Wednesday, November 03, 2010

There Are Some Serious Home Truths Here. Read, Mark, Learn and Inwardly Digest!

This excellent brief article appeared last week

Six best practices for EHR implementation

October 25, 2010 | Jamie Thompson, Web Editor

Peggy E. Delany, MBA, CHBC, CEO, DR Management, LLC, Member of the National Society of Certified Healthcare Business Consultants (NSCHBC), and Thomas S. Nelson, CIO, COO, DR Management, LLC, shared the following six best practices for hospitals and medical groups when implementing electronic health records.

1. Tailor your EHR to fit within staff workflows
"You cannot implement the system to meet 100% of each individual’s needs, but neither can you implement in a generic manner and assume that everyone will adjust," Delany and Nelson emphasized. But it is important to determine which aspects can be adapted to work on an individual basis, and which aspects can work across a wider spectrum. Securing the opinions and recommendations of the staff - as well as their cooperation and commitment - are crucial to making sure the EHR will work for everyone.

2. Identify ways the EHR could potentially fail in order to prevent problems in the future
Gather input from stakeholders to pinpoint ways the EHR could fail, and use that knowledge to determine what it will take for the EHR to be successful. "Remember that you are dealing with huge amounts of data. Be sure to allow for enough storage and fast enough computers to quickly access the data," said Delany and Nelson.

3. Don’t rush implementation, take time to train
"Train for every step of the process and do several short training sessions," advised Delany and Nelson. They also stressed that beginning with the basics is important, and to follow a planned-out procedure so as to ensure the accuracy and efficiency of implementation.

The other three best practices are here:

This sentence especially struck a chord with me:

‘"You cannot implement the system to meet 100% of each individual’s needs, but neither can you implement in a generic manner and assume that everyone will adjust," Delany and Nelson emphasized.’

What logically flows if this is true - and I believe it is - is that there must be discussion and negotiation with those on the ground in each site and workplace as to what will work for them and what won’t. This is just the total opposite to the centrally imposed one size fits all approach that has been adopted - with considerable pain and anguish - in some State jurisdictions.

To not proceed in this sensible fashion is something as complex as e-Health implementation is really a very bad idea I believe.

Indeed I would suggest that there really needs to be much more focus in general in making solutions work for the Health Sector broadly - rather than what we frequently seem to see coming from policy makers and bureaucrats - where somehow the impacts of their grand designs don’t quite seem to work out when implementation is attempted.

Six points worth sticking on the war room wall!



Anonymous said...

How flabbergasting. Gillard today announced Australia will give $500 million to build or upgrade 1500 Islamic schools in Indonesia.


Dr David More MB, PhD, FACHI said...

The gutless author of this has spammed the blog with this. The PM is trying to improve education in Indonesia not do the sort of unwarranted act Anon implies. Where does the PM say the funds are for Islamic schools?

Here is what was announced today:

"The two leaders agreed on a new $500 million Education Partnership under which Australia will construct or upgrade up to 2,000 schools across Indonesia.

This new five year program will build on the success of previous partnerships between the two nations to help Indonesia reach its goal of providing every child with nine years of education by 2015.

The program will also improve the quality of school management by training 293,000 school principals, school supervisors and district education officials."

Supporting education is a way to make us safer, not put us at more risk as the writer suggests - in my view.

This is not a big P, political blog. If you want to discuss this material go elsewhere.


Bruce Farnell said...

Good article. All six points do ring true - the reference to clinician workflow is very important I believe.

Does anyone know of any EHR implementations in Australia that may have used guiding principles such as these? Aside from the smaller-scale GP and specialist systems, which do at least consider the clinician workflow issues, I can't think of any. However, I'm happy to be proven incorrect.

It is interesting to look at how some of the larger EHR systems may have developed with reference to the six points. For example, the Veterans Health Information System and Technology Architecture (VistA) from the US developed in a modular and decentralised manner. Presumably this allowed clinicians at the coal-face to have a reasonable input into how the system was developed over time. These is no reason why we couldn't do this in Australia for larger EHR systems - all it needs is leadership.

Anonymous said...

This article is about implementing EMRs. Many of these points would also apply to SEHRs/IEHRs/PCERHRs.

Anonymous said...

Medicare Locals are now the main game. With Government funding for AGPN and Divisions to be transferred to Medicare Locals which DOHA states will arise from Divisions. This is a truly masterly strategic play by Medicare and Government enabling them to sweep aside troublesome parties, restructure Divisions into a smaller number of larger Medicare Locals, and exercise the control it aspired to but lost over development of the SEHR into one national health record. On the other side of the equation it is fair to say the RACGP and AMA have been well and truly outmaneuvered by the AGPN-DOHA partnership.

Anonymous said...

Friday, November 05, 2010 8:00:00 AM is right on the money but I think that view is somewhat limited and further expansion is required as follows:

Medicare Locals are the beginning of the reform process. However we should not forget that deeply inter-woven into the Government's ideology are a critical mass of well dispersed Super-Clinics, a whole new population of primary care (first port of call) Nurse Practitioners, and a new wave of pharmacists working in medical practices and linked into robotic dispensing machines. This will lead to substantial changes in the way general practitioners and shop-keeper pharmacists go about their business of delivering primary health care to the community. The system is on the threshold of major change.

Anonymous said...

Don't forget that the state based health systems are also implementing their own versions of EHRs and EMRs. presumably the federal PCEHR will draw upon information provided by these systems as well as data from GPs and private providers.