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Study: Hospital EMR Rollouts Didn’t Cause Patient Harm

Posted on September 14, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Rolling out a hospital EMR can be very disruptive. The predictable problems that can arise – from the need to cut back on ambulatory patient visits to the staff learning curve to unplanned outages – are bad enough. And of course, when the implementation hits a major snag, things can get much worse.

Just to pull one name out of a hat, consider the experience of the Vancouver Island Health Authority in British Columbia, Canada. One of the hospitals managed by the Authority, which is embroiled in a $174 million Cerner implementation, had to move physicians in its emergency department back to pen and paper in July. Physicians had complained that the system was changing medication orders and physician instructions.

But fortunately, this experience is definitely the exception rather than the rule, according to a study appearing in The BMJ. In fact, such rollouts typically don’t cause adverse events or needless deaths, nor do they seem to boost hospital readmissions, according to the journal.

The study, which was led by a research team from Harvard, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center and Massachusetts General Hospital, looked at the association between EHR implementation and short-term inpatient mortality, adverse safety events or readmissions among Medicare enrollees getting care at 17 U.S. hospitals. The hospitals selected for the study had rolled out or replaced their EHRs in a “big bang”-style, single-day go-live in 2011 and 2012.

To get a sense of how selected hospitals performed, the team studied patients admitted to the studied facilities 90 days before and 90 days after EHR implementation. The researchers also gathered similar data from a control group of all admissions during the same period by hospitals in the same referral region. For selected hospitals, they analyzed data on 28,235 patients admitted 90 days before the implementation, and 26,453 admitted 90 days after the EHR cutover. (The control size was 284,632 admissions before and 276,513 after.)

Apparently, researchers were expecting to see patient care problems arise. Their assumption was that in the wake of the go-live, the hospitals would see a short increase in mortality, readmissions and adverse safety events. One of the reasons they expected to see this bump in problems is that some negative problems related to time and season, such as the “weekend effect” and the “July effect,” are well documented in existing research. Surely the big changes engendered by an EHR cutover would have an impact as well, they reasoned.

But that’s not what they found. In fact, the researchers wrote, “there was no evidence of a significant or consistent negative association between EHR implementation and short-term mortality, readmissions, or adverse events.”

I was as surprised as the researchers to learn that EHR rollouts studied didn’t cause patient harm or health instability. Considering the immense impact an EHR can have on clinical workflow, it seems strange to read that no new problems arose. That being said, hospitals in this group may have been doing upgrades – which have to be less challenging than going digital for the first time – and were adopting at a time when some best practices had emerged.

Regardless, given the immense challenges posed by hospital EHR rollouts, it’s good to read about a few that went well.  We all need some good news!

Will Your EMR Go-Live Education Miss The Mark?

Posted on June 3, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

LinkedIn conversations can be quite the font of wisdom, and today was no exception. In comments on a post discussing how training can lead to buy-in, David Kelley, D.O. made it clear that such training often leaves participants cold:

[Have] been the recipient in a couple of Go Lives and been on a few Go Live support teams. The younger/tech-savvy people verbalize the pre-Go Live to have been not worth their time as it was targeted for below their knowledge base. In stark contrast, the more senior/less tech-savvy verbalize near-hatred of those pre-Go Live educational courses as they were so far above their heads as to equate to tech-gibberish.

By reposting these remarks, I’m by no means suggesting that go-live training is a waste of time. Nor am I suggesting that every time hospitals attempt to prepare staffers for EMR implementation, they bore the heck out of staffers while accomplishing nothing. But if Kelley’s experience is any guide, many such trainings are doing a lousy job of connecting with their audience.

His complaints also raise several questions for me, including the following:

  • Who was teaching the courses? Was it vendor reps? If so, it’s little wonder that they produced content only a developer could love.
  • What was the focus of the courses? From Kelley’s comments, it sounds like clinicians and staff typically got a general overview which didn’t do much to foster success.
  • Did the training offer hands-on instruction? And I don’t mean a quick look at basic functions, but rather specific guidance on how to perform key job functions.
  • Did instructors explain the advantages of the new systems? To get buy-in from clinicians and staff, instructors need to hammer home how the new technologies save time, improve efficiency and better patient care.

Regardless, what I gather from Kelley’s story is that too often, hospitals often talk at future EMR users rather than helping them get productive and oriented. It would appear that those responsible for go-lives often fail to consider how the implementation impacts specific functions, and talk around the issues rather than blending training with problem-solving.

I’ve actually seen the effects of what seems to have been a questionable go-live training strategy here in metro DC. Now, the hospital talked a good change management game — even loading screen savers onto all computers stating that “[vendor] is coming!” and posting signs letting patients know about the upcoming shift — for months prior to the system kickoff.

But what do you suppose happened when I spent a few days as an inpatient later that year? I saw nurses and doctors desperately trying to make the system behave by sharing workarounds with each other. Now, you tell me: Would clinical staffers be going to these lengths if they’d had thorough, pitch-perfect, hands-on training?

Healthcare IT Consulting Job Slowdown

Posted on December 1, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A recent poll on HIStalk, caught my eye. In the poll he asked readers “For health systems: how much IT related consulting will you use in 2015 vs. 2014?” Here’s an image of the responses:
Healthcare IT Consulting

It seems only fair to acknowledge that this wasn’t a deep study. It was an online poll with plenty of potential sample bias. Plus, it only had 107 respondents to the poll. Especially with it being an online poll, I’d have liked to see more respondents. However, it’s worth noting that 50% of those who did respond are planning to use less healthcare IT consulting in 2015. Although, just as surprising is that 14% plan to use more health IT consulting.

This was somewhat expected from my point of view. The consulting market just exploded over the past couple years as hospitals raced to implement an EHR and show meaningful use. As that program has started to mature, there isn’t as much need for consultants. So, it’s no surprise that the government incentivized EHR consulting market would contract back down to a more reasonable market.

That’s not to say that there aren’t still lots of opportunities for EHR consulting still. In fact, I’d argue that the opportunity for EHR consulting has never been bigger. It’s the EHR staff augmentation companies which often dress up as EHR consultants that are likely taking the hit. My feeling is that EHR staff augmentation is way down and EHR consulting is going to continue trending up. All of these hospitals need to start maximizing their EHR investment. That requires a consultant as opposed to more hands on deck for the EHR go-live.

We’re currently seeing this play out on the Healthcare IT Central job board. The type of jobs that are being posted are much more advanced. Plus, we’re seeing a maturing of EHR adoption and that’s shifting towards more full time EHR staff vs consulting.

What are you seeing in the market? Are you using more health IT consultants or fewer? Where do you see the industry headed?

Planning for EHR Consultants in an EHR Go Live

Posted on December 13, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

At CHIME 2012 I asked David Tucker, MBA, MHA, FCHIME, VP of National Sales at ESD and Kelly Mulligan, RN, BA, Chief Operating Officer at ESD about how a hospital CIO should plan for an EHR consultant. While we’d love to think that a hospital could just ask for an EHR consultant and have one there the next day, the reality is much different. Sure, you could have an EHR consultant there the next day, but if you want the best EHR consultants it takes some forethought and planning to make sure you get on their schedule. David Tucker, former hospital CIO, talks more about planning for EHR consultants in the video below.