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.

Risks and Mistakes are Inevitable.

As defined by the Britannica Concise Encyclopedia, safety defines activities that seek to minimize or to eliminate hazardous conditions that can cause bodily injury.

There are innumerable risks to human safety and the management of those risk to ensure a safe environment is a task that is imposed on every human being from the earliest age as a genetic imperative around which cultural taboos, social norms and engineering, in all its aspects, cocoons society and its members.

Risk Management is all about identifying safety risks and putting in place controls to minimise or eliminate those risks. Errors and mistakes are an inevitable part of human development be it as a child touching a hot surface, tripping over, ingesting inappropriate materials to their elders speeding, utilising infectious needles or simply loosing control with legal or illicit drugs.

Mistakes can often be as good a teacher as success, (Welch, Jack) if you survive. If you don’t of course that meets the genetic imperative. The Darwin Awards make light of some of those issues. Unfortunately one person’s mistake, sometimes remote from the final outcome, can lead to the deaths of many whose loss to humanity should never be underestimated.

Safety First!

What makes a computer application used in the health care industry safe?

Simple answer is we do!

All tools – cars, aeroplanes, hammers and chisel are extremely safe until a human decides to use them. Mind you an unused tool is not really a tool at all and a computer application that is not used is of no intrinsic value to anyone. It is only when the button is pressed, the icon released or the message sent that those relying on the accuracy of the underlying systems and the human input provided are in receipt of a benefit or harm as a consequence.

Many applications look fantastic, attractive and modern but are incredibly unsafe either in their own design, the systems they reside upon, the messages they send or the lack of skill of the human at the interface.

This site hopes to look at all aspects of creating safe health information systems and the issues the applications development.