Last week at the 2014 Executive Leadership Retreat, I had some great conversations with executives from across the country on a wide range of leadership issues and management challenges. And my session, The Failed EHR Implementation: What’s A CEO To Do?, had some really great discussion and ideas about a “not-uncommon” issue in health and human service organizations – a failed electronic health record implementation.
The topic was the focus of our executive case model discussion, where I opened with my “An Ounce Of Preparation Is Worth A Pound Of Cure” approach – I think there are four groups of EHR implementation tasks that, when done incorrectly (or not at all), can derail any implementation.
Routine Elements – These are the typical elements of an EHR implementation that require time and focus, but are not complicated in and of themselves. Examples include vendor training and implementation, hardware, data conversion, and mobile system use.
Complex Elements – These are the trickier areas of the implementation that require increased attention and careful management. Examples include workflows, clinical content, system set-up, billing testing, reports, interfaces, and meaningful use.
System “Freeze” & Final Preparation – These are all the final, “game-time” tasks and steps before going-live with the new EHR. Examples include final workflow testing, training materials, training execution, and the final, go-live preparations.
Expanding & Leveraging the EHR Implementation – After launch, you will need to continue implementing other features of the EHR application to get the most out of your new technology. Examples include the EHR supported use of business intelligence tools, and clinical/analytic use.
For CEOs, when any of these factors are “out of sync” – bad vendor selection, bad technology, bad contracts, and implementation delays (or failures) – the result are costly.
You have to do all these things right – and the key to implementation is “ownership.” Lack of ownership, or passive project management is a sure first step to failure and spiraling costs. The attendees came up with two elements to a solution. In the first element, there must be project management at every step of the implementation, with the right leadership (hint: it isn’t your IT or finance director). And second, organizations need to be aware of all the costs – both necessary and potential.
Leveraging your EHR for maximum organizational benefit is another manifestation of competitive advantage, and when you lose the advantage, you can consider you EHR implementation failed. In addition to the above solutions, I took away two more points from my discussions of the case studies and the experience of attendees:
- The contract is critical – Both in case studies and real-live experience, the actual contract with the EHR vendor could have been better in two key areas. The first was ensuring warranties for specific functionality (ideally, for the software specifications detailed in a vendors response to a competitive RFP), and the second was tying payments to implementation milestones.
- You have to have the right internal project team – This team is typically 6-8 people, from an array of clinical and administrative departments, often led by someone out of the quality assurance department. One attendee even spoke of providing significant financial incentives to his internal team at milestones of the implementation to ensure project success.
For more on selecting the right EHR and getting the most of of it, check out these resources from the OPEN MINDS Industry Library:
- The Importance Of Selecting The Right EHR Partner: An EHR Return-On-Investment Analysis
- Great EHR Performance Begins With Great EHR Selection
- Ready, Set, Implement!
- Choosing An EHR Software System: Best Practices In Vendor Selection & Contracting
- EHRs In Behavioral Health Care: Tips & Tricks For Managing A Successful Implementation
And for even more about selecting the right EHR, join my colleague Nic Cuccia, at the 2014 OPEN MINDS Technology & Informatics Institute for his presentation, Finding The Value In Your EHR: How To Make Meaningful Use & Health Information Exchange Work For Behavioral Health.