The Obligatory EHRImplementation “Lessons

Learned” Presentation

Jack L. Shaffer, Jr.Chief Information Officer

Community Health Network of West Virginia

I’ve been down this road a hundred times with many, many different IT systems. I have over 20 years of enterprise IT experience in a variety of industries, so I’ve seen just about everything.

People in the health care industry think that all of this stuff is new.

It’s not new. It’s just new to them...and perhaps YOU.

Disclaimer

The Three T’s

• Your EHR implementation has a better chance for success if you organize it into:– team, – tactics and – technology.

Team• Identify one or more EHR champions or don’t

implement.• Make sure your organization’s senior executive

fully supports the EHR. • Use an experienced, skilled project manager.• Utilize sound change management principles.• Have clear, measurable goals.• Make sure users share your goals.• Establish realistic expectations.• Don’t try to implement an EHR in a

dysfunctional organization.

Tactics• Plan, plan, plan.• Redesign your workflow.• Don’t automate processes just because you can;

make sure the automation improves something.• Design a balanced scanning strategy.• Consistently enter key data into your new EHR

charts.• Get data into the EHR electronically when

possible.• Utilize a phased implementation.

Tactics• Train, train, train.

• Be flexible in your documentation strategy and allow individual differences in style.

• Lighten your workload when you “go live” and for a short period afterward.

• Don’t underestimate how much time and work is involved in becoming “expert” with an EHR.

• Utilize “power users” at each site.

Technology• Don’t scrimp on your IT infrastructure.• If you’re a small organization, consider an

application service provider (ASP) model.• Make sure that your IT personnel do adequate

testing – especially with wireless!• Utilize expert IT advice when it comes to servers

and networks.• Make sure your servers and interfaces are

maintained on a daily basis.• Back up your database at least daily.• Have a disaster recovery plan and test it.

Technology Infrastructure?

• Hardware– Power/Electricity– Cable– Network cards (NIC’s)– PC’s– Switches– Wireless Access Points– Routers– Firewalls

Technology Infrastructure

• Software– IOS/Firmware– Drivers– Operating Systems– Applications

• Security• Antivirus/Spyware prevention

Technology Infrastructure Layer Cake

EHR

Technology Infrastructure

A failure at a lower layer causes a failure to all higher layers

Why should I care?

• Mission critical information– Financial / billing information– Patient information

• Key component in operations– A technology outage basically stops work

progress– Processes are too complex to perform

manually

Infrastructure and EHR/EMR

• EHR/EMR is a more demanding application– Client/Server– More disk space– More bandwidth

• Demographic data• Images• Telehealth / Telemedicine

Infrastructure and EHR/EMR

• EHR/EMR is critical to the treatment of patients– Clinicians and providers become dependent on the

technology– Speed of information important– Reliability is crucial

• Technological problems, such as poorly written software or inadequate server memory, can cripple an EHR implementation.

Infrastructure and EHR/EMR• With a poor infrastructure (lower levels of the

layer cake) EHR/EMR could be:– Slower– Unreliable– May not deliver the expected results

• Network & Telecommunications are key – Especially for ASP– Reliability a must– DSL/Cable – Asymmetric up/down speed

• Clinicians and providers will blame the application – even when it is not the applications fault.

The “Plagues of Pharaoh”

• DSL is evil. • Fire at Clay, Flood at Lincoln.• Wireless problems, problems and more

problems.• Data Center power problems. (I need

more power, Scotty!)• Tablet Troubles.• User Interface Issues.• It all adds up to user frustration.

Lessons Learned

• Treat the network as a utility at your own peril!

• Technology is as key as any other asset used in patient care when using an EHR/EMR.

Lessons Learned

• Disaster recovery – integrity of data and the network.– Broadband loss is prevalent in WV.– Lots of single points of failure.– Redundancy is a must.– Prepare baseline, “if all else fails” backup

plans – i.e. PAPER

Infrastructure and EHR/EMR

Just like the NFL – you have to have a minimum level of equipment before you are allowed to step on the field – otherwise you will get hurt.

Infrastructure and EHR/EMRIf you do not know where your network equipment is, or if it looks like this.....

.....then we need to talk.