Negative 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.