While conventional wisdom typically says to bet on the tortoise, I’m putting my money on the hare when it comes to electronic health records implementations. Slow and steady simply doesn’t work in this race.

First off, there are those American Recovery and Reinvestment Act deadlines. With the pressure to not only implement but to prove the meaningful use of electronic records technology only months away, there’s simply no time for the long, drawn out, phased-in implementation.

But even without the added meaningful use pressure, I still advocate strongly for big-bang implementations over phased-in approaches. Why?  When it comes to information technology in the clinical care setting, I’ve learned that a phased-in approach simply doesn’t work.

First off, a staged approach sends the wrong message. If leaders are trying to sell staff members on the importance of using an EHR, how can they say that it is OK for half of the hospital’s users to keep using paper for months--even years--while others are using electronic records? It’s a mixed message that will cause staff to disregard the importance of electronic systems.

A phased-in approach also is extremely inefficient. Here’s what typically happens: A solutions vendor will send out a pharmacy resource and build that part of the system; then, the vendor sends a documentation trainer and builds that part of the process; then a registration resource is sent to the provider to work on yet another component of the whole. The end result: The hospital limps along carrying the weight of all these siloed technology builds on its shoulders.

What’s more, when a hospital implements an EHR in phases, processes are broken--and then fixed--during each stage of the implementation. So, leaders spend an inordinate amount of time trying to fix what was just broken, as opposed to simply implementing the whole system at once, and fixing the broken process in one fell swoop.

The slow build is not only cumbersome, it’s costly as well.  Maintaining both paper and electronic processes requires significant technology, materials and human resources. Industry studies have shown that the existence of dual environments has a negative impact on physician workflow. Doctors have to check records in multiple places and need to remember various processes to input records--as they might have to write a note into the paper record in one department and then enter a note in the electronic record in another area of the hospital.

What worries me the most, however, is that this dual environment is a real patient safety hazard. With all the confusion, doctors, nurses and other members of the care team might not check the right record – and miss important patient information related to safety such as a list of the patient’s medication allergies. As such, patient care is easily compromised.

In the case of hybrid computerized provider order entry, it's nearly impossible to outline a vertical or horizontal deployment and adoption strategy (i.e. only certain physicians, certain clinical units, certain medical disciplines, or certain order protocols) that don’t fall apart operationally under the slightest workflow analysis. The real problem with phased approaches is that the care to the patient is a continuum with complexities that are entwined, overlapping and iterative and not a series of linear phases that are easily segmented.

Even though I strongly believe in utilizing a big-bang approach instead of a staged approach, I do have one caveat. Moving quickly doesn’t mean going into an EHR implementation unprepared and letting things happen haphazardly. On the contrary, a big-bang implementation actually requires more meticulous planning than a phased-in approach. Because processes will be changing quickly, each and every move, down to the very last detail, needs to be mapped out well in advance. 

In the final analysis, though, all the hard work is worth it as health care organizations get to quickly move beyond the disruption associated with change and reap all of the clinical, financial and operational advantages linked to EHRs. And, of course, there’s a bonus as well: The approach will also enable your hospital to collect its full share of the government’s incentive payments. 


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