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EHR rollouts aren't an IT issue. How execs need to get involved

August 12, 2014

    Clare Rizer, Daily Briefing

    On the surface, implementing a new electronic health record (EHR) system sounds like a problem for the hospital's IT department. But this assumption can quickly tank any rollout—as officials at a Georgia hospital saw earlier this year.   

    Hospital CEO resigns after botched EHR rollout

    EHR rollouts are complicated and affect nearly everyone from the CEO to the newest nurse on staff. But how can leaders—clinical, technical, and executive—make sure all of the key players are heard and incorporated into the process?

    I spoke with several Advisory Board experts to shed light on the issue and they all agreed on one key takeaway: Successfully executing all the moving parts of implementing an EHR system starts in the C-suite.

    From the C-suite down: Rolling out a new system

    C-suite involvement in EHR implementation might seem natural, but many CEOs view EHRs as merely a technical tool. It often takes a "visionary" CEO to recognize the strategic value of an EHR system, says Doug Thompson, a senior research director for the Advisory Board's health IT suite.

    Thompson explains, "It's only the more sophisticated executive teams and CEOs who have this idea of driving strategic value from an EHR and are involved as active participants in pushing EHR adoption and putting their influence behind it to make things happen."

    Ernie Hood, another senior research director for the Advisory Board's health IT suite, stresses that the most important executive-level task is having conversations with clinicians in order to determine their needs. And executives should do it before they select an EHR system.

    Prior to the start of the rollout, Hood says executives should:

    • Speak with different types of clinicians separately in order to get a complete picture of what different positions value in an EHR;
    • Ask staff questions like, "How can we make this work for you?" and "How can this EHR make you a better performer?"; and
    • Allow staff to air any potential grievances about EHR implementation in order to show them that you hear what they are saying, but try to "stifle any lofty or ridiculous claims" and instead capture legitimate concerns.

    As the implementation is underway, Hood recommends that executives:

    • Stress improvements to the patient experience and meeting clinical goals as the reasons for the implementation to encourage physicians to embrace the system; and
    • Stay involved with clinicians through the entire process and recognize that it "involves a complete transformation of care delivery."

    And once the system is fully in place, Hood says executives should continue to meet with clinician leaders to assess how care is being affected by the system's use.

    Hood notes that becoming involved in implementation from the start and continuing to check up on clinicians' feelings throughout the process will prevent clinicians from feeling that an EHR rollout is being "done to them" rather than "for the patients."

    In addition, he says, seeing leaders invested in choosing a system that meets the needs of their entire hospital workforce will likely make providers more supportive of the change.

    Why a surgeon built his own EHR system

    It's not just the CEO: How doctors and nurses should get involved

    Most of the insight that Hood, Thompson, and senior research director Peter Kilbridge shared with me can be applied to clinician leaders as well.

    For physicians and nurses, having candid team discussions about needs and expectations can significantly reduce frustration. Hood says physicians should lead their nurses through EHR implementation by listening to and addressing their needs upfront and optimizing the EHR's functions so that nurses can practice at top-of-license.

    Our experts at the Nursing Executive Center also stress the need for building systems that meet an organization's needs. They note that clinical workflow disruptions during an EHR rollout generally occur because a particular vendor or product was set to feature function rather than customized to improve outcomes.

    But if hospitals (from the top down) take the time to have the right conversations and take the necessary steps, clinicians and executives will find more harmony in the EHR implementation process and avoid a nightmare rollout. 

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