At the recent HealthAchieve conference, I had the opportunity to speak with a young health informatics professional working for a prominent Ontario research hospital. During this conversation, he asked me what separated Meta from other vendors. Certainly a valid question, I thought to myself. Almost immediately, I responded by outlining Meta’s client-partner approach: our dedication to our clients, our belief that no two providers are the same, and our process of working with users to develop individualized, client-specific solutions.
He seemed shocked by my answer.
He went on to tell me of his current EHR situation. His hospital implemented a marquis system, and expected marquis results. What it received, however, was anything but that.
“We implemented (the system) a year and a half ago, and were just now entering the optimization phase,” he told me.
I was puzzled by his statement. Almost reluctantly, I decided to inquire further. “You’re just now entering the optimization phase?”
He responded brusquely, “I’m glad you picked up on that…”
There was no doubt in my mind; the hospital had been hoodwinked.
Prompted by this encounter, I decided to create a shortlist of things to be aware of when implementing new EHR systems. These five simple points will spare you the time, effort, and resources that many facilities squander as a result of EHR failure.
- There are so many companies out there competing for your business—go out and find the vendor (or vendors) that suits your needs.
- Sometimes, a single source solution is your best option. Certain vendors can offer a complete package and one-time installation that fit your requirements and your budget. However, certain organizations may want to consider collaboration between vendors. Partnering with different vendors allows you to select solutions that are specific to your environment.
- Be wary of vendors that promise speedy deployment during a large-scale implementation.
Read the fine print. If it’s not in writing, there’s a reason. Also, when negotiating between multiple vendors, always contract for “single-point-of-contact” partnership. This will help to simplify communication between parties and lessen the burden on your facility.
- The upfront cost of an EHR system is justified by cost-savings in the long-term. By the same logic, delaying implementation will cost you in the long run.
- Devise a strategy—identify the areas in your facility’s workflow requiring the greatest
improvements, and allocate resources accordingly. Key identifying factors should be patient safety, clinical efficiency, and economic efficiency.
- For example, if you’re overspending on pharmacy operations due to inefficient formularies, you may want to prioritize a pharmacy management system. However, if your facility has a high relapse rate, you may want to invest in more precise follow up documentation methods, follow-up event scheduling, and patient education initiatives.
3. Investments in Education and Technology
- The investment in technology is, for obvious reasons, the most essential aspect of an EHR implementation. However, without an adequate investment in education, any technology enhancements will be fruitless.
- Implementing a system without educating staff is like buying a sports car without knowing how to drive. Yes, you may have a new car, but you’re also bound to cause an accident.
4. Weed Out Inefficient Practices
- A workflow analysis can help to optimize system usability through the identification of inefficient procedures and practices.
- By performing a gap analysis and identifying bottlenecks in workflow, facilities can improve staff productivity and obtain the highest possible return on investment. This ultimately translates to improvements in the delivery of care.
5. Embrace Positive Change
- A popular slogan being used in the argument against EHR use is “let doctors be doctors.” However, providers need to understand no machine can account for the face-to-face interaction between a patient and client. EHRs are not meant replace doctors, but rather assist them.
- An EHR, like an MRI, is nothing more than a tool. When used properly, it enhances the delivery of care. However, if it is misused, there will be negative consequences. Providers must understand and embrace this fact in regards to EHR systems.
- In the past, providers have embraced changes and seen improvements as a result. In diagnostic imaging, for example, the introduction of MRI scans in the 1970’s saw a decrease in the use of X-ray imaging. Now, cancer centers are even combining MRI and PET scans to improve accuracy and reduce stress on patients.
- By embracing positive change across the healthcare spectrum, facilities can increase clinical efficiency, reduce wasteful spending, and improve the wellbeing of both patients and clinical staff.
Adapt, Transform, Improve.™
Well before the advent of Meaningful Use, Canadian lawmakers demonstrated foresight in establishing Canada Health Infoway. Its goal of catalyzing nationwide EHR adoption—though since outpaced by its American counterpart—was both promising and progressive. However, neither program has been without its flaws; and from these past shortcomings valuable lessons should be drawn.
Let’s set the scene:
The year is 2001. Canada has determined that wide scale health IT adoption would dramatically improve data accessibility, clinical efficiency, and most importantly, patient outcomes. Legislators spring into action and establish Infoway: a federally-funded organization with a mission of realizing interoperable solutions for nationwide, digital healthcare.
Among Infoway’s most important goals is the adoption of a nationally interoperable electronic patient medical record (similar to the primary aim to the US “Meaningful Use” incentives program). Infoway will receive federal funds, and invest them strategically to promote adoption. At this point, the future of Canadian healthcare looks ripe with innovation.
Now, fast-forward to 2009. The American government has decided upon a plan of its own, and by now, Canadian EHR efforts have failed to live up to expectations. However, the American Medicare/Medicaid EHR Incentives Program functions a bit differently. Providers are reimbursed based on their “meaningful” deployment of an EHR system, which is determined by a list of CMS-approved requirements. The program, looking forward, will ultimately help to catalyze US adoption rates, leading to a 2014 Commonwealth Fund survey in which America [69%] would rank eighth out of eleven countries in EHR adoption, outscoring tenth-ranked Canada [56%].
The biggest difference between the American and Canadian EHR efforts is the “stage” structure of the Meaningful Use program. This encourages adoption based on a set of rolling requirements, which has been met with moderate success: a 30% increase in EHR adoption between 2009 and 2013.  However, this method also relies on a “one-size-fits-all” mentality, which has proven detrimental to smaller, cash-strapped, or specialized providers, such as rural hospitals and long term care facilities.
Today, providers from both nations are advocating for change. In Canada, medical professionals have called for an increased leadership stance from the federal government. Dr. Peter Barnsdale, a family doctor from Mission, British Columbia, recently put forward a motion at the Canadian Medical Association’s (CMA) general council in response to the lack of progress under Infoway. He pledged that, moving forward, the CMA would play a greater role in the promotion, organization, centralization, and management of patient health records.
Though Canada has traditionally left decisions regarding public health to the discretion of provincial governments, Barnsdale also called for further federal direction. In an interview with CMAJ, he stated:
[The reliance on paper-based systems] is a routine source of frustration. I just think it’s crazy… It would be great if we had a federal government that actively cared about the public health system.
In the interim, provincial governments are being forced to circumnavigate the issue without a steady hand for guidance; but the lack of real progress indicates a need for federal direction, sooner rather than later.
However, criticism has not only been reserved for Infoway. In a 2014 open letter from the American Medical Association (AMA), the very first recommendation in an exhaustive list of Meaningful Use criticisms was to “adopt a more flexible approach for meeting MU… [and] remove the existing program’s all-or-nothing [one-size-fits-all] approach.”
Both nations need to consider a more centralized yet flexible strategy in regards to EHR adoption, and learn from both their own shortcomings and those of their neighbor. However, it’s also important to remember that the immediate focus must always be the needs of the provider. If no two facilities or practices are the same, then we cannot expect blanket requirements or casual federal commitment to adequately address an issue of such manifold importance. In order to truly realize the potential of EHR systems, we must understand that all facilities are unique, and encourage adoption of systems using this as our basic guiding principle.
 Hsiao, Chun-Ju & Esther Hing. Use and Characteristics of Electronic Health Record Systems Among Office-based Physician Practices: United States, 2001–2013. http://www.cdc.gov/nchs/data/databriefs/db143.htm
When Dr. Benjamin Stone set off for Beverly Hills, he had lost touch with his purpose. His motives were self-serving, and isolated from what it truly means to care for someone. Fortunately, however, we don’t all need to total a Porsche Speedster to be brought back down to earth.
For those of you who have absolutely no idea what I’m talking about, the context for my introduction comes from the 1991 film Doc Hollywood. In the film, a young hotshot jumps at the chance to make it as a plastic surgeon in Hollywood before a series of encounters in rural America coaxes him into reconsidering. As with any clichéd romantic comedy, Ben learns the error of his ways by story’s end, and meets the girl of his dreams along the way.
However, the film’s message isn’t meant to be narrow in its scope. Beyond its apple pie warm-heartedness, Doc Hollywood serves to remind us of what it truly means to practice medicine; to reawaken us all to our collective responsibility; to put care back in healthcare.
Although the film predates our current era of digital health, this collective responsibility subsumes all healthcare professionals, including HIT providers. Its message should be applied universally, but embraced by these individuals in particular. The current healthcare landscape dictates that digital healthcare no longer be optional. These initiatives—from HIE to EHRs—have become integral to patient care. With this evolving reality, vendors, like clinicians, must be held increasingly accountable for the care administered with their systems.
In truth, vendors should no longer be considered vendors. In reality, we must all be partners working towards a communal goal: improving the overall delivery of care. However, speak with any provider, administrator, or board member and they will all agree; no health information system can endure without a dedicated and supportive IT partner.
As we work alongside our partners, we understand that our role is critical to the patient care process. That’s why Meta cares about its users, their work, and the patients they serve. We work alongside our facilities to ensure that they always possess the tools necessary to carry out their work as care providers. We are aware of no other vendor that interacts with clients at this level—an undervalued but significant factor that separates us from our peers.
As a whole, however, healthcare IT corporations need to move away from a model of impersonality, and recognize the shift from vendor to partner. Though the rules may have changed, the game is still the same. Healthcare is about caring for those in need, and we as developers must all play a more proactive role in carrying out this responsibility.
Adapt, Transform, Improve.™
The best gift doesn’t always come in the biggest box—so why should EHR selection be any different? Competition and collaboration are driving innovation in health IT.
Roughly two months ago, the Department of Defense awarded its contract for a national Electronic Health Record to a formidable team of IT providers: Accenture, Leidos, and Cerner. Though it may be too early to comprehend its full impact, I’ve since contemplated how this deal will influence future developments in the EHR marketplace. After much deliberation, I can conclude that its implications, like all things in health IT, aren’t so cut-and-dry.
Although these companies hold prominent roles in the market, the content of the proposed solution was certainly the deciding factor in the DoD’s decision. Even more importantly, however, it appears collaboration between vendors proved crucial in securing the deal. This begs the question as to why—when collaboration often brings the best out of individuals—so many providers are content relying on a unilateral solution.
“Market share was not a consideration,” stated DoD Under Secretary for Acquisition, Technology and Logistics Frank Kendall. “We wanted minimum modifications [to the existing solution].”
Large HIT corporations often market themselves as cure-alls to healthcare enterprises, enticing potential clients with the “one-stop-shop” approach. For this reason, hospitals and healthcare organizations often settle on a single vendor without adequately assessing its applicability in their environment. Now, many of these same enterprises find themselves bound to their current vendor either by contract or fear of repercussions, and debilitated by wasteful resource expenditure.
Paul Levy, former President and CEO of Beth Israel Deaconess Medical Center (BIDMC), aptly describes this phenomenon in his article The Stockholm Syndrome and EMRs. Levy’s description of the vendor-client power dynamic, though outdated in terms of market representation, holds true even today:
As a result of the billions of dollars allocated by Congress… those companies who had a head start in implementing electronic medical records quickly found themselves in demand. Of all those companies, Epic [was] the most successful…
What is striking about this company is the degree to which the CEO has made it clear that she is not interested in providing the capability for her system to be integrated into other medical record systems. The company also “owns” its clients in that it determines when system upgrades are necessary and when changes in functionality will be introduced. And yet, large hospitals sign up for the system, rationalizing that it is the best.
After the establishment of the EHR incentives program, several hospitals and organizations rushed into relationships with big-name vendors, limiting their resources and ability to operate in the process. However, the market has since encompassed technology and practices that were unheard of just five short years ago. Although the “one-stop-shop” approach may have sufficed in 2009—when Meaningful Use was the yardstick for greatness—this simply isn’t the case anymore.
Alternative routes have opened to healthcare providers. As ZH Group Chairman Shameem C. Hameed has stated, “You don’t have to be the poor sheep who is being herded for financial slaughter. There is so much competition in the market today for EHR systems… Go around and find one that will meet your demands.”
Like anything that is built to last, information technology needs to be both collaborative and competitive in order to maximize its potential. These two factors proved crucial to the DoD deal, and will undoubtedly play a larger role future of health IT. If this recent deal offers any indication of current market direction, then hopefully we have begun moving away from our current model of complacency, and towards a model of competition, collaboration, and innovation.
 Levy, Paul. “The Stockholm Syndrome and EMRs.” http://runningahospital.blogspot.com/2012/10/the-stockholm-syndrome-and-emrs.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+blogspot%2FmJlm+%28Not+running+a+hospital%29
 Hameed, Shameem C. “6 Ways Physicians can Free Patient Records.” http://www.openhealthnews.com/articles/2015/6-ways-physicians-can-free-patient-records
Parking on a busy street in New York City can often be overwhelming, just by the sheer number of parking signs posted on the same corner. NO STOPPING MON-FRI 7 AM – 7 PM; ALTERNATE SIDE PARKING IN EFFECT; COMMERCIAL VEHICLES ONLY; SNOW EMERGENCY ROUTE; the list goes on and on.
“I don’t have time for this—parking shouldn’t be so difficult,” you tell yourself as you hurriedly pull up to the curb. You attempt to read all the signs, but you’re quickly losing patience.
So you park your car in the next available spot you see and return three hours later; and although you thought you followed all of the posted instructions, you come back to a $115 parking ticket on your windshield. It seems that, distracted by the other parking signs, you overlooked an equally important instruction—MAX TWO HOUR PARKING.
Like parking signs on a city street, clinical alerts are often overwhelming. However, while electronic health records (EHRs) have utilized clinical alert systems to improve overall patient safety, prescribers are often bombarded with so many messages that, for time’s sake, they become conditioned to override them all. This ‘conditioning’ is known as alert fatigue, and it presents one of the most harmful obstacles to patient safety.
Sometimes it’s an important reminder: maybe the patient has a peanut allergy; or maybe an underlying condition such as diabetes. These things should be considered while writing orders. However, if a prescriber is provided regularly with information that does not apply to the diagnosis at hand, he or she risks developing alert fatigue; even though, under different circumstances, these same reminders could alert to something far more important, necessary, or even life-threatening.
Orders, in particular medication orders, are subject to close scrutiny for appropriate doses, precautions for age and gender, patient medical history, interactions with other drugs, and potential allergic reactions, to name a few. However, with alerts range from rather insignificant to potentially life threatening, clinicians have difficultly discerning between the two.
If a doctor receives the alert “MALE PATIENTS AT HIGHER RISK FOR HIGH BLOOD PRESSURE” when treating a female patient, for example, he may become conditioned to overriding these alerts due to their inconsistency. However, if one physician orders epinephrine and disregards an alert detailing an earlier MAOI administration, the result could be deadly.
When do these ‘alerts’ stop being helpful, and start deterring us from our initial responsibility? Sometimes, we become so confused by the amount of instructions, that we forget basic directions like stop and go.
Facility environments are in a perpetual state of change, with formulary lists constantly being updated. Only under certain preconditions are drugs to be administered, and never under others. That’s why, for safety’s sake, decision support systems and clinical alerts must be able to manage, process, and communicate patient data both intelligently and efficiently. Systems must be fine-tuned to present physicians with only the warnings that are applicable to their specific patients.
That’s why Meta has been working to combat alert fatigue for nearly twenty-five years. After witnessing the potential danger of disregarding clinical alerts, we developed a system that can be customized by end-user decision makers during implementation to work with clinicians.
That’s why MetaCare™:
Alerts to therapy changes on a real-time basis, based on real-time clinician input—to ensure the user knows why the alert has occurred, and how to resolve it;
Prompts for documentation before and after administration, and requires justification reporting to override any and all clinical alerts;
Utilizes our IntelliMed™ rules-based guidelines module, to provide users with comprehensive and customizable evidence-based rule sets, tailored to each unique care setting;
Has employed a team of highly-educated and highly-qualified clinicians for nearly twenty-five years—to constantly enhance the functionality of each alert module with recent and relevant healthcare knowledge.
Not only can specific modules be controlled by severity and turned on or off, but they can also be tailored based on the mandates of the facility environment, and the type of clinicians using the system. The net result is a system that provides the most applicable content possible, so that when clinicians are presented with clinical alerts, they are always deemed significant.
The further we progress into the age of digital healthcare, the more information there will be to consider during evaluation. Susceptibility to alert fatigue will only grow unless EHRs can conform to an ever-changing healthcare environment.
But if software developers are pro-active and constantly vigilant, they can create their EHRs to be efficient and universally improve the quality of care.
Are you ready to make a change, and make a difference?
Adapt, Transform, Improve.™