Lessons Learned from Over 30 EMR and CPOE Implementations
By Kenneth L. (Marty) Martin
Senior Implementation Consultant, Physicians EHR, Inc
As an implementation professional with over a decade of experience implementing Electronic Medical Records (EMR) systems, I've been "in the trenches" on more than a dozen CPOE implementations. I've collaborated with numerous CIOs, CMOs, CMIOs, and CEOs through planning and execution, and frequently review CPOE case studies to evaluate challenges and best practices.
I've also noticed lengthy discussions among members of the Office of IT Policy as they work through reporting details of CPOE processes, and in particular whether 30,000 private practices will have to hire another person whose sole job is to enter data just to manage new meaningful use workflows.
To effectively build and manage your electronic orders and results management, I'd like to share lessons learned from implementations, and also fold in my thoughts on how to capture meaningful use measures.
- Include providers at the earliest stages of the project. Their voices, opinions, impressions, mis-impressions and participation are essential.
- Enlist at least one "Provider Champion" – a provider who actively practices and sees patients. This provider should have a high level of informal influence with his/her peers.
- Develop a team of Physician Ambassadors. These physicians won't work at the same level as the Provider Champion, but they will be influential in engaging their colleagues during the project.
- Keep senior leadership active, engaged and visible throughout all phases of the project.
- If your CPOE implementation requires a high level of customization (templates, order sets, etc.) be sure your internal physician consultants know how the software functions before they play a key role in suggesting design/development.
- Learn from the experience of those who have gone before you. Study many of the available CPOE case studies – especially from a setting similar to yours. Learn from the successes and failures of those who've already implemented. Don't make the same, costly mistakes.
- Allow ample time for technical testing, end-user validation and acceptance testing. Invest in gaining your end user population's acceptance before you start training and implementing.
- Stress functional design to encourage provider adoption. Order sets, protocols, templates, and other components of high-usability improve provider acceptance/adoption.
- Communicate! Use all available media types, and use them early and often. Send consistent and accurate messages of the benefits, challenges, and expectations of staff. Make opportunities to keep the CPOE product visible throughout the project – meetings, staff dinners, demos, etc.
- Make training mandatory to practicing/credentialing. Training must be required and it must be completed in order for providers to be competent with the software. Publish training schedules at least 4 weeks in advance and make it very clear that completion of training is a prerequisite to seeing patients after the CPOE go-live date.
- Assume that some providers will require 1:1 training. It is resource intensive, but an essential component of a training plan. Some practices have experienced greater than 30% of their providers that required 1:1 training.
- Provide comprehensive, 24x7 support for at least 2 weeks. Make your support team highly-visible and available. Make plans to have your help desk and support staff well trained.
- Develop a web-based venue for providers to suggest and/or request revisions, enhancements, and other changes to the software.
- Plan for a 20-30% reduction in productivity for at least two weeks. Change staffing, patient loads, visits, and visit time accordingly. Provide additional nursing staff for this period.
- Develop an ongoing training and support plan. Typically, within 90 days, you will have demand for advanced training, tips/tricks, etc.
Crosswalk between Stage 1 Meaningful Use and CPOE Workflows
- Use evidenced-based order sets
- Use clinical decision support at the point of care
- Use drug-drug, drug-allergy, and drug formulary checking
- Maintain a current problem list
- Use CPOE for ALL order types: medication, lab, procedure, imaging, referral, consults
- Reconcile medications at each visit
Comments or good stories? We'd love to hear from you.
Marty Martin has been a successful leader and consultant in the EHR arena for almost a decade. His roles have included Project Lead or Senior EHR/CPOE implementation consultant on many multi-million dollar healthcare IT projects. With an extremely diverse background, Marty has lead all aspects of large EHR projects, including project initiation, vendor assessment/selection, training, implementation, and clinical/medical staff support. Marty has been a speaker at several healthcare IT conferences and local HIMSS chapters. His presentations typically focus on strategies for change management, communication, training, improving the IT adoption rate of medical and clinical staff, and extracting measureable ROI on healthcare IT investments. |
