Six tips for surefire EHR implementation success

Joel N. Diamond, MD, implemented an inpatient EHR, including 100 percent adoption of computerized physician order entry at the University of Pittsburgh Medical Center St. Margaret Memorial Hospital. This was one of the first successful community hospital installations in the United States.

Before launching CPOE in September 2004, Diamond went on a one-year campaign among St. Margaret’s 300 private physicians to promote acceptance of CPOE and identify those who resisted it. Because of this, the hospital launched the system two weeks ahead of schedule and now enjoys full participation by the medical staff. During the January 24 HealthLeaders Media (a division of HCPro, Inc.) Webcast “Bringing the Digital Hospital to Life: Expert advice and real-world lessons,” Diamond offered the following six tips for successful implementation:

1. Don’t be afraid to put your foot down

Often, leaders don’t want to be too firm. But in Diamond’s case, being firm is exactly what UPMC needed to do to make a paperless environment a reality. For example, there needs to be a “drop-dead” date to change a process. A drop-dead date simply means that after a certain date, an old practice or procedure is no longer valid. So, Diamond picked a day and said, “We’re going to stop printing labels.”

This forced physicians to use computers, rather than printouts, to administer care. Before the drop-dead date, physicians said to Diamond, “Patients are going to die because I can’t have my results on paper.” In other words, physicians didn’t feel comfortable giving up a paper practice entirely.

Of course, Diamond said, patients didn’t die because of the new rule, and the physicians adopted the technology (all of the complainers have subsequently apologized for their doubt). Eliminating printing was the right thing to do, he said.

2. Create buzz

To get the hospital ready for CPOE, Diamond and his team posted countdown signs all over the hospital. They made T-shirts, passed out favors, and achieved a positive buzz. He said they made only one mistake--they actually counted down to the pilot, rather than the full go-live date. He remembers that the pilot go-live date was a Sunday, and when he walked around to check on the progress, he noticed that physicians whom he didn’t remember asking to be part of the pilot were using CPOE. Physicians said to him, “I just entered 15 orders online,” or “Hey, this is going great!” It turned out that all of the physicians were using CPOE.

Diamond had to tell the CIO that he and his team had made a mistake. The good news was that the physicians liked CPOE, but the bad news was that everyone was off schedule.

3. Don’t call it an IT project

At no point did UPMC call any phase of its planning an IT project. “Instead, we called the EHR implementation a quality improvement project,” said Diamond. No one can argue when you show them how they can provide better care.

4. Create a multidisciplinary team to get a full perspective

Diamond convened nurses, housekeeping, volunteers, physicians--virtually every position that the EHR would affect--and asked them all how they would interact with hardware in the patients’ rooms. All specialists except the physicians wanted computers in patients’ rooms. “The physicians got outvoted because they didn’t understand the transparency of technology,” he said.

Once the physicians learned how much nurses and others relied on computers to do their jobs, they agreed. Because the physicians were hesitant at first, Diamond made sure that UPMC would have enough computers.

He didn’t want physicians to need a computer to give care and not be able to find one.

5. Evaluate physician willingness with a survey

Before training, Diamond surveyed physicians with a short questionnaire. He asked them the following:

He then could tailor training based on those two answers alone. Either physicians were familiar with computers, or they weren’t.

6. Don’t use only one kind of training

When it comes to training, one size doesn’t fit all. So, Diamond decided to break down the training by specialty, in a peer-to-peer model. The organization developed the training materials in-house.

He took the most respected leader from each specialty and had those physicians teach their colleagues. In fact, the chair of orthopedics’ training session had a 100 percent attendance rate. Diamond knew staff would be more likely to attend a training event hosted by a peer than one hosted by an outside training vendor.

Diamond also knew that he needed to anticipate every possible excuse he’d hear from physicians about why they couldn’t attend a training session or didn’t need to learn about a module.

So, UPMC offered an incentive to physicians who attended a training session--they’d receive remote access privileges. “We were not going to let people slip through the cracks,” Diamond said.