Information technology leaders gathered last fall at Health Data Management's Health IT Stimulus Summit in Boston to exchange lessons learned when implementing electronic health records. Here's a summary of some of the key presentations.

Tips for Speeding EHR Implementation

When Allina Hospitals and Clinics in Minneapolis decided to implement inpatient and ambulatory electronic health records across its 11-hospital delivery system, it adopted the single-vendor model and chose Epic Systems Corp., Verona, Wis. The selection process took six months, "which for a system of our size is quite remarkable," says Susan Heichert, senior vice president and CIO.

Allina completed its hospital installations in October and continues to implement EHRs in ambulatory facilities. Lessons learned along the way have produced processes that other delivery systems can use to implement EHRs on a fast track to qualify for Medicare and Medicaid incentives for meaningful use of EHRs under the American Recovery and Reinvestment Act.

For instance, Allina spent a year getting the EHR installed in its first hospital and the implementation timetable toward the end was nine months. The ambulatory timetable is 12 weeks, and it then takes about six weeks to get fully up to speed after go-live, Heichert says. "We're trying to get that down to two weeks."

In September, Allina had 28,000 EHR users and 100,000 consumers using a personal health record. The delivery system had 3 million records online and was adding four gigabytes of data a day. "If you do EHR, you're going to have to store all that data someplace, so get a good storage application up front," Heichert advises.

The operations unit, not I.T., has led Allina's EHR project to enable participants to fully focus on the initiative. "If you need to do something quickly, like meet the incentives, you'll need to focus," Heichert says.

Tough Call

Mandating computerized physician order entry will speed meaningful use of EHRs, Heichert notes. But the move requires courage and fortitude. "We changed medical staff bylaws so if you practice at our hospitals, you had to use CPOE. It was a stake in the ground."

Allina initially saw some physicians quit practicing at its hospitals, and Heichert warns other organizations that they have to be ready for that. Some physicians came back after rival delivery systems in the region also started implementing CPOE. "By the time our third hospital was up, it wasn't a problem anymore as CPOE had a growing base of support."

Another way to speed implementation is to implement nearby facilities at the same time, Heichert advises. At one point, Allina had eight ambulatory implementation teams working concurrently. Comprehensive e-learning supplemented with personal training, when needed, will speed the learning curve for users.

Another nod to speed was a decision to minimize customization of software, and that also requires a stiff backbone, Heichert says. "We were really unpopular; it doesn't make people happy," she acknowledges. "But it makes things move a lot faster."

Setting a scope plan and sticking to it also will save time in addition to money. "Be a 'Scope Nazi,'" Heichert says. "Ask if you really need an addition or upgrade to meet meaningful use criteria."

More time can be saved by not doing other major projects at the same time. That may not be possible, however, because many organizations also must implement the ICD-10 code sets and HIPAA 5010 transactions standards during the same time they'll be putting in EHRs.

Above all, an organization needs strong support and stiff backbones of senior leaders to successfully implement EHRs, especially on a fast track, Heichert cautions. "If you don't have leadership commitment, don't do it."

Weighing EHR/PHR Links

Provider organizations have to address several critical issues when launching personal health records projects, one consultant says. Among those issues is whether to enable patients to access a complete electronic health record and export it to a PHR - a step that John Moore, managing partner of Chilmark Research, Cambridge, Mass., advocates.

Hospitals and clinics also must decide what data elements are most essential to a PHR. Although many agree that medication lists and allergies must be in a PHR, providers are pondering whether to include all lab tests as well as diagnostic images, Moore notes.

Providers also must determine whether to enable patients to add their own notes to data imported from an EHR to a PHR,

such as to question a doctor's findings, the consultant says. Plus, they must determine whether those patient notes will then flow into the EHR.

A strong advocate of two-way links between EHRs and PHRs, Moore also says practice management systems should be added to the mix to help enable patients to use a PHR to, for example, schedule an appointment.

CIO: Nurses Play Big Role in EHRs

Nurses are key to the success of an electronic health records rollout at a group practice and will largely determine whether physicians will become more productive, contends Phyllis Schuck, CIO at Pinehurst (N.C.) Surgical. As a result, practices should break off nursing implementation of EHRs from other provider implementations, she says.

Practices hoping to rapidly deploy EHRs to qualify for federal maximum Medicare and Medicaid incentives need to make sure the nurses are working well in the EHR environment before bringing in others, the CIO advises. Pinehurst hired three floating EHR training nurses to train and support other nurses.

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