Moving to an EHR system: The first step in healthcare transformation
Electronic health record (EHR) systems are now considered essential to healthcare, placing a range of data about each patient, and even entire populations of patients, at the fingertips of clinicians. It's also well known that setting up, rolling out, and maximizing the benefits of using EHRs can be challenging.
To help those planning to move to an EHR prepare to get the most out of it, while managing the challenges of implementation, two top Leidos experts teamed up in a TribalWise webinar for American Indian/Alaskan Native communities and organizations working with them. “Once you get a baseline EHR system in place, you begin to transform healthcare," said Leidos Chief Medical Officer Donald Kosiak, M.D.
The EHR webinar, a follow-on to Leidos' previous webinar, Modernizing Health IT Systems to Enhance Tribal Healthcare, began by considering the IT groundwork that needs to be done well in advance of implementing the EHR itself. Doug Barton, chief technology officer of the Leidos Health Group, and the other expert in the webinar, recommended that the IT infrastructure work begin at least a year before the planned go-live date of the EHR.
That long lead time, he explained, is largely because most sites will need to expand or upgrade their IT equipment, and right now, supply chain issues have led to delays in product availability.
“These are the worst procurement delays I've seen in 40 years," said Barton.
Another potentially lengthy process, he added, is adding any additional broadband connectivity that's needed, which might require working with multiple telecommunications vendors. Getting that connectivity can be especially challenging for some very rural Tribal sites. Acquiring and adapting printers, bar-code readers and other peripheral and mobile devices to work with the planned EHR can take time, too, he said.
Cybersecurity is another critical consideration, said Barton, given the special sensitivity of health information. But tightening security ahead of time is only a first step, he noted, because EHRs tend to be modified on an ongoing basis.
“As the EHR evolves, you have to make sure the changes aren't opening up new vulnerabilities," he explained.
Barton suggested that whatever IT work is needed to prepare for the EHR, it should all be completed at least three months before the planned go-live date. “You want everything to be stable so that the technology can stay out of the way of clinical implementation," he said.
Clinical considerations to prepare for a new EHR
Addressing the clinical side of EHR preparation, Kosiak recommended tackling the job of pinning down the clinical workflows, order sets, and the basic health information that will be represented in the electronic records at least nine months before go-live.
The first step is to engage a group of clinicians at the organization to help develop standards for the records that will be maintained across the entire enterprise, he noted.
“You can start with a baseline configuration that might come from the vendor," Kosiak said. “Adapting it to the needs of local sites and individual clinicians can come later, closer to three months before go-live."
To avoid the common problem of some clinicians being resistant to adopting the EHR, suggested Kosiak, it's important to select a few clinicians who will serve as clinical champions for the project.
“They may themselves at first be resistant to the changes," he said. “As long as they're natural leaders of the medical staff, they can help get the others to adopt the system."
Getting all the clinicians to invest at least a few days of training on using the system before go-live is also critical to a smooth roll-out, contended Kosiak.
Advice to limit frustrations
Barton and Kosiak also offered advice for limiting and dealing with the inevitable glitches and frustrations that can happen during go-live and the initial days after. Barton recommended pre-identifying specific IT teams, each prepared to respond to particular types of problems.
“It can be hard to diagnose what's behind an outage," he said. “But if you've got the right team ready, it can collaboratively talk through the problem and identify what needs to be fixed in the infrastructure."
A similar approach can work on the clinical side, said Kosiak, by ensuring that several “superusers"—clinicians who have had extra training on the EHR—are on hand to help any users who are encountering difficulties. To help minimize the stress and strain of getting everyone going, he also suggested arranging for reduced patient loads around the time of go-live.
“For a week or two it would be good to try to have half the normal load," he said. “Then, as everyone starts to get comfortable with the new system, you can start bringing more and more patients in."
Some of the biggest benefits to an EHR require a bit more complexity and will come a little further down the road from initial implementation, said Kosiak. One of those advanced benefits is when clinicians can start working with population health management by comparing their own patient data to that of groups of similar patients across the enterprise.
“Once you start doing advanced analytics with EHR data, the world really changes," said Kosiak. “An EHR isn't the end of the transformation; it's just the beginning."