5 Lessons Healthcare Executives Have Learned about EHR Integration

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H!X LogoHCE talked with four healthcare leaders about what they have learned from the integration of electronic health records at their respective organizations. We have listed five of these lessons below:

1.)    Centralize all of your corporate processes around the EHR.

Dr. Deepak A. Kapoor, president of Advanced Urology Centers of New York, said his organization began integrating EHR eight years ago. They determined early on that every process within the organization had to hang on the EHR if the integration was going to be effective.

Being effective right out of the gate was important to them since Advanced Urology Centers spans seven counties in the New York Metro area and conducts 20 percent of urology in the state and 1.6 percent of urology in the United States.

“What most groups do is they try to get everything organized and then a few years later try to layer the EMR on top of it,” Kapoor said. “The problem is that you’ve already created a corporate culture, you’ve already created an infrastructure, you’ve already created a methodology of operation that then you have to change.”

2.)    Budget more for your EHR implementation than you think it will cost.

Mark Bogen, chief financial officer and senior vice president of finance at South Nassau Communities Hospital, oversaw South Nassau’s adoption of the Allscripts EHR system. The organization originally budgeted between 20 to 25 million dollars for the implementation, which also included some hardware renovations.

At the end of 2013, they had actually invested $30 million.

“Whatever someone determines to be the cost of going onto electronic medical record,” he said, “I would say increase by something close to another 20 percent of that.”

3.)    Focus on integrating one EHR vendor, not multiple EHR vendors.

Keith Robison, chief information officer at WCA Hospital, a 342-bed hospital in Jamestown, N.Y., said his organization has achieved Stage 6 in the HIMMS EMR adoption model after being completely paper-dependent in the in-patient and out-patient areas.

When the meaningful-use opportunity came up, he said, WCA formed a team of 80 people that consisted of administrators, physicians, directors, managers, and staff who were actively involved in the selection of an EHR solution.

During the process, the team decided to focus on a single-vendor approach rather than multiple vendors with multiple interfaces. They saw many benefits and cost savings in using a single vendor, he said, in this case Siemens.

Yes, there are still integration challenges between the different systems within one vendor, “but it’s one finger pointing at one vendor,” Robison said. “It isn’t a finger pointing at two different vendors. And then they’re pointing the finger back at each other, saying, ‘It’s not my problem. It’s your problem.’ We’ve gone through that too many times.”

4.)    Conduct extensive testing of the system before the go-live date.

Bogen said South Nassau had originally scheduled to go live with its first phase of implementation in November 2011, but as the summer wore on, his team realized the conversion to a brand-new pharmacy clinical information system necessitated a dramatic amount of testing.

As a result, South Nassau delayed going live with the first implementation phase for six months in order to test every single pharmacy entry item. He said they wanted to make sure the clinical information system was working and would appropriately feed not just the EHR, but also the patient accounting system. He wanted to make sure the system would be properly charging patients and insurance companies.

“And even with that delay and additional testing we still have had some kinks that we’ve tripped over just from seeing bills that would be posting where something that should have been charged as a couple of dollars would be charged at thousands of dollars,” he said.

5.)    When providers say they don’t want to use the EHR because it takes too long, they’re right. It does.

Ryan Sandefer, HIM department chair at The College of St. Scholastica in Duluth, Minn., heads the regional extension center tasked with assisting small hospitals and rural providers with meeting the challenges of meaningful use in Minnesota and North Dakota.

According to Sandefer, most organizations don’t have a problem with the technology itself; it’s with the buy-in.

“Some people don’t want to use it because they don’t like it,” he said. “That’s a good point. These systems were not initially designed for the most part to be a clinical decision support tool. They were developed for administrative reporting and all kinds of other tracking, not necessarily clinical documentation. So they’re being redesigned around the initial intent, not the other way around.”

He added, “There are some real usability challenges that we’ve been working with organizations on to approach their vendors with. When providers say they don’t want to use it because it takes too long: Well, it’s because it does.”

Each of these leaders had other lessons to share with their peers in the healthcare community. We’ll return to this topic in the near future, but in the meantime, what are some of the lessons you have learned about the implementation of electronic health records? How would you advise your fellow executives?

-by Pete Fernbaugh

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