There is no worse feeling than arriving at your go-live date and realizing your hospital is inadequately prepared to use your EMR to care for patients, many administrators say. Here Kevin Burchill, director of healthcare management consulting firm Beacon Partners and former hospital executive, shares five mistakes hospitals make during EMR implementation.
1. Failing to plan for your facility's needs. Different facilities have different needs, and if you fail to consider your organization's "mission, vision and values" before beginning implementation, Mr. Burchill says you're heading for trouble. Before you begin, carefully assess the kind of organization you're running. Are you a large, urban academic medical center who can afford to pursue an integrated EMR from one of the top five vendors, or are you a smaller hospital who might consider a "best of breed" approach? Will your training involve thousands of employees and physicians, or can you talk to all your staff members in a single auditorium? How will your administration govern the implementation of your EMR?
Hospitals who don't plan for their specific needs often end up with a one-size-fits-all implementation, where the only goal is achieving financial incentives in the next few years. "There are going to be more soft benefits than hard benefits," Mr. Burchill says. "You want to focus on mission, vision and values so you can achieve those soft benefits as much as possible."
In order to plan for your specific needs, Mr. Burchill recommends implementing a steering committee to examine the governance structure and mission of your organization. It can help to hold a planning retreat so physician leaders and administrators can focus solely on your EMR plans without being distracted by their other responsibilities.
2. Underestimating the amount of training you need. Your staff will always need more training than you expect, Mr. Burchill says. "Training is the piece we consistently see people undervalue, in terms of hours of training needed per person," he says. "As much as possible, you need hands-on training in the test environment."
A hospital that fails to provide adequate training will run into even more chaos come go-live, Mr. Burchill says. You don't want to arrive at go-live and realize that your staff members have been nodding along in group sessions without ever developing a confident, in-depth knowledge of your system.
Particularly with physicians, he says, nothing replaces one-on-one training. In many facilities, physicians are used to practicing by themselves and relying on their own knowledge to treat patients. When you put them in a group learning environment, Mr. Burchill says they may be reluctant to ask questions. "If they feel like they're behind the learning curve, they're not going to ask for help," he says.
When planning your implementation, budget for considerable one-on-one training time and give your physicians and staff members a space to ask questions in private.
3. Giving your staff false expectations about your EMR. Mr. Burchill recommends you think of EMR implementation as a conversion, not an upgrade. "When people talk about the system being upgraded, there's always a hope that it's going to be better," he says. Telling your staff that an EMR will save you time and money while improving patient care — though that may be true in the long run — is setting yourself up for failure. Instead, say your implementation is simply converting your hospital from a paper environment to an electronic one. The change doesn't mean that every process will suddenly be simpler, cheaper or more effective; it simply means a different way of doing things that every hospital will have to adapt to in the next five to ten years.
Mr. Burchill says it can be easy, when you see a demonstration of an EMR's capabilities, to focus on the "pretty" aspects and ignore the time-consuming labor your implementation will involve. "When you're looking at the screen, and it's point and click, that's the easy part," he says. "You can put your logo on the top corner, but when you're talking about the hard work of asking your physicians [in-depth questions about their day-to-day practice], that's different." It will be hard work to build order sets and preference cards, so you should prepare your facility for a lot of work before you reach the point when your EMR makes everyone's life easier.
4. Assuming every doctor works the same way. Right away, you should recognize that there are different types of physicians, Mr. Burchill says. Some physicians like to go to the nurses' station or patient care center, read all the charts lined up for the day, understand who the patients are and what they're going to do, and then see each patient in succession. After the visits, they will go back to the charting area and document the information for each patient they saw. This kind of physician will work well with an electronic workstation in a central location. But too often, hospitals assume that every physician can rely on a centralized workstation, causing physician to feel dissatisfied when they have to change their traditional practices.
For example, other physicians like to round up their records and make their rounds with a nurse and a group of other mid-level practitioners. As they see patients, they can discuss their impressions and the necessary orders as a team, taking each patient one at a time. "These physicians are best suited for a computer on wheels or another mobile device," Mr. Burchill says.
Still other physicians like to take a chart, sit on the side of the patient's bed and take notes in the chart while they talk to the patient. "For these physicians, a tablet or an iPad is perfect," Mr. Burchill says.
Budget for different kinds of hardware to fit the different needs of your physicians. The stress of implementing an EMR can be alleviated somewhat if your physicians know that you're paying attention to their personal practices and doing what you can to make a complex overhaul simpler for them.
5. Relying on your traditional help desk to handle EMR problems. Although your hospital probably already has a help desk, don't assume it will fill your needs after your EMR is implemented. "Ask yourself, 'What does our 24/7 help desk entail now?'" Mr. Burchill says. "Often, in a pre-electronic environment, the help desk is really open for daytime hours and some evening and weekend hours, and on-call thereafter." With an EMR, you will need clinical decision and patient care support 24 hours a day, and your help desk's availability has to match those needs.
He says the need for help desk support is similar to the need for one-on-one training prior to go-live. "Part of being electronic is having real, live people available to support issues that pop up with your electronic records," he says.
Read more about Beacon Partners.
1. Failing to plan for your facility's needs. Different facilities have different needs, and if you fail to consider your organization's "mission, vision and values" before beginning implementation, Mr. Burchill says you're heading for trouble. Before you begin, carefully assess the kind of organization you're running. Are you a large, urban academic medical center who can afford to pursue an integrated EMR from one of the top five vendors, or are you a smaller hospital who might consider a "best of breed" approach? Will your training involve thousands of employees and physicians, or can you talk to all your staff members in a single auditorium? How will your administration govern the implementation of your EMR?
Hospitals who don't plan for their specific needs often end up with a one-size-fits-all implementation, where the only goal is achieving financial incentives in the next few years. "There are going to be more soft benefits than hard benefits," Mr. Burchill says. "You want to focus on mission, vision and values so you can achieve those soft benefits as much as possible."
In order to plan for your specific needs, Mr. Burchill recommends implementing a steering committee to examine the governance structure and mission of your organization. It can help to hold a planning retreat so physician leaders and administrators can focus solely on your EMR plans without being distracted by their other responsibilities.
2. Underestimating the amount of training you need. Your staff will always need more training than you expect, Mr. Burchill says. "Training is the piece we consistently see people undervalue, in terms of hours of training needed per person," he says. "As much as possible, you need hands-on training in the test environment."
A hospital that fails to provide adequate training will run into even more chaos come go-live, Mr. Burchill says. You don't want to arrive at go-live and realize that your staff members have been nodding along in group sessions without ever developing a confident, in-depth knowledge of your system.
Particularly with physicians, he says, nothing replaces one-on-one training. In many facilities, physicians are used to practicing by themselves and relying on their own knowledge to treat patients. When you put them in a group learning environment, Mr. Burchill says they may be reluctant to ask questions. "If they feel like they're behind the learning curve, they're not going to ask for help," he says.
When planning your implementation, budget for considerable one-on-one training time and give your physicians and staff members a space to ask questions in private.
3. Giving your staff false expectations about your EMR. Mr. Burchill recommends you think of EMR implementation as a conversion, not an upgrade. "When people talk about the system being upgraded, there's always a hope that it's going to be better," he says. Telling your staff that an EMR will save you time and money while improving patient care — though that may be true in the long run — is setting yourself up for failure. Instead, say your implementation is simply converting your hospital from a paper environment to an electronic one. The change doesn't mean that every process will suddenly be simpler, cheaper or more effective; it simply means a different way of doing things that every hospital will have to adapt to in the next five to ten years.
Mr. Burchill says it can be easy, when you see a demonstration of an EMR's capabilities, to focus on the "pretty" aspects and ignore the time-consuming labor your implementation will involve. "When you're looking at the screen, and it's point and click, that's the easy part," he says. "You can put your logo on the top corner, but when you're talking about the hard work of asking your physicians [in-depth questions about their day-to-day practice], that's different." It will be hard work to build order sets and preference cards, so you should prepare your facility for a lot of work before you reach the point when your EMR makes everyone's life easier.
4. Assuming every doctor works the same way. Right away, you should recognize that there are different types of physicians, Mr. Burchill says. Some physicians like to go to the nurses' station or patient care center, read all the charts lined up for the day, understand who the patients are and what they're going to do, and then see each patient in succession. After the visits, they will go back to the charting area and document the information for each patient they saw. This kind of physician will work well with an electronic workstation in a central location. But too often, hospitals assume that every physician can rely on a centralized workstation, causing physician to feel dissatisfied when they have to change their traditional practices.
For example, other physicians like to round up their records and make their rounds with a nurse and a group of other mid-level practitioners. As they see patients, they can discuss their impressions and the necessary orders as a team, taking each patient one at a time. "These physicians are best suited for a computer on wheels or another mobile device," Mr. Burchill says.
Still other physicians like to take a chart, sit on the side of the patient's bed and take notes in the chart while they talk to the patient. "For these physicians, a tablet or an iPad is perfect," Mr. Burchill says.
Budget for different kinds of hardware to fit the different needs of your physicians. The stress of implementing an EMR can be alleviated somewhat if your physicians know that you're paying attention to their personal practices and doing what you can to make a complex overhaul simpler for them.
5. Relying on your traditional help desk to handle EMR problems. Although your hospital probably already has a help desk, don't assume it will fill your needs after your EMR is implemented. "Ask yourself, 'What does our 24/7 help desk entail now?'" Mr. Burchill says. "Often, in a pre-electronic environment, the help desk is really open for daytime hours and some evening and weekend hours, and on-call thereafter." With an EMR, you will need clinical decision and patient care support 24 hours a day, and your help desk's availability has to match those needs.
He says the need for help desk support is similar to the need for one-on-one training prior to go-live. "Part of being electronic is having real, live people available to support issues that pop up with your electronic records," he says.
Read more about Beacon Partners.