Why do so many hospital EHR implementations continue to fail?

By Jennifer Bresnick

– After five years of EHR adoption spurred on by the carrot-and-stick of meaningful use, one would think that the healthcare system has a solid foundation of best practices to fall back upon when implementing an EHR.  The vast majority of hospitals already have some experience navigating the difficult process of shifting away from paper-based healthcare, and most organizations seem more than willing to share the lessons they learned.  Yet horror stories pop up every day about botched conversions, poor planning, a lack of sufficient investment, and disaffected staff rebelling against questionable leadership.  How can late adopters avoid the pitfalls that continue to plague an industry struggling to make sense of its technical infrastructure?

“Don’t pick Epic,” may be the advice from some observers who have watched hospitals struggling to dig themselves out from under massive debts incurred by the wildly popular but costly system, but it may not be a fair criticism.  In 2013, Epic powered twice as many meaningful use attestations as its nearest competitor, Allscripts, and is eyeing the ambulatory market as its next area of growth.

“It’s a safe bet for Meaningful Use Stage 2,” acknowledged Beth Israel Deaconess CIO John Halamka. “Epic has a strong track record of providing products and the change management required to help hospital and professionals achieve meaningful use.”  Epic not only provides trusted software backed by a company that has a proven track record of stability and size, but it also offers providers a detailed methodology for organizational conversion and clinician buy-in.

The hospitals that fail don’t do so because they choose the expensive system, but because they don’t adhere to the governance structure, advanced project planning, and adequately flexible budgeting required to make their investment work.  Whether a hospital chooses Epic or one of its competitors, it will have no hope of succeeding if it doesn’t think ahead.

Two organizations recently in the news, Ventura County Healthcare Agency (VCHA) and Athens Regional Medical Center (ARMC), opted to go with Cerner.  Physicians at ARMC ended up ousting their own CEO after complaining of a lack of leadership that left the system unusable and prompted clinicians to renounce their privileges at the hospital.  VCHA faced censure from a Grand Jury, which flagged an absence of project management and insufficient training and hardware purchasing as the catalysts for the problems it experienced.

“This was a reasonably large capital program, and from the time you start your requests for proposals, you need to have something in place that lays out the whole program,” said Steven Weiss, foreman pro tem of the Ventura County Grand Jury.

Weiss’ comment strikes at the heart of why EHR implementations go wrong.  Successful providers repeat one word over and over when talking about their adoption process: structure.  Structured leadership; structured workgroups; structured budgeting; structured approaches to education and training.  Those that fail mention a different word: leadership – and it’s always preceded by “lack of” or “insufficient.”

“Nobody is to blame, because nobody is in charge,” said one LinkedIn reader commenting on the University of Arizona Health Network’s Epic woes. “This has nothing to do with technology and has everything to do with leadership. This is what it looks like when the governance structure for the project falls apart. Whenever I see a project like this go south, I look for similarities between the project outcome and the leadership who is supposed to be driving the bus.”

Investing in a comprehensive project plan that budgets for the unexpected yet never loses sight of the original goal is clearly the key component of a successful EHR implementation.  From the organization of physician buy-in and cultural change to ensuring that clinicians have access to the technology they need in order to continue delivering high-quality patient care, providers who succeed in leveraging their EHR investment understand where they want to go and how to get there before they ever set foot on the road.

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