A CIO's journey to EHR success and stability

The many years spent in planning, budgeting, organizing, advocacy, and the treatment of Daily unknowns life after the implementation of their electronic medical record (EMR).

For many people who go beyond this stage, it's a relief to embark on the world of optimization and look for new ways to render care to patients. But such a transition can be a little dangerous for unprepared hospitals. The new environment surrounding the post EMR transition is quite different from the days of implementation.

Here are some things to keep in mind:

You are going to need a new management model. The world of EMR implementation is full of defined structures, processes and timelines. We are following all the work orders of the project's all-powerful work plan and developing secondary work plans for the project's main work plan to keep our teams focused and on track. The EMR implementation is much less structured and requires a management model that keeps the team focused and productive.

It is much more difficult to say NO in the post-EMR implementation environment. Many companies are committed to providing a fixed deliverable associated with their EMR facility. Requests that come out of this fixed scope are often filed for later activation. Of course, this approach is well supported by senior leaders because they want the system to work as quickly as possible, with minimal expense and disruption. After the activation of the EMR, the gateways to the backlog of the filed requests open. Everyone wants part of the optimization team; gently and not so gently, reminding the team of their partnership by delaying their request with the promise that it would be addressed after the activation.

Hospitals that switch to a new EMR change provider and, as a result, the captured, distributed and reported data differs from the previous paper or electronic system. It is not that new system data is false, but their definition, calculation or other characteristics are simply different. This phenomenon is related to the revelation that in multi-entity organizations, each entity often calculates seemingly standard measures (ie: admissions, censuses, readmissions …) in different ways. Thus, no matter how the system reports the data, it is considered inconsistent throughout the organization.

With the thrill of activating the DME that fades quickly, what's a DSI and a project manager to do? Becoming aware of these common events is a good start and having the understanding that, with a little preparation, these elements can be easily addressed going a long way.

Some Suggestions to Consider During Your Journey to the Success and Stability of the EMR:

Your EMR implementation team will most likely be fatigued after EMR activation. The long days spent working to meet project deadlines and the even longer days that support EMR activation can impact your team. Be sure to give these people a break and have a new set of resources in place to provide the post-activation and optimization efforts. In addition, have a link between the implementation and optimization teams to make sure everyone understands the rhyme and the reason for the proposed changes.

The Number One Key to Post-Activation Survival: Governance, Governance and Governance. Operational leadership should help provide guidance on the priority and scope of post-activation activities. People closest to the front line of the user community are often best placed to lead this effort, are invaluable in maximizing effort, and most easily recognize the benefits associated with the system.

Mobilize and strengthen your data governance committee to activate the EMR. Identify the key metrics that your organization uses to manage activity and make sure that these data elements are consistently defined throughout the organization and correctly calculated in the new system.

Since the final activation of my organization's EMR in March 2017, I've shared the metaphor with a lot of people who involve the EMR, it's like participating in the Tour de France because you spend a lot of time and energy hanging out. And then the runners reach a point where the peddling painful and distressing (the implementation) passes to the downhill part, extremely fast and quite treacherous of the race (post implementation).

The two experiences are very different but they are filled with equal levels of activity and euphoria. I suspect that many people who have reached the top and who have begun to disagree appreciate the feeling of being on the other side with the ability to bring great benefits to their organization.

Thanks to the efforts of my team and operational support, I am one of those who experience this thrill.

We are now starting a new stage of the journey.

Mike Restuccia is CIO of Penn Medicine.

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