I recently found out it was American motor racing legend, Bobby Unser, who said: “Success is where preparation and opportunity meet.” My experience with electronic health records (EHRs) bears this out…there’s nothing quite like preparation to turn the right EHR opportunity into a more worthwhile enterprise than a pure technology project.
So where is the best place to start, and is it worth the time? I’ve been asked this many times, and my answer is always the same: “Yes.” There are definitely things you can do now to help you achieve success later. To get started, I would focus in these three key areas:
Workflow harmonisation is quite broad, and can certainly become unruly without close oversight and scope management. It is a great way to refine your governance structure - as I previously discussed. One of the trends I see throughout Europe is multiple hospitals / municipalities / regions coming together to procure a common EHR. This is good, but adopting a single technology often translates to a single workflow, or at least, maintaining fewer varieties. My advice is: start small. First understand who, within a common workflow across multiple sites (i.e. emergency room processes), are the outliers – meaning they use unique processes. This is an opportunity to understand these operational variations and reduce variation before the pressures of the more technical, EHR adoption.
One of the biggest, most controversial areas that you will encounter is clinical governance and content development. Leveraging the benefits of a standardised workflow, and embedding clinical standards in your EHR is certainly best practice, but can also be viewed as taking away clinicians’ decision-making ability. Understanding how decisions will be made around clinical content, where potential areas for standardisation may be logical, and who will be responsible, are all questions that are system-agnostic.
Finally, look behind the curtain of the various organisations and understand the vast numbers of applications that are in play. Then look for ways to conduct application rationalisation. While it seems daunting to look in every server room and closet, understanding the tools in use today (and having a strategic conversation about the application portfolio going forward) will test the strength of your governance structures and help minimise possible data conversions and interfaces down the road. Look for opportunities to consolidate systems throughout the newly formed “enterprise”.
Yes, this is a great deal of work – more reason to get started now. Addressing these areas makes EHR implementation, and maximisation of benefits, much easier. It limits change during the project itself to only what’s necessary, reduces disruption to potentially health-critical systems and allows clinicians to maintain their focus on patient care as much as possible.