What are we learning in the Electronic Health Record World?

Recently I sat through a Gartner talk on the EHR.

While many of the points below are valid issues and relate to an major EHR implementation there was little focus on the underlying knowledge management issues, such as cross system integration, standards in data sets and interoperability.

Issues around safe user interface design and new and innovative uses of telehealth and seamless patient movement around a nation have not been taken up. The USA model of the big vendor system (e.g. CERNER, EPIC, ISoft) misses the wonderful integration achieved by Australia in the last few years and while it is far from perfect in many ways it leaves the USA gasping in its wake.

As long as you never move between hospitals things will be fine and well integrated for those patients but change providers, move between jurisdictions and your EHR rapidly becomes hidden and of diminishing value.

The following points though are all valid and important but don’t for one minute think this is all you have to deal with.

There clearly needs to be consideration of planning, project management, vendor selection, change management and execution.

The following areas were highlighted as a main focus of complaints and concerns during and after implementations.

  • Lack of clear executive clinical leadership
  • Complex technical organizational regulatory, cultural challenges
  • Lack of dedicated resources
  • Poor project management
  • Weak governance
  • Poor change management
  • Weak benefits realization process
  • Poor communication
  • Vendor inability to deliver to specification
  • Clinical rejection of system

Many lessons therefore should be considered constantly both before, during and after implementation.

  • Unrealistic timelines
  • Failure to review clinical workflows / processes
  • Failure to understand the technical requirements
  • No clear vision as to why we are doing this
  • Stakeholder conflict
  • Scope creep
  • Inadequate in-house support
  • Lack of clarity on interface requirements
  • Underestimating data conversion

 

The following cycle of issues may be of value to follow and review n a very dynamic manner and particularly  as warning signs are developing.

  • Develop a communication plan
  • Review Total Cost Ownership
  • Review EMR Lessons
  • Review Procurement Model
  • Review Readiness Assessment
  • Review EMR Strategy
  • Identify stakeholder Engagement model
  • Review Governance
  • Plan for Change Management

Other Factors to Consider

  • Standardisation of medical practice and reducing variability and variance between practices
  • Development of the CMIO role to assist in the redesign of clinical workflows
  • Develop and review your engagement strategy as issues and tension develops.Some of the long term demanding issues will be sustainability and optimisation over time.

    Gartner is pushing The Real Time Healthcare System


Telehealth – A Time For Growth

Telehealth has been alive and reasonably well in Australia for over a decade now. There are a multitude of services being provided across a wide range of specialties and professional groups.

While some innovative apps, home monitoring and consultation styles are being developed or in some cases are well entrenched and in place, there seems to be a gap and  limited growth in the seamless electronic medical record with the non-virtual health world.

This is about to change with integrated repositories of patient data, a national infrastructure of providers and access, web based user interfaces for viewing and studying repository material.