Five Cs to successful EHR implementation

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Belinda Wiegand, RHIA, senior director of EMR services for PHNS Inc., discussed five steps to a successful move to EHRs during her educational session at the AHIMA 2006 Convention in Denver last week. She has worked with numerous facilities as they made the move to an EHR system.

1. Complexity. This is where most organizations struggle, Wiegand said. “First, you have to establish just what an electronic record means to your organization. Will you scan documents? Or will you create an interactive database for clinical decision-making and benchmarking?” Making those decisions takes time and thoughtful consideration but must be made before you can move forward.

2. Commitment. Your organization’s leaders must be actively engaged, said Wiegand. “Their attitude and commitment filters out to the rest of the organization. Leaders need to be visible, not just sitting behind glass doors.”

You will have to make some tough decisions, she warned. It’s not unusual for a facility to have a highly respected physician who ends up as the squeaky wheel — fighting the change and spreading a negative attitude about it.

Despite the challenges, stay focused on the ultimate outcome, she said. The outcome and goal are better patient care.

Wiegand recommended that those working to implement electronic records first create an EMR roadmap. “Does the roadmap ensure alignment with the organizational business plan and culture, capital spend, time, and resources? That is the question to ask when developing roadmap,” she said.

3. Culture change. This is a long and slow process. We are creatures of habit, Wiegand pointed out. “Failure to engage all the staff leads to a disaster, investment loss, and a reversion to paper.”

4. Communication. This can be an organization’s biggest pitfall. Be upfront and open with the entire staff, Wiegand said. They will be frightened and anxious. “I’d be more concerned if they weren’t frightened,” she said. Convey that they will increase their skill set through this change. “Give them something to get excited about.”

5. Contract negotiation. If there is a particular function or tool you want, don’t take the vendor’s word for it that they can deliver. “They can show you anything in a demo,” she said. “Have them prove it to you through site visits where the tool or function is working. Get references and call people.”

Wiegand said you shouldn’t pay for any portion of a system unless you have a deliverable that’s working. You might even want to establish a number of days that component must be working before your payment is due. She recommended that you arrange a shared risk guarantee with your vendor. That means that if the project is delayed or costs more than originally expected, they share the risk. “You’ll be surprised how much more attentive they are to you.”

Change control


A firm change control process minimizes scope creep and ensures the project deliverables are what is expected, on time, and within budget, Wiegand said.

Key categories, at a minimum, for that process are:

  • organization communication plan
  • forms management
  • business process evaluation and workflow automation
  • legal/regulatory requirements
  • master patient index duplication resolution process plan
  • infrastructure assessment/readiness/plan
  • system design, build, and test plan
  • integration plan
  • education/training plan
  • implementation methodology/plan

Eighty percent of EMR success is process evaluation and redesign, Wiegand said. “Your current manual process should not drive the automated process. If it does, you are guaranteed to fail.”