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April 13, 2015
By Karsten Scherer

The U.S. healthcare industry is in the early stages of its first true redesign in seven decades, with all the attendant growing pains. And while most of the issues heavily involve IT staff and initiatives—especially electronic health records (EHR) implementations—this can spell serious trouble for CIOs.

EHR cautionary tales abound

In 2013 MaineHealth invested $150 million to pilot EHR technology at its 600-bed Maine Medical Center hospital. Four months later, the hospital posted a $13.4 million operating loss and the CIO was out of a job. Why? Poor training and go-live support led to suboptimal user adoption. In 2013, at Athens Regional Health in Georgia, a $31 million EHR investment led to the CEO’s resignation less than a month after go-live. A rushed implementation with poor communication between the hospital’s clinical and IT sides of the house and their EHR vendor led to medication-related errors and scheduling issues.

Meaningful use challenges

As the Healthcare Information and Management Systems Society (HIMSS) kicked off its annual national summit yesterday, the topics being covered are wide-ranging and complex, from population health management, interoperability, mobile health, security, ICD-10 or Accountable Care Organizations (ACOs). But meaningful use stage 3—and the difficulties healthcare organizations (HCOs) are experiencing with the technology behind it—stands out as especially critical right now for healthcare IT organizations.  

In a nutshell, EHRs and related telemedicine and care management systems are elements of larger transformational programs geared toward improving efficiency and driving clinical excellence, thereby keeping cost-of-care increases more manageable. EHRs also play a critical role in the overall population health strategy.

Meaningful use of EHRs will hit providers in three stages:

  • By 2012, health delivery organizations (HDOs) need to have mastered data capturing and sharing
  • By 2014, they’ll need to demonstrate an advanced proficiency with clinical processes
  • By 2016, they should show a clear and measurable impact on improved outcomes

Although EHR adoption is voluntary, the motivation for implementation beyond patient care improvement is real: HDOs face reimbursement reductions of Medicare and Medicaid if they don’t.

Meaningful use: How are other healthcare organizations faring?

EHRs are incredibly difficult to implement well. In the word of Tom Handler, a research vice president at Gartner, “[no] other healthcare IT initiative is likely to be as complex, face more opposition or have greater potential to transform the organization and its healthcare delivery." In essence, it’s a make-or-break moment in an HDO CIO’s career.

And right now, CIOs are struggling. In 2014 Centers for Medicare and Medicaid Services research showed  less than 17 percent of HDOs have demonstrated meaningful use stage two requirements, and under 40 percent of eligible hospitals and critical access hospitals have met any stages.

Common EHR obstacles

When initiatives of this scale fail, there’s never only one reason. But in a recent conversation, Handler said he sees several commonalities across EHR failures. Let’s examine two of them:

  • Organizations consider the EHR implementation an IT-only initiative: HDOs must recognize that an EHR implementation is first and foremost a clinical excellence program, not a conglomeration of IT projects. Without early involvement of clinical leadership and physicians, and clarity around what the program's long-term expectations are, hospitals and practices will get locked into an adoption-for-adoption’s-sake model, and will be much less likely to unlock EHR’s potential.
  • Organizations neglect go-live support: End-user adoption and satisfaction are important with any new technology, but critical when they impact patient care. In the MaineHealth example above, patients weren't being charged for serviced rendered because physicians weren't aware that with the new system, they were now responsible for registering charges. Without adequate training on new interfaces, processes and protocols, and with apologies to The Who, the new technology ends up being the same as the old.

In conclusion, it’s worth noting EHRs are likely to be the single largest IT investment most health delivery organizations will make. Ignoring or glossing over the factors mentioned above have already and will continue to derail multimillion-dollar implementations. I find it interesting that industry analysts like Tom Handler are beginning to use the phrase ‘truly meaningful use’ to describe the value HDOs can derive from EHR technology once they've mastered the intricacies of implementation and adoption. Perhaps a reboot in how healthcare organizations run these implementations is in order.

EHR implementation help

TEKsystems Healthcare Services experts will be on hand at HIMSS 2015 to discuss EHR integration, go-live, optimization, clinical desk and applications, among other HIT challenges.

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