Improve EHR Adoption by Starting at the Beginning

Recent headlines tell us physicians lag in EHR adoption and I expect that we will see that headline repeated for a while. But in the midst of our country’s unprecedented investment in eHealth, we're also learning how to do things right, and I do think best practices are emerging to lessen the EHR adoption curve for doctors and other personnel.

One important lesson is that the planning stage is as critical as the implementation and launch. As a former CEO, I believe there is as much to do in the beginning to lay the groundwork for user acceptance as there is at the end of the project.

From the outset, hospitals should involve and empower not just physician users but all bedside clinicians and administrators in vendor selection, design of the system and implementation. This helps ensure ownership and knowledge in the end product across a broad spectrum of stakeholders.

In engaging your internal team, take time to learn the unique strengths and abilities of your end users. As I helped my hospital grow to CPOE, I was ignorant that a very respected cardiologist had spent years before med school writing code. He was the ultimate neglected asset. Lesson learned.

It’s also valuable to look across your entire organization with an eye for those who know what it’s like to implement large systems.

At one time I worked in an 11 hospital system that was last in line to move from a fragmented legacy system to the new integrated system. We worked closely with select personnel from the other hospitals in the system that had already been brought online and their experience and peer-to-peer mentoring proved invaluable.

Your internal team will play a critical role in helping vendors and third-party consultants analyze and truly understand the workflow and decision processes that occur in the delivery of care. This is not the same as slavishly reproducing existing workflow. Existing workflow patterns may have grown inefficiencies and workarounds. The transition to EHR is the opportunity to “get it right”. This is the time to design IT that drives effective workflow and enhances decision processes.

Early on, hospital leadership should actively publicize the vision of where you will be with the successful EHR implementation, how you will get there and what will be expected of the community. To get to the end of your journey, your team will want to know where you are taking them and what benefits are possible at the end of the process.

The administration should also commit to learning and becoming facile with your chosen EHR. While C-suite users may never be power users, their intimate knowledge of the EHR provides credibility and understanding.

There are other important EHR adoption steps to be taken during the implementation and launch phases—and I’ll address those in a future post. But don't wait until you reach these end phases to begin thinking about user acceptance. If you do, it might be too late.

Frank X. Speidel, MD, MBA, FACEP is Chief Medical Officer for Healthcare IT Leaders and former CEO of St. Luke’s Hospital at the Vintage, Houston, TX.