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There have been rumblings from hospital leadership and congressional committees about the Veterans Affairs (VA) hospitals' implementation of the Cerner Corporation electronic health record (EHR) replacing the VistA EHR. The $10 million EHR overhaul has been controversial since the staggered rollout started in Spokane, Washington. One report noted that months after the go-live, fewer users knew how to operate the system well.
From the perspective of an outside informaticist, such frustration can be multifactorial. The typical issues are made worse by the COVID-19 hospital restrictions on normal hospital operations. However, many of these issues could have been mitigated by offering expanded in-person expert support to hospital staff supported by virtual technical assistance.
Due to system failures, the U.S. Congress has halted the Cerner implementation process at VA hospitals. Lawmakers want concrete answers about why the issues encountered were not planned for, why training was inadequate, and the problems with software functionality. Critics are also calling into question the decision to award the EHR contract to Cerner instead of rival Epic Systems.
Before COVID-19, I participated in a Cerner implementation at Department of Defense hospitals in Washington. At the time, I saw numerous challenges, the most concerning being workflow integration with the new system. That challenge is likely being seen at VA hospitals undergoing this transition. The question here is how a healthcare system can navigate through the disappointment and come out more resilient.
I recommend my clients use the following five E's to fix an implementation that has gone awry.
Evaluation
Leadership needs a complete assessment of what is causing the challenges at hand. The hospital has to evaluate workflows so the system could be tailored to the department's needs.
Eliminate
This is the most challenging portion of the process. First, leaders need to eliminate infighting, which can lead to dysfunction and animosity between work groups. Focus on internal dynamics. I suggest a team-building session involving critical leaders from all specialties and departments, not just doctors and nurses. It should also include everyone with access to the EHR, even personnel like chaplains and dietitians.
Second, eliminate process waste. Process wastes are ideas or tasks transferred from the old systems that staff still feel the need to complete. It can also include inefficiencies learned by the team when they are inadequately trained on the new system.
Engage
Engage the clinical team with the IT team. These two groups need to communicate the issues to be fixed based on priority while maintaining patient safety.
Make sure that all of the hospital staff are fully informed in simple language that ensures transparency. The less jargon, the better. Workers need to understand their role while also feeling valuable; this promotes cohesion within the organization and each team.
Entrust
Invest in what the team needs to make an implementation a success. If they need more expanded in-person support, supply it; if they need to come in out of their regular schedule to be trained on the system, budget the time.
EHR systems are expensive, but if employees do not utilize them properly, the money has gone to waste.
Experience
Mistakes and failures will potentially occur. Maximize learning from other organizations that have done implementations in the past or learn from the challenges that you have faced from your implementation. It is essential to learn from your mistakes and successes.
Failed EHR implementations are expensive, demoralizing, and intimidating. However, they can be corrected -- and often faster than what many believe.
Afua Aning, MD, is a physician informaticist.
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