How to turn around an EHR disaster: three case studies
EHR disasters can arise from any number of circumstances that range from internal software crashes, attacks from external threats such as ransom ware 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 situations where an EHR choice or implementation results in a financial disaster for a practice. Regardless of the nature of the disaster it is important for practices to have a strategy for damage control and can turn around a complete EHR disaster.
Strategies to regarding how to turn around a complete EHR disaster can be illustrated by the following three case studies.
1. Involving key stakeholders after a failed EHR roll out
When the Robert Wood Johnson University Hospital, in New Brunswick, N.J., experienced a disastrous EHR implementation, the post mortem of the failed implementation revealed input had not been taken from front line nursing staff. After a significant retooling period, the organization underwent a massive leadership overhaul and could reset and try another implementation on a different EHR system.
This time the hospital included front line nursing staff in their planning and implementation, thus the hospital reported massive improvements in a number of quality of care metrics, when compared to the period prior to the failed EHR implementation. As such, the implementation and rollout process improved and overall organizational performance improved.
2. Responding to 10-day EHR outage
An outage was something inconceivable using paper records. The only situation that could result in all a practice’s clinical records being unavailable related to their destruction or being misplaced. Either scenario was rare and not viewed as something to be included in a contingency plan.
With electronic records, the likelihood clinical records could be inaccessible increased due to the fact these records are stored in electronic format, thus needing access to a database. A 2013 case at Boulder Community Hospital in Colorado involved an EHR outage whereby the entire hospital information system would be down for 10 days.
The organization, albeit, was running at a diminished capacity for this 10-day window, however it could avert problems beyond minimal inconvenience and reduced productivity by having an extensive for system outages and and data loss. One of the contingency plans in place, was described by Linda Minghella, vice president & chief information officer at Boulder Community Hospital as an “organizational commitment to have continuously updated paper records that can be used at a moment’s notice. We have also made a commitment to regularly train staff, particularly new team members, to ensure that they are familiar with our paper system.”
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.
Mr. Perry’s reasons for resignation cited what characterized as the organization is rushed EHR implementation that he alleged prioritized meeting implementation deadlines 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.
All three of these case studies illustrate the importance of proactive planning and contingency planning in the case of a disaster.
Proactive planning, such as in the case of the Robert Wood Johnson University Hospital could have accounted for the fact the hospital’s implementation plan should have included nursing staff in the planning process. Whereas in the case of the Boulder Community Hospital, a contingency plan could mitigate the potential damage caused by the outage. Lastly the NYC Health + Hospitals case illustrates the importance of realism, flexibility, and buy-in when constructing an implementation plan.
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