Tuesday, December 27, 2011

Expect These Unexpected EHR Challenges

We all know the expected challenges of implementing an electronic health record -- not having enough time, money or resources to go around. However, unexpected challenges are more likely to throw a wrench in your EHR implementation timeline and budget. The following four challenges are common, but usually unexpected.

Getting Dictation Data in Discretely. If your providers dictate notes, it’s important to understand how the dictated data is stored. Many organizations print and scan the dictated note into the EHR.

However, scanned data is not stored discretely; you cannot search this data nor can you use it in reports. There are a few companies that specialize in taking the dictation as a Word document and importing it into a template or visit progress note.

Most templates, however, make the text in the dictation searchable but will not actually populate discrete data items. The solution and the challenge is to create templates which format the dictation in such a way that it populates the discrete data elements whenever possible.

Creating Security Access for Smaller Practices. It’s relatively easy to define information security access at large practices, as staff members usually have clearly defined roles. It can be more difficult in smaller clinics that are within a larger organization.

Staff roles may be less defined. Limited staff means fewer people doing more, and many clinic staff members are performing tasks outside of their job scope. Therefore, their roles are not as easily translated into electronic security templates. To make sure the access rights and roles are assigned for the appropriate user, you may also have to conduct additional audits. It may take some tweaking and some extra time to get your security process in place, but if you know about this, you can plan for it.

Defining a Naming Convention. Once everyone in the organization agrees on how the new EHR is going to function, and future workflows have been documented, it’s time to split up the build work and have your build team start building, right?

Wrong. Before you have multiple people building in the system, you need to define how you’re going to name the different elements within the system. How will items be labeled? Should we use ALL CAPS? Do we start with the name of a department or facility? (Not a good idea, by the way.) How will forms be categorized?

These seem like small decisions that each builder could decide along the way, but if you have 10 people building in the system, you will have inconsistencies throughout, making documentation, training, and especially maintenance difficult. It’s worth the time up-front to define these conventions beforehand. If you’re interfacing with other clinical systems or if your data feeds a clinical data repository, make sure you use the same naming nomenclature for labs, procedures, etc. Normalizing the data across the enterprise is a requirement if you’re going to report on clinical quality measures across the organization.

Setting up Master Files that Make Sense. When set up correctly, master files save time and help users avoid errors. However, it’s important to set them up in a consistent matter up-front, similar to defining a naming convention.

If you have multiple lab interfaces, for example, it’s important to be able to tell one result from the other and each lab from the other. Understanding, naming, and configuring the identity for each result component, and having continuity between the components, is critical. You don’t want to set up five separate hemoglobin results in the system, but you do need to get the results from five different labs for each hemoglobin and be able to tell the types of results apart. So how do you set it up? If possible, attach Logical Observation Identifiers Names and Codes (LOINC) to the components so that you can identify, for instance, the body fluid.

Too often you cannot identify the fluid from the name of the component result. If possible, try to have an identifier in the names of components without LOINC codes to enable specimen identification. Providers may want urine results instead of blood results or vice versa, so the ability to identify the correct components saves time and improves accuracy.

There are many reasons to mitigate risks and challenges of an EHR implementation besides the obvious cost of delays and rework. Success in terms of being a meaningful user—and receiving MU incentive dollars-- depends on the ability of your organization’s EHR to provide accurate data in a timely manner.

There’s also a timeline attached to receiving meaningful use funds. User and physician adoption of the EHR is critical to its effectiveness; when something doesn’t work well after implementation, it can impact users’ trust in the system. However, when the EHR does function well, it can be a game changer, in a positive way – improving user and patient satisfaction.

- Tracy Welsh, vice president at Hayes Management Consulting

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