The HiMSS group on LinkedIn features some interesting discussion. One of the longer threats evaluates why EHR/EMR implementations fail
Well, I must ask – please define failure! And this questions goes right to the heart of the matter. Defining success is probably one of the most prominent things any project management and executive steering committee must accomplish at the onset of the project – even before a vendor is picked.
I am well aware of the challenges associated with the technical implementation, workflow definition, workflow standardization and Computerized Physician Order Entry (CPOE) and much has been written about this topic.
A key point of any successful EMR is that the physicians and nurses accept the system and want to use it. Honestly, what’s in it for them?
Thus far, physicians in larger organizations had the luxury that someone would transcribe their scribbled notes and mumbled dictations, so that they could focus their time on patient interaction. The fact that healthcare administrators want to reduce errors and establish audit trails of clinical decision making has often been perceived as being of little value to the physician – especially if viewed in comparison to the perceived hassle of learning a new system and having to type patient notes. In a litigious society such as the one in the United States, some physicians may be more comfortable without any trail of clinical decision making that could potentially used against them in trial.
So, for EMR implementation success, a few key principles must be considered:

1. Define clear success criteria. Administrators, tech experts and clinical staff must work together to jointly arrive at a common goal.
2. Workflows. Pay close attention to how much hassle it is for the clinician to complete a workflow. Software must support users, not the other way around. When I was at a major EMR vendor, we actually counted the number of required clicks to complete a task as a key performance metric of the system. In the development cycle, no workflow could execute slower or with more clicks in a new version.
3. Access. This is at the heart of the matter. Organizations should establish clear metrics on how a physician accesses the system. Set an aggressive goal – such as “no more than 15 seconds for the first interaction of the day, no more than 3 seconds to log on to any terminal and get the session back”. This can be achieved through virtualization technology and session roaming with Citrix XenApp and XenDesktop. The use of two factor authentication such as proximity sensors in the user’s security badges or certificate carrying smart cards negate the use of typing in passwords. Think about the access modality as well – is it a thin client, a tablet, an iPad, a computer on wheels? How many hands will the physician have to care for the patient? Are cable or monitor arms in the way? Are there terminals in the hallways so that a note can be amended without disturbing the patient?

I’ve written about this topic in a previous blog as well.

Please provide your thoughts and comments.

Florian
Twitter: @florianbecker

There are two interesting trends going on in healthcare at this time (no, I am not talking about the current debate in congress). One is that we will see more and more healthcare providers use electronic medical records – a trend that is fueled by financial incentives through “stimulus money”. The other is one of the consumerization of IT – specifically healthcare IT.
We see this trend in other areas as well – like employees using their personal cell phones of choice to access corporate email, or even bringing their personal laptops to work.
In healthcare, doctors are already heavy users of mobile technology – cell phones, smart phones, the ubiquitous pager etc. But today we’re at a point where the consumer technology is good enough to be used for clinical purposes and can actually contribute to giving doctors a little bit of their free time and their personal life back.
Case in point: The patient calls their on-call doctor after hours with a rash or burn. In the old days, it would have required the physician to drive a possibly long distance to see the patient in order to recommend treatment. Today, she can simply ask the patient to take a picture of the ailment with a smart phone and simply email it over. In many cases, the image quality is good enough to recommend treatment and help the patient immediately.

This trend is obviously troublesome for healthcare administrators. Many actually recommend against their physicians employing “unapproved” avenues to make remote diagnosis out of fear of litigation and legal compliance violations. The dilemma is that both patients and doctors use technology out of convenience where it makes sense. It is against doctor’s nature to hold back care if it is obvious how the patient can be helped right then and there.
However, I stipulate that this is actually nothing new.

• For a long time, doctors have consulted their patients over the phone and gathered enough information to diagnose and make a recommendation for treatment, so the digital information exchange actually reduces risk in many cases.
• The patients are the only rightful owner (note that I am not saying the only legal owner, this would be a different discussion) of their medical data. If they choose to share some of it over less than secure connections with their physician, it’s their choice. In the age of social media and Internet-based commerce, people have become accustomed to giving up some privacy and security in exchange for faster and better service online.

So, can both groups – doctors and their patients on one side and privacy advocates, regulators, and lawyers on the other side be happy? Yes.
Some electronic medical record system vendors incorporate an internal, secure messaging feature that allows patients to communicate with their doctors and nurses directly, but through the established channels of an existing EMR implementation. In addition (or in lieu) of this capability, healthcare providers can use their smart phones, netbooks, tablets, home computers etc. to securely connect to their employers system to upload data, annotate patient notes in real time etc, check for potentially harmful allergies, etc. If the EMR implementation does not expose a fully functional web based user interface, both desktop and application virtualization technologies can make it so.
Instead of getting into the cold car and driving 50 miles through snow and ice to see a patient, the doctor on call can simply pause the movie on the living room TV, switch the set to the connected PC and securely connect to the patient’s medical record, review pertinent information, write a prescription electronically (a must have under the proposed “meaningful use” criteria) and finally go back to being a private person. More personal life for caregivers, faster service for patients – enabled through technology.

Follow me on twitter: @florianbecker

Well, not quite, but as a physicist working on the grand unified theory would say: The arrows are pointing into the right direction.
While patient care is not delivered virtually quite yet, the experts in the field of Health Information Management and Systems will have their annual gathering in Atlanta in early March (http://www.himss.org) to ensure we’ll get there in the future. If you haven’t been to the HIMSS show yet – it is an exciting conference with well over 20,000 attendees.
Questions on health record portability, privacy, interoperability, and the plain old task to get physicians to warm up to the idea of using a computer as the primary means of documenting clinical information will be at the center of the discussions, while musings on whether the federal government is going to pay for your healthcare IT initiative are sure to be overheard as well.
I myself will make my way up to Atlanta to find out what’s going on in the industry and I seek to speak to many attendees and presenters on application delivery challenges in this unique field. Stay tuned on these pages for regular updates and follow me on twitter for a play by play of my HIMSS journey.
Before I pack my bags and decide whether or not to include foul weather gear and snow shoes, please let me know what specific topics around healthcare IT you are interested in.

Twitter: @florianbecker

Florian