Industry View: Six do’s and don’ts of successful EMR deployments

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Picture: Dimitri Fane, director of product management for InterSystems TrakCare®

Guest column by Dimitri Fane, InterSystems director of product management for TrakCare, and Lindsay Kiley, InterSystems Asia Pacific marketing director.

Research findings indicate low satisfaction with electronic medical record system deployments, but experience shows there are ways to successfully implement them.

The industry-wide pace of digitally driven innovation in healthcare is accelerating. Introducing change within a healthcare environment is challenging, however, and requires a considered approach.

In a recent presentation we shared some insights, based on the experience of our customers, of what works and what doesn’t work in electronic medical record system deployments.

Those insights are consistent with KLAS Research’s best practices study, Creating the EMR Advantage. Coming out of a global initiative to listen to feedback from clinicians regarding their EMR experience, the study shows a 43 per cent overall dissatisfaction rate with the EMR experience.

That certainly leaves quite a bit of room for improvement. The following do’s and don’ts should help make your EMR implementation a success.

Do run benefits realisation programmes and benchmarks

Developing a strong business case for an EMR and clearly defining the project and its objectives is usually seen as necessary for securing project funding or evaluating suitable systems. But what happens after the EMR implementation?

Too often organisations fail to follow through to ensure their business cases are actually achieved. In addition to project governance, there needs to be governance around achieving the desired outcomes. EMR systems should be implemented with a focus on benefits realisation.

Any organisation that wants to demonstrate improved outcomes must be prepared to measure their performance – before, after and into the future. And that means identifying pre- and post-implementation benefits measures and building benchmarking into your EMR solution.

Don’t run an EMR implementation like an IT project

Organisations that run an EMR implementation like an IT project are destined for failure. According to the KLAS study, the EMR system used is just one part of a larger equation, where factors like education and training, organisational culture and governance are equally or more important.

In our experience, executive engagement and leadership is critical, as is effective clinical governance and change management. Effective clinical governance not only ensures that EMR solutions reflect an organisation’s clinical requirements, but it has a broader role in ensuring EMR adoption and speeding up innovation.

The adoption of new technologies with EMR systems – such as mobile devices or patient monitor integration – can create opportunities for new and innovative workflows, but only when effective clinical governance is in place.

Do train clinicians on EMR usage

Training is absolutely critical to EMR success. Successful organisations not only have a well- resourced change management programme, they also prioritise both initial training and ongoing education. Actively involving clinicians in training and education efforts is also important, including recruiting leading clinicians from within the organisation as trainers and mentors.

According to the KLAS study, initial EMR training is the top predictor of EMR user success. Organisations that require newly hired clinicians to complete six or more hours of training taught by other clinicians see significantly higher satisfaction, while the effects of poor initial training remain with users for years after they go live.

In our experience, almost all organisations set an initial goal of ensuring system users have the knowledge and the skills to promote effective adoption of the new EMR system. The most successful organisations, however, also invest in ongoing education to promote positive attitudes towards the system as it continues to evolve and avoid clinician burnout.

Don’t do too much customisation

Striking a successful balance between customisation and standardisation is vital when implementing major technology solutions such as an EMR. Too often, however, the balance errs on the side of customisation and the result is an inflexible solution that cannot keep up with the pace of change.

Gartner’s concept of bimodal IT applies quite well to healthcare. Healthcare organisations have a need for stability, reliability and gradual change when it comes to functions like patient care, financial management, compliance, staffing, supply chain and operations.

But they also have a need for continuous, rapid innovation to adopt trends such as precision medicine, big data, machine learning, the internet of things, mobile apps, artificial intelligence, smart pills, medical devices, human/machine interfaces and patient self-service.

Adopting these innovations is virtually impossible without an EMR system offering rich clinical and patient administration functionality. But the EMR must also integrate the new innovations to remain useful and relevant, and to drive user satisfaction.

EMR solutions that are heavily customised add complexity and cost to the integration process and the process of upgrading to the latest EMR software. While your organisation may have unique clinical workflows that require technology customisation, ask yourself whether they:

  • represent best practice
  • meet data handling and regulatory reporting requirements
  • require clinical staff to be specially trained
  • impede other innovations
  • add complexity and cost that cannot be justified.

Do personalise the experience of EMR users

The KLAS study also shows that the use of personalisation settings has a dramatic effect on the user experience, yet fewer than half of the personalisation options that users have are actually being utilised.

In our experience, the speed and convenience of information retrieval and search is critical to satisfaction. This can be achieved with the use of favourites, customised views, and the ability to achieve more with fewer clicks.

Don’t discontinue the EMR project post go-live

Going live is just the first step in the journey to realising the benefits of an EMR system. Post implementation, you need an actionable plan to drive continuous improvement to achieve the benefits you have set out to achieve.

This typically involves identifying gaps between current and desired EMR adoption levels and benchmarking against other organisations, and boosting adoption levels by making it easier and more rewarding for clinical and administrative staff to use the system.

We have found that tools such as dashboards that statistically measure actual system usage by clinicians, surveys of clinical end-user perceptions, shadowing of clinicians and regular training sessions are useful for uncovering opportunities for improvement and often turn up surprising findings.

It is also important to identify ‘quick wins’ to keep clinicians engaged in the ongoing process of improvements. Executing those changes promptly will remind people that participation delivers payoffs and will help to build confidence within the organisation that more complex, slower changes will also be worth the effort.

Dimitri Fane is the director of product management for the InterSystems TrakCare® unified healthcare information system. Lindsay Kiley is the marketing director, Asia Pacific, for InterSystems.

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