ehr implementation: factors for success tess settergren, mha, ma, rn-bc director, clinical...

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

Decision Support

Multi-disciplinary Guidelines

QM/UM Scheduling

Results Reporting & Imaging

Documen-tation

Order Entry

Registration Coding & Grouping

Confidentiality and Security

Unique Patient and Provider Identifiers

ScanningAutomated Data Capture

Data Exploration and Display Tool

TECHNICAL UNDERPINNINGS

ScanningAutomated Data Capture

EHR Target: Provider Level

Patient

RIGHTINFORMATION

AT THERIGHTPLACE

TO THERIGHT

PERSON

AT THERIGHTTIME

ATREASONABLE

COSTStaggers & Leaderman, 2000

EHR Target: Community Level

Population

Interconnected Clinicians &

Informed Practice

Personalized Care

Care Quality-- Outcomes

ResourceEfficiencies

Economic Growth

Enabling Technologies

EHR “Opportunities”

• 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• 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