EHR Benefits & Challenges Jennifer Cavallaro National University
EHR Benefits and Challenges
Providence Health & Services (PHS) healthcare organization is part of a large Health care system up and down the west coast from Alaska to Southern California. The Southern California part of the group is made up of five ministries serving many medical communities; including acute care, long-term care, psych, chemical dependency, outpatient surgery, many inpatient, and outpatient rehabilitation and therapy services, and other specialized care centers.
The announcement of the American Recovery & Reinvestment Act (ARRA) of 2009, and the lucrative compensation offered to the healthcare industry for complying with the initiatives, stimulated many healthcare organizations including PHS into action. Title XIII of the ARRA act, subtitled: “Health Information Technology for Economic and Clinical Health Act (HITECH). It is this section that deals with many of the health information communication and technology.” ("ARRA and HITECH," 2013, para. 2). To meet the objectives of the act as it related to healthcare; improved electronic health record (EHR) technology, meaningful use reporting, Medicare, and Medical incentives. The organization made a system level decision to replace the outdated EHR system with one capable of meeting the requirements of the act.
Benefits and Challenges
Of the many EHR systems available today; the initial challenge facing the healthcare organization is choosing the optimal system. A balance of cost-effectiveness, use- friendly functionality and compliance with other third party systems used is essential. Because of contractual obligation to a particular vendor the organization chose to implement the vendors next generation EHR. Eyeing vendor familiarity as a benefit, knowledge of vendor operations and support strategies can be integral to a successful build and implementation.
On the technical side, five implementations dictated a very aggressive timeline to reach the first deadlines for compensation, especially with one ministry making the transition from paper to EHR. This necessitated the purchase and installation of massive amounts of hardware and wireless infrastructure, followed by thorough testing and validation of the equipment and wireless network capability.
The IS team found benefit from a certain amount of familiarity with the product from the same vendor as the previous system. A major difference, the new system, built as a hybrid of two programming languages presented its own unique challenges. Often the improvements realized from the newer language were offset by the inability of the two languages to coexist in certain modules within the system, leaving the analysts to create workarounds. Acquiring the distinction of being the first multi-facility operation to implement the system, although not officially designated as a ‘beta-site’ at times it certainly seemed that way. Unexpected obstacles occurred throughout the build, such as sporadic dictionaries not respecting facilities specific directions; example: discharge instructions must include the facility address, the report dictionary not respecting the facility forced analysts to create five copies of the same report just to
distinguish the address.
Management also faced staffing challenges; normal operating procedure for any company preparing to implement a new system is supplementing regular staffing with outside contractors. Owing to the infancy of the software experienced contractors were scarce leading to IS personnel retention issues during a stressful implementation period. The original strategic plan to build, train users, and roll-out the system to five ministries in two years evolved to almost two and a half years and saw large amount staff attrition due to burnout. Efforts to retain non-contract staff
through the implementation period included offering a one-time retention bonus, and where possible, the use of contractors to relieve regular personnel of the overwhelming workload.
The clinical side also presented some unique challenges, including as previously
mentioned, one of the five ministries converting to electronic documentation from paper for the first time. The EHR Intelligence website lists 10 obstacles to EHR adoption, #9. Culture: states, “Some providers have worked so long in a paper world that the transition to a digital format proves daunting,” (Murphy PhD, 2012, figure 9). A campaign initiated to ‘sell the product’ to the end-users comprised of frequent EHR demonstrations along with question and answer sessions. Encouragement of end-user input in the development of the documentation piece, providing the users hands-on familiarity with the system. A staggered implementation replaced the preferred ‘big-bang’ method which “affords providers a gentle learning curve to grow with the capabilities of the system. Choosing the wrong strategy could lead to waning support of the EHR experience,” (Murphy PhD, 2012, figure 4).
Building a regional documentation system for five facilities, with different processes, and workflows proved challenging for the analysts. For the clinical areas resolution came in the form of facilitated Ad-hoc meetings comprised of end users, clinical specialists, educators, subject matter experts (SMEs), and analysts. The team developed regionalized evidence-based clinical processes and screens utilizing the functionality of the system. This collaboration culminated in what the website HealthIT.gov lists as increased “practice efficiencies and cost savings,” ("Benefits of EHRs," n.d., p. 1). It also provided increased volume of ‘like’ data extraction for improved “accuracy of diagnoses and health outcomes,” ("Benefits of EHRs," n.d., p. 1). Other realized benefits of the EHR, a truly interdisciplinary record and increased patient safety resulting from reduction in both medication administration and transcription errors add to the
cost-effectiveness of the transition to the EHR and most important, to enhanced quality of patient care.
Non-clinical benefits of the regionalized EHR include streamlined reporting, particularly for meaningful use, quality, and performance improvement. A centralized supply ordering system decreases expenditure, and a regional billing office (RBO) supports improved fiscal monitoring for both organization and customer. A singular system for admissions, scheduling, and health information management (HIM) significantly improves clinician accessibility to medical records and continuity of care throughout the southern California ministries. Conclusion
The healthcare industry is moving forward so rapidly with the EHR, the learning curve is bound to be steep, implementation guidelines will evolve from post roll-out lessons learned. Currently organizations often seem to ‘fly by the seat of their pants’ in the rush to meet government mandates and receive the stimulus funding. In the journal article “Overcoming barriers to EHR adoption,” Haughom, Kriz, & McMillan discuss their own trials and tribulations during an EHR adoption. In closing they recall the reason the health care industry is moving in the direction it is; “to consistently deliver the best possible care across the health system
References
Benefits of electronic health records (EHRs). (n.d.). Retrieved from
http://www.healthit.gov/providers-professionals/benefits-electronic-health-records-ehrs Haughom, J., Kriz, S., & McMillan, D. R. (2011, July). Overcoming barriers to EHR adoption.
hfm (Healthcare Financial Management), 65, 96-100. Retrieved from http://ehis.ebscohost.com.ezproxy.nu.edu/eds
Health care reform and health IT stimulus: ARRA and HITECH. (2013). Retrieved from http://www.ahima.org/advocacy/arrahitech.aspx
Murphy PhD, K. (2012). Top 10 EHR adoption challenges. Retrieved from http://ehrintelligence.com/2012/08/20/top-10-ehr-adoption-challenges/