In 2009, the U.S. Congress passed the Healthcare Information Technology for Economic and Clinical Health (HITECH) Act, which requires doctors’ offices and hospitals to implement electronic health record (EHR) systems. Facilities face penalties if they do not implement EHR systems meeting certain standards by 2015. The idea of EHR systems is to improve the quality of care by enabling patient health record interchange among doctors, nurses, and other healthcare professionals, to coordinate care, reduce duplicate tests and conflicting medications and reduce errors. Hospital IT departments have been working hard to implement EHR systems, and, as is often the case with large-scale IT projects, the results so far are mixed. Although nurses and doctors using some EHR systems are satisfied, in many other cases they feel that the systems are ineffective and difficult to use.
What sets the successful EHR implementations apart from the rest? The answer is no different for EHR systems than it is for other IT projects, large and small: Get the requirements right, and involve the end users.
Get the Requirements Right
A successful EHR project starts with a complete, correct set of user-level requirements. Although the HITECH Act provides a high-level framework to work within, many of the details of how users are to interact with the system are left to the system designers and developers. Getting these details right means considering all of the end users of the system (such as doctors, nurses, and facility administrators), the processes that must be supported, and the working environments in which the users will use the system. For example, a general practitioner working at a desk will use the system in a very different manner from a nurse working in a hospital emergency room. This is a formidable task, especially in large facilities with many departments (and possibly multiple locations), each of which has its own special needs.
Get the End Users Involved
So how do the designers identify, document, and validate all of these detailed user requirements? The end users must be involved in every phase of the implementation. They have to be observed in their working environments, they have to be interviewed, they have to review and confirm the documented requirements and they have to help test the system.
Apart from ensuring a complete set of requirements and getting the bugs out of the system before it is rolled out, keeping the end users involved gives them a sense of ownership and empowerment. The alternative—deciding for them and cramming it down their throats—is a recipe for low morale, high turnover, and difficulty in attracting talented personnel, plus poor-quality care for the patients.
Without good requirements and end user involvement (plus good project management), you can implement an EHR system that meets the letter of the HITECH law, but is a complete disaster for practitioners and patients alike.
Written by Dean Van Dyke, Vice President, Business Process Optimization
Dean Van Dyke is the Vice President of Business Process Optimization for iBridge. He brings more than 18 years of customer relations, business process outsurcing, lean six sigma, program/project management, records management, manufacturing, and vendor management experience to iBridge. Mr. Van Dyke was the former head of Microsoft’s corporate records and information management team, and served honorably for over fourteen years in the U.S. Navy and Army National Guard. He received his Bachelor of Science in Business Administration from the University of South Dakota and his Master’s in Business Administration from Colorado Technical University.