Written by Stevie M. Davidson Tuesday, 06 July 2010 18:05

I think what I find myself saying most these days when educating providers, their staff, and other healthcare professionals, is "EHR adoption is not an IT implementation, it is a clinical implementation".  I think that is the biggest piece that is missing from everything you read and see. Endless webinars, blogs, HHS and CMS fact sheets on how to manage Meaningful Use in your practice, how to...how to...how to....I want to know how many of these folks (and some have), really ever implemented themselves?  Seriously? Everyone is an expert.

Do you know what scares me the most?  The push for adoption is evident and clear.  What about providing the right support and resources to ensure that implementation is done successfully?  Now, you can argue millions of dollars are being spent on curriculum development at Community Colleges and Universities.  What are they teaching?  Are they teaching EHR industry education? Technical aspects and functionality of EHR?  What does certification mean?  Workflow?  These are good, however, don't you think that there needs to be a level of experience of the "trainee" of how a practice runs, the variables, patient safety risks, and all of the critical moving pieces to actually implement it in a practice environment?  Who are the teachers?  What do they know?  Are they required to be implementers themselves or are they reading from a book.  These people need OJT in addition to course work or forget about it (as us NJ and NY people say) LOL.

So now you will have an influx of IT people, new students, people changing careers, and others who will be guiding, performing workflow, and helping to move adoption and getting physicians to Meaningful Use.  From an unemployment perspective and giving people the opportunity to have a career and take care of their families, I am all for it.  We need it, but please explain how this can be done safely and successfully when they do not have any experience and a deep understanding of clinical workflow, EHR vendor knowledge, and patient safety and overall clinical best practice knowledge?  There has to be more to their training then what I am seeing, and who is developing this curriculum?  Doctors only?  People like us who are in the dirt every day living and breathing this and the pain of getting this done successfully.  We are not consulted.  Obviously we know nothing about what really happens and the risks. 

I did a wonderful workshop for a leading Medical Malpractice Insurance Company today.  The outcome of our discussion with the risk management consultants was "OMG, if EHR is not done right, it will increase patient safety risks, and liability".  Yeppers, and we are already seeing it happen.  Doctors are implementing too quickly, vendors are backed up big time on implementations,  which means quick sales, aggressive go-live dates, more big-bang implementations, less training time, and as a result a huge increase of potential failure and patient safety concerns.  ONC needs to consider these issues and put risk management on the forefront of HIT adoption. Not shoving timelines and unrealistic criteria in their faces and then penalties to boot.  So the 44k that will most likely not be achieved will be because a bad implementation will prevent them from getting the workflow and process in place to manage the requirements needed.  Not to mention RAC is right behind the check that will be in the mail to audit your documentation against your billing.  Oops! Did I mention the quality of documentation that we see on EHR is tanking because they don't have time to complete their notes?  Billing is going out before a note is signed and is still open?  You betcha!  

I am a big believer in EHR.  I think it is a tool that can truly change the quality of healthcare.  Accompanied by an HIE solution, good reporting, and other modules to manage preventive care and health maintenance, it can be a beautiful thing.  However, an EHR is a tool. It is a vessel that is only as good as you make it.  Shortcuts, bad process, and a lack of good accountability and process management will compromise the integrity and successful outcome of what we all hope it will do.  I use my pumpkin and pumpkin pie pictures during my workshops.  Can't take credit, swiped it from somewhere, but it is great and kudos to the creator.  EHR is the plain old pumpkin.  Meaningful use or just using it right is the pie.  However, depending on the quality of the ingredients you use to make that pie, is whether it is a nasty fast food apple pie, or a drop dead pie that you find at a top notch bakery.

Physicians, practice managers, clinical support staff, administrative staff, and other healthcare professionals need education, and seasoned consultants that can provide experienced proven success of how to select the right EHR, contract protection, and best practice implementation support and planning.  Want to know the most important piece?  They must know how to transform.  Map out current workflow, identify what stays, what changes, and what goes away.  Incorporates the development of clinical protocols, patient safety, risk management, legal EMR, testing, contingency planning, customization, project management, HR processes, accountability measures, and it goes on and on.  Please take the details from this blog and interview every person that even attempts to try to get your business to guide you on EHR adoption.  They can put you out of business if they aren't experienced.  We will be doing our own webinars soon, so stay tuned.  You cannot afford a Medical Claim, loss of your patient base due to satisfaction issues, staff turnover if chaos prevails, or the introduction of other risks that you may not even know about yet.

Remember....if they can't name you 10 clients that they have helped with selection, contracting, transformation, and implementation at some point in the game, walk away.  I would not go to a cardiologist to manage OBGYN needs.  Do not go to an inexperienced specialist in their field for EHR because you trust them.  Go to the source of experience and expertise to protect yourself, your patients, your staff, and the longevity of your business.  Until next time.....