Top 10 Lessons Learned from Electronic Medical Record Implementation in a Large Academic Medical Center

摘要

Electronic medical record (EMR) implementation efforts face many challenges, including individual and organizational barriers and concerns about loss of productivity during the process. These issues may be particularly complex in large and diverse settings with multiple specialties providing inpatient and outpatient care. This case report provides an example of a successful EMR implementation that emphasizes the importance of flexibility and adaptability on the part of the implementation team. It also presents the top 10 lessons learned from this EMR implementation in a large midwestern academic medical center. Included are five overarching lessons related to leadership, initial approach, training, support, and optimization as well as five lessons related to the EMR system itself that are particularly important elements of a successful implementation. Keywords: Electronic medical records, implementationIntroductionHealthcare organizations across the United States have made a significant and sustained push to implement electronic medical records (EMRs), based largely on the promise of this technology to improve the quality, productivity, and function of healthcare systems.~(~(1), ~(2)) Yet implementation efforts often experience only limited success.~(~(3), ~(4), ~(5)) Research has identified individual and organization-level barriers that may hinder implementation, including reluctance to change practice,~(~(6), ~(7), ~(8), ~(9), ~(10), ~(11), ~(12), ~(13), ~(14), ~(15), ~(16)) concern about new errors introduced,~(~(17), ~(18), ~(19), ~(20), ~(21)) and concerns about loss of productivity during initial implementation phases.~(~(22), ~(23))EMR implementation in a healthcare setting that includes a diverse mix of specialty providers and differing practice styles presents particular challenges. Specifically, variability with respect to the training needs of groups of end users, timing of implementation, and staffing arrangements present planning and logistical challenges and require flexibility in how the implementation team approaches the process.This case study presents the experiences of implementing an EMR system across a large academic medical center serving multiple specialties in both inpatient and outpatient settings. Throughout the implementation, the chief medical information officer and her team held informal reporting sessions where participants could comment on their observations of each implementation stage and identify potential improvements for the next stage. From these sessions we distilled 10 lessons learned for EMR implementation that we present here.SettingThe Ohio State University Wexner Medical Center (OSUWMC) is an academic medical center comprising six hospitals, two campuses, and 46 outpatient sites located on the campus of The Ohio State University. OSUWMC serves all populations and patients, with the Medicaid and underserved populations accounting for approximately 25 percent of the patient mix.EMR implementation at OSUWMC began in 2008 with introduction of an ambulatory EMR. Subsequent implementation phases included all outpatient sites as well as a “big bang” implementation across the rest of the enterprise in 2011. The result has been a single EMR system for inpatient and ambulatory documentation and orders, registration, scheduling, and revenue cycle management. In January 2012, we initiated Meaningful Use reporting for eligible professionals (EPs), including physicians and midlevel providers who met eligibility criteria for the Meaningful Use Incentive Program.~(~(24)) For 2012 we successfully attested Stage 1 Meaningful Use for 94 percent of the 600 EPs.ResultsOn the basis of our experience with EMR implementation, we identified five overarching issues that are relevant to every aspect of implementation, as well as five issues specific to this EMR system that involve new aspects of information management users needed to master for successful implementation. Below we present these 10 lessons learned.Five Lessons about the Implementation Process1. Ensure Leadership SupportWe learned early on that organizational leadership support and communication from the outset are keys to a successful implementation. Leaders can be identified at all levels—system, hospital, department, division, and unit as well as from a medical school that may be associated with the institution—and also include those in the areas of compliance, legal, privacy, security, and patient safety. It is important for organizational leaders to send the message from the very beginning of the implementation that everyone will be involved, everyone will use the EMR, and there will be no option not to participate.Leadership must be kept informed about EMR implementation progress to capitalize on opportunities to support and encourage others. The OSUWMC implemented a “scorecard” feedback system (see Figure ?Figure1).1). This scorecard approach enabled leaders to easily identify areas of lagging compliance so that issue