Anyone in the biz knows that you don't just put in an EMR and expect success. The federal subsidies, which require "meaningful use" of EMRs, up the ante. Still, implementations continue to fail, or at least not live up to expectations.
A new book, Beyond Implementation: A Prescription for Lasting EMR Adoption, examines the pitfalls of EMR projects and discusses why and how organizations should focus on user adoption, not just implementation. The authors, Heather Haugen and Dr. Jeffrey Woodside, spoke at length about the book with CMIO magazine.
"As Jeff and I were working with our clients on the implementation and adoption of EMRs, we were seeing some recurring themes. We started doing some formal interviewing of CMIOs and CMOs. We thought, 'someone needs to publish a book about this,' not just a paper but really a methodology around barriers," explains Haugen, corporate VP of research health IT consulting firm The Breakaway Group, and co-director of health information technology at the University of Colorado.
"I experienced firsthand a failed implementation, the major cause being lack of adoption. The EMR was implemented well, but it soon became apparent that many users, physicians in particular, were actively seeking workarounds to using the EMR as it was intended to be used," Woodside, former executive VP and CMIO of UT Medical Group, Memphis, Tenn., says.
"As Heather and I conducted our interviews and further research, it became apparent that organizational focus was on implementation rather than adoption, e.g., using the EMR according to organization's policies and procedures and best practices. Metrics were not being routinely collected to determine one way or another whether it was actually being adopted," adds Woodside.
Haugen advises that CMIOs in particular should pay close attention to performance metrics when implementing an EMR. "If you can provide a dashboard of metrics to the leadership team you can dramatically improve how engaged they are in achieving adoption," she says.
For his part, Woodside calls physician adoption the key to success. "Physicians bring patients to the hospital, order and/or personally deliver patient care and thus drive the patient safety and quality of care and drive the organization's costs. They're enormously influential in the organization through their informal power derived from trust and credibility with staff and colleagues and their medical expertise. They may adopt and embrace the EMR and thereby motivate other physicians and staff or they can subtly communicate negativity that can be infectious," Woodside says.