Wednesday, June 16, 2010

EHR Lessons Learned

Navy Capt. Michael Weiner, DHIMS Program Manager and Chief Medical Officer, reports that for decades the Military Health System (MHS) has relied on its electronic health record to track and share health information data with providers. He recently posted several valuable lessons learned within MHS regarding the purchasing and use of their electronic health record system.

One of the first lessons MHS learned is to ensure that the EHR fits in with the current work flow before the system is purchased and absolutely before it is deployed. Work flows are similar enough across the environments and that should be a top consideration since customizing the look and feel of records for each station is not feasible nor is it possible. The MHS had to develop a system standardized enough to allow a doctor stationed in Texas who transfers to Germany or is deployed to be able to start using the system on the first day at the new station.

Any piece of software selected for the EHR must have hardware that can run it. When choosing hardware, it is important to choose the hardware that best fits the work flow. The lesson is that not only does the software have to meet the needs for the work flow in order to have a smooth and semi-painless adoption, but this is also equally important for the hardware.

Always purchase an intuitive system that is easy for medical providers to understand plus use software that is easy to use. It shouldn’t take a long time to figure out how to use the system especially if it is similar to the system and software that the user already knows.

Training should be conducted with a hybrid mix of training done in the classroom or it can be training one-on-one or both types of training. MHS has found that even training done in short bursts at busy military treatment facilities will provide each user with an adequate amount of knowledge.

The Defense Department has to host information on its own servers to protect national security and also because DOD needs to deal with an enormous volume of information. Since the MHS services 9.6 million beneficiaries, it makes good fiscal sense for MHS to do their own hosting. It has been found that web hosting increases speed and increases reliability. A centralized server eliminates the need for constant upgrades at the local level and enables upgrades to occur faster.

Wireless is here and it should be used to not constrain medical providers with wires. To best support work flow, wireless tablets, and notebooks should be used to make documentation easier and quicker to use and be portable in the battlefield. Portable technology increases the ease of incorporating EHRs into standard practices and increases the chances of buy-in by the users.

MHS and the VA have more data available than any other two healthcare organizations in the world and need to share data on millions of patients. Not all data needs to be computable to be useful, but some information like information on allergies and medications is really important and needs to be included while other data may not be so important to include.

Empower the staff from the very beginning to feel ownership of the EHR. When the users take ownership and buy in they are more willing and even eager for the change. Users need to be included from the first step of purchasing and then be included in all of the following steps in deploying and using the EHR. The users also need to include physicians, clinicians, nurses, clerks, and administrative support.

The next step is to empower patients to take responsibility as a partner in their own healthcare as very often new technologies can empower patients to have access to their own healthcare data. Offering patients a web-based personal health record will enable patients to email their providers, refill medications, and make appointments, which in the long run benefits both patients and clinicians.

The last lesson is to realize that NHIN is the next generation in our EHR evolution. As NHIN develops, all healthcare organizations and their EHRs will connect into this secure network. The NHIN is the dial-tone for the future and the broker of healthcare for the entire country.