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Top Elements to Achievement in EHR Implementation

By Drew Barrows

Implementing a new electronic health records (EHR) is undoubtedly a complex task.  This is further complicated when the EHR is for a network of distributed ambulatory care providers.

We list the most important components for an effective new electronic health record.  These vital considerations are detailed below:

Distributed users – these practices are located in a distributed, metro geographic area rather than a central location. Therefore, the requirements, planning, and execution of training, procurement, and support are all different.                                                                                   

 2.    Technical issues - Since the users are geographically dispersed, special technical needs have to be addressed. Some examples include consistent connectivity through public-access last-mile networks like DSL or cable, remote backup strategies, and different EHR system designs and their impact on performance.

3.     Total cost of ownership – the costs and funding of these projects are subjected to different laws, different budgets, different funding sources. Many organizations are struggling with how to quantify needs, translate them into costs and then how to develop a financing model that is affordable to the physician’s organization and the practices.

4.    Staffing for these projects is challenging, as the physician’s organization staffs typically do not have any room to take on such large projects.

On-going support of these practices – The support models traditionally utilized by hospital data centers serve a centralized, more automated user base. In this distributed model, there is a need for a high touch, hybrid support model of on-site and remote support.

6.    The CIO and IT organizations’ role – Since these organizations are affiliated, most CIOs and IT organizations are involved and, in fact, guiding the efforts because of their experience. But they often do not have the bandwidth or staff to execute on these initiatives.

7.    Standards – Developing clinical and technology standards across a diversified group of non-owned practices is challenging. Balancing individual practice needs versus aggregated clinical reporting needs must be determined. Technology standards across individual practices needs to be balanced with existing equipment and requirements. Using a centralized model vs. federated vs. hybrid are some of the considerations.

8.    Governance – Project management and stakeholder management are very different as you typically have multiple constituencies involved: the hospital IT organization, the hospital clinical leadership along with the physician organization leadership and board. Several organizations are in essence coming together to become a service provider to the practices The CIO and IT organization usually do not have as full of control of the process. Therefore in addition to resource constraints, they must work within the context of the dispersed governance model.


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