EHR Adoption Pitfalls, Strategies to Overcome Problems Are Focus of White Paper

The ability of primary care practices to successfully adopt and use electronic health records (EHRs) is driven, in large part, by how well they integrate EHRs into six major practice areas. That's according to a white paper (15-page PDF; About PDFs) recently issued by Qualis Health, a nonprofit health care consulting company that manages the Washington and Idaho Regional Extension Center (WIREC).

WIREC is one of as many as 70 organizations funded through the Health Information Technology for Economic and Clinical Health Act and charged with helping physicians choose, implement and achieve meaningful use of electronic health records.

Qualis Health uses the experiences of nearly 700 primary care practices that participate in WIREC as the basis for the white paper. It draws on the experiences of the practices to identify common mistakes and pitfalls, as well as specific strategies that could help primary care practices minimize the risk of practice disruption and associated costs.

The six practice areas noted in the paper as affecting EHR implementation are

These six categories represent areas where primary care practices cannot cut corners when implementing an EHR system, says Peggy Evans, Ph.D., one of the study authors who also manages WIREC on behalf of Qualis Health. Cutting corners in these areas "eventually will come back and lead to bigger problems," she adds.

The paper breaks down each of the six categories. For example, most leadership problems "stem from inadequate leadership support and failure to manage the EHR implementation project," says the paper. "This is often compounded by a lack of skills, knowledge and understanding of change management principles. Frequently, smaller practices have instituted decision-making processes that lack structure, including formal communications with staff."

The white paper cites other common errors that undermine leadership capabilities, such as a poor decision-making structure or the wrong people leading the health information technology project. Other problems include a lack of a good bidirectional communication between leaders and staff members and a failure to understand the principles of change management.

The authors of the white paper suggest that even leaders at the highest level of the organization are responsible for setting goals for EHR implementation and ensuring those goals are met. "This requires articulating a business case for clinical quality, as well as allocating resources, removing barriers, and fully engaging providers and patients," says the paper.

Informal leaders also can help build support for health information technology, and clinical leaders, in particular, can help other staff members understand how using health IT to manage and measure clinical quality can help meet patient needs. "Clinician champions are essential for solidifying provider support based on an agreement for how the EHR will be used to improve patient care," says the report.

Evans points out that "a leader for the health IT project does not necessarily need to be a CEO of an organization. It can really be anyone who is given the authority and the power to make change within that organization. This could be a medical assistant, for example, who just happens to have an interest and a passion for health IT and who is appointed the project manager for EHR rollout."

Another problem area is workflow, according to the paper. Clinicians often don't have much experience with or knowledge of a practice's workflow and the roles of other health care professionals. "This blind spot results in inadequate planning for the most important determinant of successful implementation," says the white paper. "Most organizations must go back after (they) go live to fix (i.e., standardize) workflows in an effort to recover from the resulting productivity drop. Without identifying a standardized best practice method to do the work, every user is left to struggle along with a complex and confusing user interface without agreement on how information should be gathered, who should enter it and where it is entered."

The paper's authors recommend mapping and standardizing workflows before selecting an EHR so a practice can learn which EHR has the tools that best support their key workflows.

According to Evans, if a practice has workflow bottlenecks before the implementation of an EHR system, the system will exacerbate those bottlenecks. "Oftentimes, people who are not practicing on the frontlines do not necessarily know what other people are doing," says Evans. "If you take a workflow with existing bottlenecks and put an electronic health record on top of it, you are taking chaos and adding more chaos on top."

"The white paper is ultimately saying that there is a good way to do (EHR implementation) and a painful way to do it," says Evans. "We have seen that the implementation of EHRs follows similar pitfalls again and again and again. What we wanted to do was put these experiences down on paper because we thought it would be helpful for smaller group practices that are transitioning into health IT to begin to understand things they can do to minimize the practice disruption that often comes with health IT implementation."