In Framework for Strategic Action, David Brailer, MD, PhD, the national coordinator for health information technology, described EHRs as "critical to delivering safe, affordable, and consumer oriented health care."

Yet achieving the comprehensive vision of an EHR that Brailer describes--one that enables complete, accurate, and timely information at the point of care--still eludes many providers. Simply put, the associated cost, legacy system interactions, paradigm changes, and other issues associated are great.

As difficult as these challenges may be, however, they shouldn't become an excuse for inaction. Providers can benefit greatly simply by taking steps to understand their level of readiness for building a migration path to an EHR. A key way to accomplish this task is by conducting a formal assessment.

Why a Readiness Assessment?

Despite the potential benefits associated with improved health IT, many risks are inherent in acquiring an EHR. Obviously, EHRs cost a lot of money and pressures are great to avoid a poor investment. Even if cost were not a factor, however, there typically are several other concerns. A formal readiness assessment can help your organization identify and develop strategies to address common issues such as the following:

Insufficient infrastructure. Many providers do not have the technical infrastructure to support the fully redundant servers, network capacity, or human-computer interface ubiquity needed to ensure full availability and desired performance.

Procedural weaknesses and inconsistencies. Most providers have not mapped their current processes to fix those that are broken or need improvement. Beginning to review clinical practice guidelines in paper form is an important start. Much of the quality improvements stemming from EHRs depend on structured data entry using a controlled vocabulary and clinical practice guidelines. Thus, the old axiom "garbage-in, garbage-out" becomes a critical factor to address.

Inadequate preparation for clinical effects. Many providers do not have staff with a proclivity toward--let alone actual experience in--clinical informatics. The assumption is that IT staff, perhaps with a super user or designated departmental system administrator, will do most of the installation, as is typically done with other applications. Yet the scope and complexity of system build and continual maintenance for an EHR crosses all healthcare disciplines, affects every department, and directly touches every clinical staff member. Too often, the clinical impacts associated with EHR use are not well understood.

Lack of knowledge about vendor capabilities. Providers need to be aware of the strengths and weaknesses associated with EHR applications. Too often, "with the click of a mouse" translates into many clicks through seemingly endless screens. And "seamless access" means that only one workstation needs to be accessed, even though multiple applications still may need to be accessed to get to data. (This form of access does not support computable data for decision support.) A key part of assessing readiness to transition to an EHR is discerning whether a vendor can meet needed capabilities.

How to Get Started

What should an EHR readiness assessment entail? Several key factors need to be addressed.

Establishing a vision for what the EHR means to the organization. EHRs come in many forms, from systems that simply automate paper functions to those that offer robust clinical decision support. Although everyone may want ultimate functionality, it may be an unrealistic goal in the near term. Therefore, a carefully thought--out vision statement that reflects a migration path forward is essential.

Performing technical, procedural, and skills inventories. Does the organization have up-to-date, clear documentation of its applications, hardware, network, processes, data needs, report requirements, and computer skills? Such information is needed to determine the cost of moving forward with an EHR. Also, documenting this information begins the process of configuration management essential to a clinical system.

Surveying clinicians on their knowledge, skills, and attitudes about an EHR. This begins to orient clinicians to the concept of an EHR and establishes expectations. When surveying technological aptitudes, it's important not to mistakenly jump to the conclusion that a typing test or keyboarding skills inventory is needed. Because template-driven EHR systems generally do not require much typing, skills such as navigating a screen, understanding how to browse, or familiarity with commonly used software may be more important.

Educating the organization about what vendor offerings are available. Discussions should take into account the organization's current infrastructure and/or willingness to revamp systems. Also, it should be noted that a readiness assessment is not a vendor selection project--even though this aspect of the assessment considers vendor offerings. It can be difficult for both the vendor and the provider to appreciate this difference. From the vendor's perspective, it is understandable that any inquiry must be treated as a lead and cultivated into a sale. From the provider's perspective, successful demonstrations can raise the temptation to purchase--a step that should be avoided at this point.

Plotting a realistic migration path for the organization. Key is addressing lack of readiness prior to going to market. Also included should be a commitment to make subsequent IT investments consistent with the migration path and standards established therein.

The Future

An EHR readiness assessment helps establish appropriate expectations and provides the organization with a solid plan to transition to the technology. Patience during the transition process is crucial. EHR technology is not like a prefabricated shed that can be set up relatively quickly. Instead, it should be viewed like an important structure designed to last for years to come, where each brick needs to be carefully laid. A formal readiness assessment is key for developing a coherent EHR vision that will guide the organization for years to come.

DON'T FOLLOW THE PACK

Developing an EHR migration path requires you to determine your organization's specific needs. Don't simply follow the masses. Just because everyone seems to be getting on the computerized physician order entry bandwagon, pursuing this technology may not be right for your organization.

FOR FURTHER READING

Margret Amatayakul is author of Electronic Health Records: A Practical Guide for Professionals and Organizations, AHIMA, Chicago, 2004.

TIP!

Focus on ways to "walk the talk." Performing a readiness assessment should not be an excuse for inaction. Always keep actions needed to progress toward an EHR system your top priority.

Margret Amatayakul, RHIA, CHPS, CPEHR, FHIMSS, is president, Margret\A Consulting, LLC, Schaumburg, Ill. Questions or comments about this article may be sent to her at margretcpr@aol.com.

COPYRIGHT 2005 Healthcare Financial Management Association
COPYRIGHT 2005 Gale Group