The HiMSS group on LinkedIn features some interesting discussion. One of the longer threats evaluates why EHR/EMR implementations fail
Well, I must ask – please define failure! And this questions goes right to the heart of the matter. Defining success is probably one of the most prominent things any project management and executive steering committee must accomplish at the onset of the project – even before a vendor is picked.
I am well aware of the challenges associated with the technical implementation, workflow definition, workflow standardization and Computerized Physician Order Entry (CPOE) and much has been written about this topic.
A key point of any successful EMR is that the physicians and nurses accept the system and want to use it. Honestly, what’s in it for them?
Thus far, physicians in larger organizations had the luxury that someone would transcribe their scribbled notes and mumbled dictations, so that they could focus their time on patient interaction. The fact that healthcare administrators want to reduce errors and establish audit trails of clinical decision making has often been perceived as being of little value to the physician – especially if viewed in comparison to the perceived hassle of learning a new system and having to type patient notes. In a litigious society such as the one in the United States, some physicians may be more comfortable without any trail of clinical decision making that could potentially used against them in trial.
So, for EMR implementation success, a few key principles must be considered:
1. Define clear success criteria. Administrators, tech experts and clinical staff must work together to jointly arrive at a common goal.
2. Workflows. Pay close attention to how much hassle it is for the clinician to complete a workflow. Software must support users, not the other way around. When I was at a major EMR vendor, we actually counted the number of required clicks to complete a task as a key performance metric of the system. In the development cycle, no workflow could execute slower or with more clicks in a new version.
3. Access. This is at the heart of the matter. Organizations should establish clear metrics on how a physician accesses the system. Set an aggressive goal – such as “no more than 15 seconds for the first interaction of the day, no more than 3 seconds to log on to any terminal and get the session back”. This can be achieved through virtualization technology and session roaming with Citrix XenApp and XenDesktop. The use of two factor authentication such as proximity sensors in the user’s security badges or certificate carrying smart cards negate the use of typing in passwords. Think about the access modality as well – is it a thin client, a tablet, an iPad, a computer on wheels? How many hands will the physician have to care for the patient? Are cable or monitor arms in the way? Are there terminals in the hallways so that a note can be amended without disturbing the patient?
I’ve written about this topic in a previous blog as well.
Please provide your thoughts and comments.