Keys to a successful EHR rollout

July 4, 2008

From timetables to training, implementing a new system is more about people than computers.

Maybe you've seen the ads in a computer magazine. Such-and-such software or hardware, they claim, works without a hitch right out of the box.

Getting started isn't so simple when it comes to electronic health records, however. Close to 20 percent of healthcare organizations surveyed by the Medical Records Institute in 2007 either had uninstalled an EHR system or were in the process of doing so. The federal government estimates that the EHR failure rate tops 30 percent.

To be sure, some flops can be blamed on a software or hardware "lemon." But most of the time, the culprits are all-too-human problems-poor planning, poor communication, and poor training.

We interviewed healthcare IT experts and doctors who've led successful EHR rollouts to learn how to avoid the typical pitfalls. If you've recently signed a contract for an EHR or you're shopping for one, you'll want to heed their advice.

Assemble a project team

EHR implementation is like moving day for a homeowner, except that you're moving data from paper to computers and the process lasts for months instead of days. So, who are your movers, and who's in charge?

If you're a soloist, you're the de facto leader, even though you may delegate technical and administrative tasks to others. Likewise, group practices need a "physician champion." This role should go to a respected colleague with a gift for communication, and not necessarily to the resident computer geek, says computer consultant Rosemarie Nelson in Syracuse, NY. "The rest of the office will identify more with a nontechie, and think, 'If it can work for her, it can work for me,' " says Nelson. "And your computer guru may use a lot of jargon that goes over everybody's heads."

You'll also need a project manager to coordinate the rollout with your EHR vendor. In a small practice, the office manager normally fills this role. Practices with more than seven doctors may need to hire a full-time project manager on a temporary basis. Your vendor probably can steer you to someone at a local IT or consulting firm who's helped other practices with EHR deployment, says FP Kenneth Adler, medical director of information technology at the 106-doctor Arizona Community Physicians in Tucson.

In a small office, everybody belongs on the implementation team, with good reason. If you don't ask your medical assistant for ideas on exploiting EHR power in her job, you can expect little buy-in from her. In a large group, you'll also want to solicit everybody's opinions, but you must limit the size of the team to manageable proportions. Recruit a member from each department-billing, front desk, nursing, medical records, and so on. While department heads are likely candidates, they may be too busy to serve, notes Nelson. "You may be better off with an enthusiastic rank-and-file person," she says.

Some larger groups also have relied on project management software to set goals, assign tasks, and monitor progress toward achieving a digital office. If that sounds like too much work, at least set up a poster in the break room or hallway that displays your implementation timetable and indicates how far you've come. Every step forward will boost morale.

"The people in charge often forget to communicate to the troops what's going on," says Adler. "If they don't get people revved up, they could meet resistance."