EHR IMPLEMENTATION:
FACTORS FOR SUCCESS
Tess Settergren, MHA, MA, RN-BC
Director, Clinical Informatics
July 19, 2005
What is EHR?
“A real-time patient health record with access to
evidence-based decision support tools that can be
used to aid clinicians in decision-making. The
EHR can automate and streamline a clinician's
workflow, ensuring that all clinical information is
communicated. It can also prevent delays in
response that result in gaps in care. The EHR can
also support the collection of data for uses other
than clinical care, such as billing, quality
management, outcome reporting, and public
health disease surveillance and reporting.”
(Brailer, 2005)
EHR Components
• Patient Data (PHI)
– Discrete, structured, sometimes coded
– Textual/other non-structured
– Digitized images, biomedical, other
• Clinical Decision Support
– Information Displays
– Rules-based Order Entry (CPOE)
– “Best Practice” Reminders, Alerts, Tools
EHR Components
• Clinical Messaging
– Results & Other Clinical Management
– Operational Efficiency
• Personal Health Record
– View Results & Reports; Add Data
– Patient Education Resources
– Clinical Advice & Messaging
• Support of Secondary Data Use
EHR Building Blocks
FUNCTIONAL
BLOCKS
Results
Reporting
& Imaging
Decision
Support
Multidisciplinary
Guidelines
QM/UM
Documentation
Order
Entry
Scheduling
Registration
Coding &
Grouping
Confidentiality and Security
Unique Patient and Provider Identifiers
Scanning
Automated Data
Capture
Data Exploration
and Display Tool
TECHNICAL UNDERPINNINGS
EHR Target: Provider Level
RIGHT
INFORMATION
AT THE
RIGHT
PLACE
Patient
AT
REASONABLE
COST
TO THE
RIGHT
PERSON
AT THE
RIGHT
TIME
Staggers & Leaderman, 2000
EHR Target: Community Level
Interconnected
Clinicians &
Informed Practice
Enabling
Technologies
Personalized
Care
Population
Resource
Efficiencies
Economic
Growth
Care
Quality-Outcomes
EHR “Opportunities”
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Technology & Standards Maturity
Health Information Technology Financing
Organizational (Cultural) Readiness
Individual Adoption of Innovation
Data Security & Availability
Transforming Healthcare Delivery
• Installation is hard, and mainly technical
• Implementation is really hard, and mainly organizational
• Transition (lasting change) is incredibly hard and purely
human
• Transformation is a state of profound new personal and
enterprise behavior [which accompanies the strategic
acceptance of information technology]
Cerner Corp
Diffusion of Innovation (Rogers, 1995)
EHR Evolution
CSFs for Successful Implementation
• Commitment to Redesigning Processes…a Vision
• Operations-Led IT Strategy
• Alignment with Strategy: Clinical/Operational,
Financial, Customer Service, & Employee
Learning/Growth
• Foundational to Organizational Metrics—
Integration of CLINICAL, FINANCIAL, &
QUALITY Measures
CSFs for Clinician Adoption
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•
•
•
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•
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Engaged & Credible Leaders
Managers Accountable for Success
Data Availability & Flexible Displays
Efficiency & Revenue “Hooks”
Easiest Path to “Doing It The Right Way”
Leverage Nursing Support of Providers
Report Card Transparency
Training, Training, Training; then Optimization