Readers Write: EHR Divorce Rates on the Rise – Four Factors that Predict Electronic Health Record Adoption Success
EHR Divorce Rates on the Rise – Four Factors that Predict Electronic Health Record Adoption Success
By Heather Haugen, PhD
Despite healthy growth in the implementation of EHRs, the lack of effective adoption plans is impeding their intended purpose of helping healthcare providers improve care.
In 2013, nearly six in 10 hospitals have adopted at least a basic EHR system. But not all EHR users are happy with their purchase. In fact, 30 percent of hospital executives admit they are dissatisfied with their system, and 30 percent of current EHR solutions are replacements of another product.
Research reveals that a myopic focus on the go-live event is the root cause of low EHR adoption rates and increases the chances of organizations’ divorcing their EHR vendor. In contrast, those healthcare leaders who focused on the processes and discipline required to achieve adoption and maintain it over the long run were more likely to achieve the clinical and financial outcomes they expected from the EHR.
EHRs have the potential to improve both patient care and work efficiencies in delivering care, but these outcomes are only possible when clinicians adopt the best practices and workflow needed to continually improve how the system serves the organization.
The research published in “Beyond Implementation: A Prescription for Long-Term EHR Adoption” revealed four key factors that predict EHR adoption:
Engaged Clinician Leadership
Engaged clinician leadership is the most important predictor of successful EHR adoption. IT leaders are often given primary responsibility for the organization’s EHR system. While their skills and experience are necessary for functionality of the EHR system, the input and expertise of nurses, physicians, pharmacists, and other clinical staff is essential to driving staff’s proper use of the EHR and improved clinical and financial outcomes.
Moreover, leaders of EHR adoption efforts need to be highly engaged through and beyond go-live. While this may seem like a given, competing priorities make it difficult to maintain the degree of engagement required after the go-live event. When comparing organizations with successful implementations and those who have become dissatisfied with their system, our research shows that engaged leaders:
- are well informed and aligned in how they communicate the value of the EHR;
- empower clinicians to make decisions about how the EHR should be implemented and used;
- understand the degree of change required and set priorities appropriately; and
- stay engaged for the life of the application.
Effective Training to Ensure Proficient Users
The way in which clinicians and users are trained impacts their level of proficiency. In healthcare, we often use traditional methods – one-time “training events” that occur at a certain time and place. The trainers focus on teaching the hundreds of features and functions available in the system over multiple days with the goal of reaching “mastery” by the session’s end. But this is an ineffective, insufficient, and unrealistic method.
Bill Rieger, CIO of Flagler Hospital (FL) originally thought that implementing his health system’s new EHR would include traditional, classroom-style training. This approach required training sessions to begin a full six months prior to go-live due to limited classroom space and a large clinical staff. By making the switch to using scenario-driven simulations – a hands-on method – the hospital was able to begin the initial training program just six weeks prior to go-live, resulting in increased retention and a more successful launch.
Simulation-based training that focuses on helping users become proficient in new workflows and best practices results in dramatically better outcomes compared to traditional training and takes about half the time. This style emphasizes an accumulation of experience over time. It happens continuously in the specific work environment and leverages role-based content to provide a level of individualized fluency. Critical thinking skills and retention of content improve significantly when the goal is proficiency, in contrast to attending a more passive training event.
Measuring for Improvement
Defining metrics to track proficiency in EHR use and communicating them with clinicians is another critical step for adoption. Without it, improper use of the system is more likely to continue. Through a process of peer-to-peer auditing and regular progress reports, clinicians can track their performance and improve in necessary areas – ultimately enhancing patient care in the process.
In addition to providing feedback for clinicians, measurement can help optimize the EHR platform. For example, if simulation reports reveal that a large percentage of users click in the wrong area when completing a certain task, it would indicate a point of non-intuitive design. Armed with such data, the EHR vendor may be able to modify the system for improved use.
Adequate Resources and Prioritization Beyond Go-Live
A focus on the people, processes, and evaluations to improve adoption over the lifecycle of the application is required for long-term success, yet very little attention is typically paid to sustainment efforts.
Even when a new EHR is well accepted by clinicians and they become proficient in the application, adoption is a process that can never be finished for two reasons:
- There will always be new clinicians and residents entering the healthcare organization. An organization with a successful EHR program will ensure that these individuals receive every bit of guidance and have the ability to be just as successful in their use of the EHR as those clinicians who had been present at the go-live event.
- EHR systems will always be subject to upgrades and changes. While the changes are meant to enhance the system, they will do more harm than good if end users do not receive the appropriate level of guidance when being introduced to new workflows and processes.
Too often, people that are recruited to work on EHR adoption efforts eventually revert back to their previous roles and work on their former projects, leaving the organization without proper resources to account for this inevitable cycle brought on by time and turnover. Flagler Hospital overcame this tyranny of time by keeping implementation committees in place and by focusing on long-term, ongoing education even through multiple EHR upgrades.
Moving from an EHR implementation focus to an EHR adoption focus requires a significant overhaul in how we think, how we lead, and how we behave. Now is the time for healthcare leaders to evaluate their organization’s performance in these four key areas that predict EHR adoption.
Heather Haugen, PhD is managing director and CEO at The Breakaway Group, A Xerox Company of Greenwood, CO, which recently delivered an HIStalk webinar on this topic that can be viewed as YouTube replay.