Question

example of failed EHR project and explain the reasons for their failure.

Answer 1

Ans) Unsuccessful EHR implementation is not something which the industry has unheard of. The percentages of failures are alarmingly higher when you include the adoption and meeting of the desired objective benefits from such investments.

It is estimated that between 30-50% of EHR implementation projects fail. According to a research report by health IT research firm KLAS, by 2016, almost 50% of large hospitals will replace their current EHR

Based on our experience of helping several hospitals in their journey of clinical transformation, here are the 10 reasons, which we think cause EMR implementation failures -

1: Incorrect Goals

What do you want to achieve out of your EMR implementation? Have you set realistic goals and expectations? Is the goal to just digitize your paper records or is to improve patient care while bringing in 20% increase in revenue? Only when you have a clearly defined and understood set of goals and expectations, you will be able to evaluate the success or failure of your EMR implementation. Goals provide you the criteria to evaluate the implementation and chalk out a plan to overcome any shortfalls.

2: No Stakeholder Buy-in

Although EMR implementation involves a lot of technology activity, it certainly cannot be only an IT decision. There are multiple stakeholders who are involved in the use of EHR and the buy-in from all the users is absolutely essential. Successful EHR implementation requires a physician champion who can help in getting the various stakeholders on the same page, respond to queries in a timely manner, and help the physicians and clinicians in reaching a consensus. It is important to note that the EHR implementation involves multiple factors such as technology, leadership, change management, training, and management and, therefore, it must support both technical and personnel-related components. This helps in avoiding situations wherein; soon after implementation of the EHR at one of the 500+ bed hospitals, the 1100+ staff physicians refused to use the system because of its lack of usability!

3: Missing Management Mandate

Most of the discussions around EHR happen around the technology but, there are several other human and organizational aspects such as vision, motivation, value, personnel, leadership, training, support etc., which are often ignored. Most of the EHR implementations cause cultural shifts and therefore, people skills like leadership and communication are absolutely essential. There is an additional onus on the leadership and management team to set high standards for themselves and provide tools to the team members to help them succeed.

4: Insufficient Infrastructure  

Need for a solid infrastructure is one of the most commonly overlooked aspects of EMR implementations. Most healthcare organizations lack the technical skills and infrastructure to support the EMR safety and fail to take care of aspects such as good wireless coverage, networking over good bandwidth, regular data backups, patient data security or scalable data centers. All such issues can severely reduce the productivity of physicians and clinicians and also hamper the patient care.

5: Incorrect Technology

Today, with the growing proliferation of mobile devices, everybody is used to working in a certain way – mobile has become the natural way of working, touch has replaced type in most of the mobile devices, compatibility across devices has been taken for granted, or the computers are supposed to work really fast. The EMR systems need to adapt themselves to such changing technological advancements. Incorrect technology which is non-scalable, non-responsive, does not work as fast as people are used to, or which cannot capture multiple data points, can soon be discarded by the users.  

6: Missing Functionality

A study by KLAS reported that 19% of the practices complained of missing functionality in their EMR.
Most of the EMRs miss on important functionality such as - comprehensive health history, ease of order entry, alerts and alarms to clinicians about patient conditions. And while data is important, the presentation of information needs to be specific to a user (For Example - the type of information and level of details needed by a cardiologist are quite different than the details needed by a nurse and the EMR should be able to offer such tailored information). Other key requirements include tracking of tasks for better patient care and patient-side health information management.

7: Unorganized Workflows

No two EMR implementations are the same and there cannot be “one-size-fit-all” kind of approach. The EHR technology should be able to adapt to each provider’s workflow which is unique to each department and hospital. With the EMRs, instead of learning the completely new system and changing the way they work, clinicians should be able to work faster and better and this can only happen if the EMR adopts their specific workflows. Workflow analysis is a mandatory step which comes before the EMR implementation.

8: Absence of Inter-Departmental Processes to Implement Change

The objective of the EMR technology should be to make the inter-departmental communication so effortless and smooth that there should not be any need for any other form of communication, apart from the communication through the EMR. In certain cases, this could be a fundamental change in the way the departments work and in such cases, hospitals need to invest in designing and implementing processes to make the communication happen through EMR.

9: Lack of Training and Change Management

Just like the implementation of any other major ERP technology, EMR implementations need to consider the “people factor”, which, if ignored, could be the top cause of project failure. Some doctors might be technology-savvy, others might be social networking savvy and there could be one lot which is not-so-tech-savvy. In such cases, there could be resistance to technology by way of withdrawal or refusal. To prevent a steep learning curve, hospitals need to invest in proper training – well in advance, even before the system goes live. The system should be able to identify those who require more training and make provision for the same. Critical buy-in and ready skills are essential for the success of EMR implementation. Proper training helps the users in understanding the fit between their needs and the EMR solution. This also helps in mitigating the problems of unrealistic expectations and loss of productivity.

10: Lack of Post Implementation Follow-up and Support

Implementation of the EMR is not the end, but in the real sense, it is just the beginning. Offering a complete post implementation support to the users and stakeholders is very critical so that they don’t feel neglected and abandoned. There has to be some way for them to ask questions, get their queries resolved, and attend training programs as required. Evaluations carried out through surveys, interviews, and observations can help in effectively determining the actual vs. expected outcomes and this data can also be used for process improvements in future implementation.