Electronic health records systems and implementation

EHR Mandate

The electronic health records mandate comes from the federal government and is described by the Office of the National Coordinator for Health Information Technology. The objective of the program is to "enable the secure collection and exchange of vast amounts of health data about individuals" (ONC, 2011). Electronic health records (EHRs) are one of the key technologies in the plan. The mandate is therefore to convert the U.S. medical system to electronic health records. This will reduce errors, enable the provision of information quickly across multiple health providers and thereby improve health care outcomes for Americans.

There are five strategic goals that come within this mandate. They are to achieve rapid learning and technological advancement; to empower individuals with health IT to improve their health and the health care system; to inspire confidence and trust in health IT; to improve care, improve population health and reduce health care costs; and to achieve adoption and information exchange through meaningful use of health IT (Ibid). The federal government has built its programs for having EHRs rolled out across the nation in a number of pieces of legislation, including HIPAA and the Affordable Care Act. Each organization must act on its own within this context. Rouse (2013) notes that 'the format and content of an EHR implementation plan will vary depending upon the expectations and needs of the organization."

The EHR mandate therefore includes things like software and hardware updates, and setting time frames for rolling out the software and training the people within the organization. A plan for each organization should focus on these issues within the context of the different strategic goals for electronic health record rollouts. It is expected that within the next decade or so, health care will join every other industry in the U.S. In using electronic records and modern software to improve outcomes.

The Plan

At a nearby health care facility that wishes to remain anonymous, the IT department has a comprehensive plan for the implementation of electronic health records. The plan begins with a set of strategic objectives that are similar to those of the ONC. They have undertaken a thorough evaluation of the different options, and presented the two best options to management, with an explanation of time frames, costs and an implementation plan for each. These options represent a wholesale implementation of EHR and a partial implementation initially, which the IT department feels is a lesser option but one that might reduce shock among practitioners, who seem threatened by the change. Both the "big bang" type of implementation plan and the more gradual one have been used successfully in other institutions (Davies, 2006).

A good example of what the organization has planned is to work with multiple vendors to help train practitioners and reduce their resistance. This plan is based on principles of organizational change, in particular of overcoming resistance. There is also an educational component to the plan, to ensure that the public understands what the change means for them. This is necessary because there are significant concerns among some patients -- in particular the older ones -- about privacy, because apparently paper records could never fall into the wrong hands. Such irrational concerns have to be addressed, and the IT department has a plan to overcome resistance through education and training, for when the EHR program is initiated.

Implementation Progress

They admit to having challenges with respect to the implementation of electronic health records. Management, in conjunction with the IT department, has explored the issue at several points since HIPAA was passed into law, but has run into a number of logistical roadblocks. Some of the issues have included funding, the rapid pace of change of technology, resistance internally from medical practitioners and issues with respect to time frames and strategic mission. Internal resistance to change seems to be a major obstacle (Hanson, 2013), as many of the physicians in particular are older and not particularly tech-savvy. They invent a wide range of excuses as to why EHR is a bad idea, to the apparent frustration of the IT department. The problem, however, is that this resistance has become embedded, and management also returns excuses. It drags its feet on making decisions, and in that time the technology changes, forcing IT to explore the new options, and sending the decision back to management.

There is a high degree of frustration within the IT department, as they feel that they could have implemented EHR a long time ago, but these roadblocks have left the health care provider with ad hoc solutions, and apparently well behind implementation targets. This state of implementation is, however, not uncommon, as many health care providers have resisted the implementation of electronic health records for years, usually for many of the same reasons.

Analysis of Challenges

There are a lot of challenges at this organization, which seems to be behind even others in the area with respect to EHR implementation. There is strong resistance to change, from physicians, management and patients alike. Management seems the most motivated to change, as some in leadership realize that the transition to electronic health records is inevitable and there may be legal consequences should they delay too long. Resistance usually is accompanied by varying excuses, but it is probably futile to give those reasons much credence. At the heart of the problem in this organization is a lack of willingness to change and to embrace new ideas. This is a major problem with EHR implementation throughout the U.S.