You’ve spent months and months preparing for this day. Hundreds of thousands of dollars have been invested in software, technology, and internal capital upgrades to make it possible. Staff have invested dozens of hours training, practicing, and readying themselves. It’s go-live day for your EHR.
A few hiccups aside, things go well. Line staff are happy and excited about the new technology. Administration is thrilled about new ways to easily view census, incidents and other crucial operational information. Implementation looks like it has gone better than expected. So what now?
At this juncture, organizations typically go in one of two directions. Successful organizations see go-live as the mid-point in an adoption strategy. It’s a time to celebrate a significant milestone, for sure, but also a time to begin the evaluation of the system implementation, measurement of workflow improvements, refresher trainings for staff, and planning for future improvements and changes. Even more crucially, it’s a time to listen carefully to staff, to ask probing questions like, “Is there anything that isn’t working like we thought it would?”, “What tasks are easier with the EHR? What tasks are more difficult?”, and “What are some questions you’ve had and have you been able to find the answers you need?”
The other direction, unfortunately, is more common. In the chaotic environment that most healthcare organizations exist in, go-live day represents a giant relief, the end to an over-time, over-budget project that was thrust on top of many other crucial priorities. Things seem to be running smoothly, and you hear few complaints, so you close the project and move on. 90 days after go live, your vendor implementation manager calls, asks if everything is going well, and then quickly closes the implementation and passes your organization on to the support team. Done and done. You return to the everyday challenges of caring for residents.
Oftentimes, when called in to optimize an existing installation, we see the aftermath of organizations that chose the second direction. We find EHR systems that are underutilized, redundant storage of knowledge (Excel spreadsheets, homegrown Access databases, paper files), and staff that have begrudgingly accepted impaired workflows. It’s a long process to re-implement systems, rebuild staff trust in technology, and finally capture the crucial business intelligence essential to an organization’s success in today’s market.
A Better Way Forward
Here’s what successful organizations do after go-live:
- Begin the next phase of the EHR project. Ideally, the post-go-live phase was already built into your project plan, and you’ve already established clear goals for the system, plans to measure against those goals, and a proactive strategy to understand how the EHR is integrating into workflows and how to adjust as necessary.
- Commit to one place for data. Many organizations are loathe to give up their trusted Excel-based census tracking worksheets and paper-based incident tracking systems. Resist the urge to keep data in different places. To fully capitalize on the business intelligence and analytic features of EHRs, you need to have all the data in one place to properly guide future decision-making. Data analytics is quickly reshaping all of healthcare. For LTPAC providers, this means you must have accurate data on rehab outcomes, rehospitalization statistics, and efficiency of operations. If your EHR solution is a barrier, press your vendor for added functionality. Chances are good they either have a solution from another provider, or, more likely, other providers are struggling with and clamoring for the same solution.
- Ask staff probing questions. It’s not enough to ask, “Is everything okay?” At one organization where I served as administrator, I discovered months after implementation that some of our med aides were not following the proper procedures to chart their med pass. In researching why the staff had not mentioned the deviation before, I discovered that they had never been able to follow the process as described, but quickly found a workaround that seemed to work. When I would ask if everything was okay in the months after go-live, naturally and honestly they answered, “Sure!” Ask staff directly if things are working as expected. Ask regularly if staff are finding different ways to accomplish tasks. Encourage your superusers to report common questions and issues so you can examine whether there are organization-wide trends.It’s also crucial to note, you must approach problems with usage of the EHR with a “just” mindset. This means if staff are not following established protocols, it’s crucial to understand why in a way that doesn’t place blame on individuals when the problems are system-induced. (And in our experience, virtually all problems with EHR usage are system-induced.)
- Stay curious. EHRs vendors are quick to promise their system will do everything under the sun. It won’t, trust us. EHRs currently on the market are clunky adaptations of LTPAC operations. For some processes, you will ask how to do something and receive an answer of either the EHR can’t do that, or it can, but requires a complex set of steps. Push your vendor to simplify steps and improve workflows. What EHR vendors lack in user experience design and functionality, they more than make up in attention to customer needs. So be vocal about what you need and what you’d like to see. Remember Robert Kennedy: “Some [people] see things as they are and ask why—I dream things that never were, and ask why not?” Ask why not. Often.
- If something doesn’t work, don’t give up on it. This part is a little shocking to us, but we find many organizations that, after struggling to adopt a certain feature or workflow, simply decide an EHR can’t support this part of their business and drop it. One time, we worked with a client that had paid for the billing/ finance module of an EHR, but had completely abandoned it in favor of staying with Quickbooks because they weren’t able to get the system to bill correctly for their independent residents. Resist the temptation. If a billing module doesn’t support your CCRC model, talk openly with your vendor about what you are trying to accomplish. Take a look at your internal process, as well, and be open to reconceptualization of your processes. While current EHRs are clunky, they are hardly impotent. Don’t give up on such a big investment.
- Be open to—brace yourself—replacing your shiny new EHR. Most vendors work hard to ensure client satisfaction, but if you find yourself with a vendor who refuses to work with your struggles and challenges, go back to your shortlist and reexamine other vendors. The cost to replace a system is truly less than continuing to use a beast that doesn’t actually improve your operations and ability to care for your residents.
What Next?
Are you considering an EHR? Struggling with a recent implantation? Learned some other lessons? Get in touch! We’d love to hear about your experiences and talk about how we might help you succeed.