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Looking Beyond EHR Implementation

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Government health IT incentives have helped set off a wave of adoption of electronic health records (EHRs) across the country. But Meaningful Use criteria were born out of a desire to elevate EHR implementation from a one-time IT project to a long-term strategic organizational initiative tied directly to improving outcomes.

It’s less about chasing dollars and more about going the last mile to make a difference in a patient’s health. It’s time to think less about implementation and more about long-term optimization of EHRs.

This requires a shift in thinking from implementing an EHR to maintaining high levels of adoption over the life of the application. After the go-live event, it can be easy to fall back into our comfortable old habits — resulting in workarounds, regression to ineffective workflows, insufficient training for new users, poor communication and errors.

But the real work begins at go-live, so what we need is a plan to sustain the changes over the long term.

The sustainment plan must first establish how the organization will support the ongoing needs of the end users for the life of the application — including time, funds and other resources. Then it must determine how and when metrics will be collected to assess end-user adoption and performance. Lack of planning and execution in these two areas will lead to a slow and steady deterioration in end-user adoption over time.

Commit Resources, Time and Funds

Adoption is never static — it is either improving or degrading in the organization. A series of upgrades can quickly lead to decreased proficiency among end users, which over time can completely erode the value of the application. Leadership must plan for the investment and fund it if their ultimate goal is improved performance.

Most organizations only achieve modest adoption after a go-live event, so it takes constant focus to achieve the levels of adoption needed to improve quality of care, patient safety and financial outcomes. Sustainability plans are most successful when they are part of the initial budgeting and planning stages for EHR.

Relentless Pursuit of Metrics

Sustainment is more than simply maintaining the status quo. If sustainment becomes a passive process of maintenance, it is a waste of resources. Metrics are the differentiating factor between a highly effective sustainment plan and one that is just mediocre.

End-user knowledge and confidence metrics serve as a barometer for proficiency, providing the earliest indication of adoption. Ultimately, performance metrics are powerful indicators of whether end users are improving, maintaining or regressing in their adoption of the system. If we get an early warning that proficiency is slipping, we can react quickly to address the problem.

If performance metrics do not meet expectations after the go-live event, it may be due to inadequate training, lower proficiency, or a problem with the actual performance by end users.

Measuring end-user proficiency allows us to identify “pockets” of low proficiency among certain users or departments and make sure they receive the education needed. Once users are proficient, we can refocus our attention on the performance metrics.

The second scenario is less common, but also more difficult to diagnose. Sometimes users are proficient, but specific performance metrics are still not meeting our expectations. In this case, we need to analyze the specific metric. Are we asking the right question? Are we collecting the right data? Are we examining a very small change in a rare occurrence?

Or, there could be a delay in achieving certain metrics, especially if the measurements are examining small changes. A normal delay can wreak havoc if we start throwing quick fixes at the problem. In this situation, staying the course and having confidence in the metrics will bring desired results.

Across the country, healthcare organizations are at various stages of EHR adoption. Those that sustain, measure and continually improve their performance will be rewarded with clinical and financial success.

Heather A. Haugen, PhD., is the corporate vice president of research at The Breakaway Group, a Xerox Company. She is co-author of Beyond Implementation: A Prescription for Lasting EMR Adoption.”