Wes RishelNegative articles continue to appear implying that incentives in the Stimulus to roll out EHR will lead to a disastrous failure. Here we want to note that there are numerous examples of successful deployment in EHRs and to identify some of the ingredients of those successes.
EHRs today are far from highly-tuned instruments anticipating and meeting the doctors’ requirements. But recent articles seem to imply that the current round of products are a sham foisted off on physicians by a cartel of powerful vendors manipulating government standards. We need to make it clear that EHRs are being successfully deployed in many situations and understand the reasons for success.
In research for some upcoming Gartner publications I have looked at five instances where organizations have assisted in selecting and implementing EHRs mostly in small practices. (These are of course all pre-Stimulus activities.) They include: HealthBridge in Cincinnati, Hoag Memorial Hospital Presbyterian in Newport Beach, California, The Massachusetts eHealth Collaborative, MedAllies in the Hudson Valley of New York State, and the New York City Department of Health and Hygiene.
These successful efforts have at least two common facets: they all started with health information exchange or included HIE in the initial plans and they all controlled, supplemented or replaced the vendor implementation and support with approaches that are more highly directive and more keyed to supporting the practices complete the workflow changes necessary to benefit from the EHR.
As I was conducting these interviews, A. John Blair, III, MD, the CEO of MedAllies, offered to contribute to my blog, giving a brief summary of the successes there. This paragraph is verbatim from John:
After two years of ambulatory EHR implementations in New York’s Hudson Valley, we have found that practices of all sizes can implement today’s full EHRs. Not all currently certified ambulatory systems are suitable for very small physician practices, but several systems work well in small offices. The critical factor for success is the initial implementation effort and ongoing support, which includes extended implementation and monitoring of system usage. Our routine implementation includes continuous monitoring for comprehensive and high eRx usage. We work actively with Surescripts to monitor all aspects of eRx. We strive to go live with bi-directional lab interfaces. Also, we configure the systems and train on reporting from the beginning. We ensure that providers are facile with the software before going live so they are documenting at the point of care at day one of go live. We have a comprehensive chart abstraction program to move fully from paper. We monitor adherence to CDS after implementation. We are currently working with 13 practices at over 70 sites to achieve NCQA advanced medical home. All groups have chosen three chronic diseases and are fully using the EHR registry functions. Our current install base includes: Solo practices-24, 2-5-12, 6-25-2, 26-100-3. We have yet to de-install a system.
No one would claim that the products these implementors are supporting are ideal or that every product will work for every practice. Far from it. In fact, healthcare reform and EHR products will, of necessity, co-evolve. As we look for the evolutionary starting point for health IT + healthcare reform, it is reasonable to ask if we want to start with protozoa or salamanders. In examining the question, the fact that we know how to make that today’s salamanders work for physicians should not be ignored.
Category: Healthcare Providers Vertical Industries Tags: ARRA, EHR, EMR, Health IT, Stimulus
5 responses so far ↓
1 ICMCC Website - Articles » Blog Archive » Successes with EHRs May 17, 2009 at 2:42 pm
[...] of successful deployment in EHRs and to identify some of the ingredients of those successes.” Article Wes Rishel, Gartner, 17 May [...]
2 Jim May 18, 2009 at 9:57 am
Added to EHRLinks.com
3 Bob Coli, MD May 19, 2009 at 2:45 pm
Mr. Rishel,
There is no question among physicians and nurses that EHRs and interoperable HIE platforms have not yet become the highly tuned instruments that anticipate and meet the demanding requirements of their work. However, compelling incentives that create a lively, value-based competition among HIT product developers will ultimately produce such tools.
From my clinical practice perspective, the usability and long-term success of today’s ambulatory and hospital-based EHR “salamanders” and HIE platforms will depend on overcoming two big challenges. The first is the ergonomically correct redesign of the healthcare computer user interface. The second is the seamless implementation of all three layers of interoperability—technical (successful data transmission), semantic (communicating meaning) and process (coordinating work processes).
http://www.hln.com/assets/pdf/Coming-to-Terms-February-2007.pdf
One glaring example of a big clinical user interface problem is the historically flawed design of the key interface between the disparate sources of diagnostic test results and the clinicians and patients who use those results in the patient care process.
Ambulatory and inpatient EHRs, PHRs, HIE platforms and clinical lab systems are still using variable formats to display cumulative test results as fragmented and incomplete data. The poor quality of the existing test results reporting interface prevents this information from being efficiently viewed and shared. It is also responsible for the mismanagement of billions of diagnostic test results and contributes to estimated duplicate testing rates in the 15% to 20% range.
In the emerging interoperable HIT era, full semantic and process interoperability will require a standardized reporting format that displays comprehensive, clinically integrated data and presents a unified and common view to EHR, PHR, HIE and CLIS users. Converting fragmented clinical data into meaningful information will provide a work flow tool that facilitates results viewing and sharing by producing a media reduction of up to 80% and greatly improving results readability.
Significantly improving the efficiency of viewing and sharing test results information among collaborating physicians and physicians and patients is part of the many efforts now underway to transform our health-care system so that it improves efficiency, increases quality and reduces costs.
This is one example of the collaborative innovation by computer-savvy clinicians, imaginative software developers and human-machine interface design experts that will be needed to create comprehensive EHR, PHR and HIE systems that are intuitive and easy for physicians and patients to learn and use.
4 Joe Bormel May 20, 2009 at 9:07 am
Wes,
Could you elaborate the metaphor of protozoa or salamanders? I’m not sure what you meant for that to conjure up for me. I recall that protozoa are unicellular and salamanders are amphibious creatures of an incomparable scale. I’m not sure whether additional attributes of either are essential to your point.
Thanks.
-Joe
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