementations.

Lack of Engagement

Engagement runs two ways within the practice. First, the physician has to be engaged and committed to the reality of the challenges and benefits that EHR adoption will have on their practice. For most practices, this means that the primary physician is driving the need for implementation but is not fully responsible for the project. In most successful implementations, the practice has designated a project manager and physician “champion.” Once the project manager and physician champion are selected and engaged they are required to ensure the critical components are managed and the strategic goals are accomplished. This is vitally important as it provides the

opportunity for broader accountability and buy in without the already time burdened physician having to mandate the effort. Second, the EHR vendor or Value Added Reseller (VAR) must also engage with the entire practice, not just the primary physician and the champion of the EHR project. This relates to two areas – understanding the practice’s mindset/reasons for adoption and making sure that the entire staff understands the value of, and their role in, the implementation and full utilization of the software. For example, if the only reason a practice is considering adopting a certified EHR is to receive the ARRA incentive payments, then they are significantly less likely to be committed to the level of change that is required to go from paper charts to fully utilizing an EHR. This will put the implementation in jeopardy right from the start. Engaging the entire practice will ensure general staff and clinicians are committed to the goal that use of an EHR will improve patient safety and clinical outcomes. When that goal is realized it generates compelling motivation to deal with the learning curve and transition issues.

WHY EHR IMPLEMENTATIONS GO WRONG

Lack of a Strategic Plan

A practice’s strategic plan for EHR adoption should include at least the establishment of goals, timelines,

financial expectations and job responsibilities. Having these items clearly defined will help bring clarity to the adoption process, outline everyone’s role and build confidence that the practice can take on this level of operational change. However, an implementation can be completely sabotaged by the lack of a strategic plan. A thorough, well-defined strategic implementation plan will help ensure all users are prepared and ready to begin using the new EHR software.

In addition to what is listed above, the plan should also take into consideration all transition issues, for example the transferring of data from the paper charts or legacy EHR to the new certified system can create problems if not planned properly. Another potential negative impact is the possibility of a slowdown in revenue, as fewer than usual patients should be scheduled during the first “go-live” days. Taking the time to address these components, especially establishing goals, will provide a solid foundation for all the operational changes associated with an implementation. A few examples of goals would include:

• Improve patient safety and promote quality of care outcomes.

• Increase practice efficiency and profitability.

• Participate in Meaningful Use and obtain its incentives. Additionally, all employees should be informed and committed as a team, without this commitment there will be uncertainty and frustrations, which can easily lead to a failed implementation.

Inadequate Workflow Assessment

An inadequate assessment of patient and clinic workflows will create a barrier to the progress of an implementation. The commitment to evaluate and ultimately purchase an EHR system is the perfect time to address workflows within the practice. Focusing on the four main tenets of a healthy physician practice – revenue, profitability, efficient workflow and patient satisfaction – will allow the practice to assess existing workflows and make unbiased modifications moving forward. This will also allow for the identification of specific areas where an EHR could provide significant support. Adding the right EHR system can streamline existing processes and help make the practice more efficient. Being able to credibly select the appropriate EHR systems for the practice starts with ensuring the practice is operating in as efficient a manner as possible.

Lack of Practice/EHR Alignment

Trying to implement an EHR software solution that does not meet the unique needs of the individual practice is actually doing more harm than good for the practice. Working in collaboration, the findings from a clinical workflow assessment effort will layout a roadmap, with milestones, that can help ensure a successful selection of an

EHR package but also the determination of a timeline and process for implementation. For example, the manner and clinical approach in which a dermatologist practices medicine is different from an internal medicine physician, which is different from an oncologist, etc… in the same way that small practices have different challenges and needs compared to large multi-specialty practices. MGMA, (mgma.com) tells us that in a practice with as few as two clinicians you will likely encounter at least six different charting techniques. All of these considerations, and many other factors, require an informed comparison between the needs of the office and the features and functionality of the EHR software.

Access and Quality of Training

With any implementation of an EHR system within the physician’s office, one of the primary factors to success is how

quickly the staff can become comfortable using the system at full capacity. The faster the practice can get to full utilization of the

EHR, the faster they can get back to seeing a full patient load. This has very obvious implications on revenue, profitability, etc. The

key to shortening that timeline is training. The lack of proper training can have very negative impacts on the success of an EHR

implementation. First, if the proper resources within the practice aren’t well trained they become a roadblock to full utilization.

Second, if the proper resources do receive training, but have either lingering questions or the type of training did not fit the

individual, and then they can become a roadblock to full utilization. Many times when looking to cut price, training is an easy line

item to remove. However, training budgets – and access to different modalities of training, including at least web-based and

onsite – must be protected by physician practices. Without it, the timelines to full utilization will lag and the practice will become

mired in underperformance and frustration.

When making the choice to select and implement an EHR, a physician practice must be aware that they are many potential roadblocks to delay and ultimately failure of the implementation. However, the practice can be protected by completing a proper assessment of the practice, choosing an internal project champion, working with the selected vendor to ensure there are a strategic plan as well as ensuring that all staff have access to and complete the amount of training required.

To learn more got to http://ehrroadmap.mbmehs.com// Contact info@mbmehs.com // (800)236-2498 ext 101