How to turn around an EHR disaster: three case studies

Electronic Health Record (EHR) systems are the backbone of modern healthcare practices, providing crucial data storage, patient management, and decision support. However, when these systems fail, the consequences can be disastrous—EHR disasters can arise from any number of circumstances that range from internal software crashes, attacks from external threats such as ransomware hacks that disable a practice’s EHR system, and intentional or unintentional data breaches.

EHR disasters can also be less high-profile from a public relations standpoint, such as when an EHR choice or implementation results in a financial disaster for a practice.

Whether an EHR disaster is caused by internal software issues, external threats, or a poorly planned implementation, healthcare practices must have a strategy in place for damage control and recovery. The following three case studies highlight how organizations can turn around an EHR disaster, demonstrating the importance of stakeholder engagement, contingency planning, and realistic implementation timelines.

1. Involving key stakeholders after a failed EHR rollout

When the Robert Wood Johnson University Hospital, in New Brunswick, N.J., experienced a disastrous EHR implementation, it quickly became clear that the failure stemmed from a lack of input from front-line nursing staff. The post-mortem analysis revealed that the exclusion of these critical stakeholders led to widespread dissatisfaction and inefficiencies that significantly impacted patient care.

In response, the hospital underwent a massive leadership overhaul and reevaluated its approach to EHR implementation. This time, they ensured that front-line nursing staff were deeply involved in the planning and implementation process.

The result? A successful rollout of a new EHR system that led to marked improvements in several quality-of-care metrics compared to the period before the failed implementation. This case underscores the importance of involving key stakeholders, particularly those on the front lines, in every stage of the EHR implementation process. Their insights and daily interactions with the system are invaluable to ensuring that the new technology supports, rather than hinders, their work.

How can key stakeholders impact EHR implementation?

Key stakeholders, such as front-line staff, provide critical insights into the daily use of EHR systems. Their involvement in planning and implementation ensures that the system meets practical needs and improves overall efficiency and care quality.

2. Responding to a 10-day EHR outage

In the era of paper records, a complete practice-wide outage of clinical data was nearly inconceivable unless records were physically destroyed or lost—an exceedingly rare occurrence. However, with the shift to electronic records, the risk of losing access to critical patient information increases due to potential system failures or cyber-attacks.

Guide: implement successfully with this six-step guide to EHR implementation success

 A 2013 case at Boulder Community Hospital in Colorado involved an EHR that could have crippled the nonprofit health system. However, the hospital managed to avoid a catastrophic failure by implementing an extensive contingency plan for system outages and data loss.

Linda Minghella, Vice President and Chief Information Officer at Boulder Community Hospital described the organization’s preparedness: “We had an organizational commitment to maintain continuously updated paper records that could be used at a moment’s notice. Additionally, we regularly trained our staff, especially new team members, to ensure they were familiar with our paper systems.”

This proactive approach minimized disruption, allowing the hospital to continue operations, albeit at a reduced capacity, until the system was restored. The case illustrates the importance of contingency planning, ensuring that alternative methods for accessing patient data are available and that staff are well-prepared to use them.

What contingency plans are there for EHR outages?

Contingency plans for EHR outages involve having alternative methods, such as updated paper records, to access patient information in the event of a system failure. Staff training on these methods is also crucial to ensure seamless care during outages.

3. Letting unrealistic deadlines dictate the implementation process

In 2016, NYC Health + Hospitals received a substantial amount of negative press with the resignation of Charles Perry, MD, associate executive director, and liaison to the Epic project at NYC Health + Hospital’s Queens and Elmhurst Hospital Centers.

Dr. Perry cited the organization’s rushed EHR implementation as the reason for his departure, alleging that the drive to meet tight deadlines took precedence over patient safety.

After substantial public blowback NYC Health + Hospitals and a significant shake-up among executive and IT staff the organization pushed back the next phase of its $764 million, systemwide Epic electronic health record system rollout by several months. In sum, illustrates that deadlines for implementation should be tied to on-the-ground conditions and not purely hypothetical timelines and that the timeline for the implementation should also be subject to buy-in by key stakeholders.

Why is flexibility important in EHR implementation timelines?

Flexibility in EHR implementation timelines allows organizations to adapt to real-world conditions, ensuring that the system is deployed safely and effectively. It also helps in gaining buy-in from key stakeholders, which is essential for a successful rollout.

How can a healthcare organization prepare for a potential EHR disaster?

These three case studies vividly demonstrate the importance of proactive planning, stakeholder involvement, and realistic timelines in avoiding and recovering from EHR disasters.

• At Robert Wood Johnson University Hospital, including front-line nursing staff in the EHR implementation process was the key to overcoming a failed rollout.
• Boulder Community Hospital's robust contingency planning helped them weather a 10-day EHR outage with minimal disruption.
• NYC Health + Hospitals’ experience highlights the critical need for flexibility and stakeholder buy-in when establishing implementation timelines.

By learning from these examples, healthcare organizations can better prepare for potential EHR disasters and ensure that their systems enhance rather than hinder patient care.