Nine Lessons Learned From E-Medical Record Veterans

[ 8 ] Think About The Future

The system organizations buy today isn't what they'll need tomorrow, says UNC's Spencer, since the needs of clinicians and patients are evolving. Medical advances are continually changing the kind of data that's important to practitioners. In addition, data collected today, once analyzed, can affect future requirements.

And more immediately, requirements for these systems are rapidly changing, particularly those related to quality of care. The government is currently finalizing its definition of what comprises the "meaningful use" of EMR systems. Since compliance with this definition will determine whether a healthcare provider will be eligible for federal funds, providers must ensure their EMRs will be able to capture whatever data is deemed important in the definition. Providers also need to be sure their EMRs can meet insurers' and other healthcare payers' pay-for-performance requirements.

Already, participation in various government-run quality-improvement projects requires that a provider perform certain types of care, such as regular foot exams on diabetic patients. In that case, Spencer says, doctors can be prodded to do the exam by having a digitized field in the EMR. And a simple visual cue can also be incorporated into the workflow, like prompting nurses to tell patients to remove their shoes.

[ 9 ] Manage Expectations

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Healthcare organizations must make sure that their users understand why they're implementing the EMR in the time frame they've chosen, and that all goals won't be achieved at once. Those were key lessons California Healthcare Foundation's Karp learned while CIO of the now defunct Santa Barbara County Care Data Exchange, an ambitious project launched in 1999 to let the region's healthcare providers electronically access and exchange patient data.

The exchange was shut down in 2006 when its $10 million in funding dried up and exchange principals refused to keep it going. Many of the doctors kept using the EMR systems they deployed during the project, but those who didn't gave up in part because the big bang they expected didn't happen, Karp says.

Expectations should be set throughout the process, says Concordant's Bennett. "The destination isn't the 'go live,' it's the ongoing use of the application and business process," he says. Not enough time is spent describing life after implementation, he says, and that discussion has a direct impact on adoption rates and meaningful use.

Users need to know that the transition to an EMR system won't be easy and that there are real business issues at stake. Most important, organizations must make users aware that an EMR will do more than just save money; it can also improve care and save lives.

Since Midland Memorial fully deployed its EMR in 2007 and made process and organizational changes related to the system's use, it has seen a marked improvement in quality of care, including a 27% decline in deaths among heart attack patients and an 88% decrease in central line bloodstream infections, says Midland's Whiles.

To those healthcare providers holding out against EMR deployments, Whiles offers this piece of advice: "This is a train that's coming, you need to get on."