Nowadays, technologies develop extremely fast, providing a wide range of opportunities for different spheres, including healthcare. Among one of the most commonly discussed innovations are electronic health records (EHRs). They are believed to be extremely advantageous for medical workers because they allow sharing significant patient information with no complications. Professionals are encouraged to use them on a routines basis for more than 5 years already. However, implementation challenges prevent some physicians and nurses from resorting to them and having a fully functional EHR.
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Regardless of this fact, EHRs turn out to be very beneficial for healthcare stakeholders because they provide an opportunity to reduce the number of errors, minimalize expenditures, improve the quality of care, and increase job satisfaction (Middleton et al., 2013). Proper usage of EHRs aligns with governmental standards as well. Their implementation may last from a couple of months to several years. Its success depends on the very implementation process. If no proper groundwork is laid, the chances of positive outcomes decrease.
1. Establish the objectives. As soon as professionals consider that the implementation of EHRs is needed, they should point out what they are willing to obtain with their help. In this way, no time will be wasted later trying to identify if improvements are observed. In addition to that, it will be easier to point out those minimum requirements that will be met by EHRs. It is vital to decide whether EHRs will be used for the reduction of currently maintained procedures or the automation of workflow. Depending on the needs of the professionals, it will be possible to integrate billing systems, improve online communication with patients, and maintain online education. This stage is also critical because these peculiarities affect the duration of the implementation process, training, and costs (Boonstra, Versluis, & Vos, 2014).
2. Evaluate the current situation. When professionals are aware of the things they want to achieve, it is significant to focus on the current situation and determine what changes are needed for these purposes. For example, the implementation of EHRs cannot be maintained without advanced software and hardware. Thus, sufficient expenses can be avoided if a healthcare system has recently updated them. Similarly, if the medical staff already has some experience with EHRs, the number of funds needed for training can be reduced. If no, additional training will be required, which can be rather costly. Professionals will prioritize problems so that they can be fixed properly and timely with no gaps. What is more, the very implementation process will be streamlined and the intervention will be more effective.
3. Identify leadership. The implementation of EHRs will require a particular leader who will communicate information among employees and ensure commitment to success. This person will make the employees more willing to accept necessary changes and minimalize the number of those who will refuse to resort to EHRs.
4. Define goals and specifications. Based on the previously outlined objectives, professionals will point out the desired functionality and prepare requests for proposals. Specifying what systems must do, they will also reduce expenses, as unnecessary functions will not be included. In addition to that, it will be significant to ensure that policy and security requirements will not be violated because of this change. For example, patient information will be locked down so that no uninvolved parties will have access to it. During this stage, professionals will also make their minds regarding design, training, and monitoring peculiarities.
5. Compare products and support. It will be possible to attend various conferences and online demonstrations that are meant to promote EHRs. These events provide professionals with an opportunity to test drive systems even without implementing them. It will be a great chance to identify those EHRs that meet the needs of a healthcare system and to maintain a kind of initial assessment of these EHRs. Representation of functionality will be extremely beneficial as it will ensure that everything will work as reported.
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6. Estimate costs and benefits. Mainly, EHRs differ in their functionality, cost, and usage peculiarities. Rather often professionals focus only on the expenses related to software and hardware, which is a wrong approach because this amount of money is only about 10% of total costs. However, it will be necessary to think of other elements as well. For instance, training and connectivity with other parties are to be discussed. While the optimal price for an EHR system is about $15,000 for a small healthcare system, it will be possible to reduce this amount of money by obtaining a grant or a subsidiary (Friedman et al., 2013).
7. Discuss, buy, and install. When professionals will decide what exactly EHR they need, they will get in touch with vendors to receive a detailed explanation of all related processes, including the provider of training, its duration on-site, and allocated support. It will be also possible to get a template for a contract and ensure that all necessary features are described and the EHR will save time and money.
8. Focus on training. As a rule, vendors tend to support their clients providing training for a particular product. However, it will be critical to make sure that it is not based on a one-size-fits-all application, because each healthcare system is unique. Practice-specific training will be required because it ensures that the focus will be made on people instead of the system itself. All in all, training will include individual and classroom education. Simulator training will also be used. The workers will obtain tip-sheets and presentations will answer the most common questions.
9. Measure. When the EHR will be implemented, it will be critical to measure obtained advantages. Rather often real pays off can be noticed only in the long run so without proper measurement it will be impossible to consider them. Similarly, if a system provides an expected result immediately, it does not mean that issues will be faced in the nearest future and implementation will fail. Proper measurement will also make it possible to find out if additional training is needed. Dashboards, checklists, and surveys will be used as monitoring tools. They will be utilized regularly so that any issues will be identified before they affect the whole system negatively. Effective functioning is critical for healthcare establishments that is why this step cannot be avoided. Promoting security, it will ensure that the EHR functions appropriately and meets all expected goals.
10. Document. Eligible providers will calculate and document meaningful use of the EHR for this information to be used in the framework of future changes. They will prepare reports that reveal both improvements and drawbacks observed after the implementation of EHR. The flexibility of technology and its effectiveness will be thoroughly discussed. Providers will get to know if the implementation is successful as well. All in all, various practices will be changed to use EHR meaningfully and effectively (Hodkins, 2015).
The timeframe of the Project
Considering previously discussed information, it is possible to gather all stages of the implementation process in four main phases. As a result, the timeframe of the proposed change will look as follows:
|Preparation||Build a team, develop knowledge, evaluate current workflow, create and prioritize objectives and specifications, point out the main requirements||90-150 days|
|System Selection||Get to know peculiarities of different EHRs, including related training and support; consider the possibility of financial assistance; prepare requests for proposal; select an EHR and negotiate a contract||60-120 days|
|Implementation||Develop an implementation plan, test the EHR, ensure training||45-180 days|
|Post-Implementation||Continue adjusting operations, ensure privacy and security, evaluate costs and benefits||6-12 months|
The implementation of the EHR will require a lot of resources. First of all, the investment will be needed to purchase appropriate hardware and software. Equipment is not the most costly intervention but it is vital because without it no EHR can be used. Security tools are needed because the information that is stored electronically can be easily accessed by hackers. Training will be required at least on a basic level because professionals will need to learn how to use a new EHR without influencing the working process significantly.
In this way, the number of temporary staff will increase, which will increase expenses for the healthcare system. As EHR will be an innovation, productivity will likely worsen until the time employees adapt to the change. It will also lead to increased costs. Implementing an EHR, it will be vital to customize it and ensure timely updates (Cocchi, 2014). It will also be rather costly even though the effectiveness of the EHR will increase. A statistical survey of information technology will be needed to measure improvements and notice possible issues.
Boonstra, A., Versluis, A., & Vos, J. (2014). Implementing electronic health records in hospitals: A systematic literature review. BMC Health Services Research, 14(370), 1-24.
Cocchi, R. (2014). 5 things to keep in mind: The full cost of EHR implementation.
Friedman, A., Crosson, J., Howard, J., Clark, E., Pellerano, M., Kash, B.,… Cohen, D. (2013). A typology of electronic health record workarounds in small-to-medium size primary care practices. Journal of American Medical Information Association, 21(1), 78-83.
Hodkins, M. (2015). Electronic health record (EHR) implementation.
Middleton, B., Bloomrosen, M., Dente, M. A., Hashmat, B., Koppel, R., Overhage, J. M.,… Zhang, J. (2013). Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. Journal of the American Medical Informatics Association, 20(1), 2-8. doi:10.1136/amiajnl-2012-001458.