Evaluation to Update Electronic Health Record System

Executive Summary

Watson Community Hospital is a not-for-profit hospital that is a part of a larger corporation, Watson Community Association. In order to better suit the community in which they serve, Watson Community Hospital (WCH) employees a group of primary care physicians and midlevel providers throughout eight clinics. Currently, the clinics are utilizing a different electronic health record (EHR) system than WCH is using. Although the EHR used in the clinics was chosen with compatibility and interoperability in mind, the system has not been routinely maintained or updated. Watson Community Association now finds themselves evaluating whether they should update the current EHR system they have in place at the clinics or if they should implement a new EHR system organization wide. WCA will base the EHR transition decision on the ability of the system to ensure patient safety, the capability to integrate information from ancillary services, and patient information being readily available for all providers to access.

In order to make an informed decision on whether to update the existing system or change systems altogether for the clinic organizations, WCH has formed a project steering committee to help define the project goal and objectives. The organization did a good job of picking vital people to be members of the project steering committee to help aid in the decision of whether the system should be updated or changed. The committee is composed of key end-users from all areas and departments of the organization and the important decision was made to have the committee be cochaired by the Chief Information Officer (CIO) which will help ensure the success of the committee. The WCH project steering committee has a well laid out plan for their system acquisition process including determining the project scope and objectives that are based on organizational needs not just the needs of the individuals included in the acquisition, system goals from the end-users, open communication with key stakeholders, plan of work, and a timeline.

Watson’s Ambulatory EHR transition is faced with the problem of deciding between the updating of the current system or moving to a different EHR platform. The steering committee must decide whether to upgrade the best of breed system currently in place, which could possibly be achieved by using a type of visual integration software, or totally revamping their system and adopting a monolithic single vendor software application. The issue with staying with the current system is that the organization may face further challenges of data integration, information security, and continuing to keep the system up to date to meet organizational requirements. Therefore, the organization should choose, based on the recommendation and findings of the steering committee, to adopt a new monolithic architecture and EHR platform. Although choosing a new EHR platform would result in the clinic organizations performing an evaluation and selection process which would result in a substantial conversion for the organization, this option, in the long run will prove to be the right decision for the organization as a whole. Choosing a single vendor for an EHR includes higher reliability, improved data flow and workflow, a single point of contact for issue resolution, decreased security risk by having a single access point, and a central data repository with more standardized data.

Problem Statement

 Watson Community Hospital and its associated clinics are currently using different electronic health record systems. Although the EHR system in the clinics has been operational for four years, the WCH board of directors decided to form a committee to develop a plan to evaluate the effectiveness of the current architecture and determine if it allows the clinicians to adequately provide patients with quality care. The EHR currently used in the clinics was chosen without the needs of the end-users in mind, therefore resulting in poor support and adoption by the clinics. The organization must now decide between taking the easy route of simply upgrading the current system, which is what the IT department would prefer, or deciding to choose a new EHR platform that would require more time and effort due to having to perform the system acquisition process and then conversion.

 Although the current system in the clinics was chosen to be interoperable with the EHR at WCH, it was done so without the end-user’s involvement. Therefore, it is imperative for the steering committee to involve the end-users in the selection process to ensure the success of the EHR implementation. The easiest choice and path of least resistance for the committee would be to elect to upgrade the current EHR system. However, the committee should examine the current and future needs of the organization and align its new IT strategy against those goals. Continuing to operate on different systems will give rise to ongoing problems for Watson Community Hospital and its associated clinics. Operating on two different systems, even updated ones, will continue to result in maintenance and updating issues, difficulty in identifying the source of issues and problem resolution, risk of providers missing important patient data, safety risks (patient and security), and decreased compliance. Therefore, in order to enhance user satisfaction, improve patient safety, and increase productivity and efficiency, the steering committee should recommend the adoption of a single vendor EHR application.

Analysis and Alternatives

The case study lays out a well-developed plan for system acquisition, whether that be upgrading the current system or adopting a new system. The Watson plan includes numerous strengths. First, a project steering committee was formed that included key people and has the proper leadership to ensure the right decision was made. Having a well-formed project steering committee is an important step to ensure that the committee will be able to meet the project objectives and system goals. Another strength of the committee and their plan was they routinely included the stakeholders in the decision-making process of the plan and provided updates on the committee’s progress. Including people in the planning and decision-making process that are not part of the committee will help ensure the success of the committee. Since this step was omitted with the previous system implementation process, it is important to include key stakeholders throughout the whole acquisition and implementation process.

One approach the Watson steering committee could improve their plan is for the committee to address the resources and budget needed to carry out the task at hand. For example, the committee should determine if the members that are chosen to make site visits or attend trade shows will have to do so in their off time and how their expenses will be paid. Having employees take time away from work for the necessary site visits and vendor shows may result in loss of revenue for the organization. The committee should also determine how it will select the committee members that are responsible for completing each task.

When deciding whether or not to stay with a single vendor for both the hospital and primary care setting the leadership team should consider the needs of the organization. The organization should conduct a workflow and process analysis to determine if updating the current system will be able to meet their current and future needs. Evaluating the current system will enable the leadership team to address the areas and processes that need to change to improve workflow and efficiency, decrease redundancy, increase user and customer satisfaction, and enhance quality (Wager, Lee, & Glaser, 2013, p. 249). Watson’s leadership team had already addressed the need for the EHR to improve efficiency and patient safety, which can be hindered by using more than one EHR. One of the greatest risks of utilizing multiple EHRs is the risk of missing important data and not being able to utilize decision support capabilities that may impact patient safety (Payne, Fellner, Dugowson, Liebovitz, Fletcher, 2012).

Watson Community Hospital has two options, perform a major overhaul of the clinic’s current operating system or implement a new EHR single vendor system. Both options have their own positives and negatives. Updating the current system is the option that would receive the least pushback from the IT department and is the route IT would prefer to go, but the operating system in place in the clinics was chosen without the needs of its physicians and other practitioners in mind. Revising the EHR in the clinics would also be the fastest and cheapest option. However, continuing to operate on multiple EHRs would eventually result in the organization facing the same challenges it is currently facing. On the other hand, choosing to utilize a single EHR vendor would result in seamless dataflow, improved workflow, and a single point of contact for support problems, but it is also the more expensive and time consuming of the two options.

Despite being the more arduous and costly task, choosing the transition to a single vendor EHR is the better choice for Watson Community. As previously mentioned, providers that utilize multiple EHR systems throughout an organization run the risk of missing important data. A study by Smith, Araya-Guerra, Bublitz, et al. (2005), stated that clinicians reported missing vital clinical information in 13.6% or 1 in 7 patient visits. This lack of crucial data being available to practitioners leads to inefficiency and may adversely affect patients. Being that Watson’s board of directors wants to improve patient safety and efficiency, continuing to operate on two different EHR systems will greatly hinder that goal. Missing important data and using multiple EHRs can also inhibit the monitoring of patient and quality outcomes which may lead to the inability of providers or organizations to detect problems. Bates and Gawande (2003) found that when organizations utilize different applications key clinical data is typically missed due to the lack of data standards between EHR systems. Utilizing a single EHR application will assist with the monitoring of clinical data and will help ensure Watson Community is providing reliable, efficient, and individualized care.

Choosing to go with a single vendor EHR will allow the Watson providers to have better access to clinical decision support. Operating under multiple EHRs can lead to missed data which will inhibit proper clinical decision support (CDS) capabilities. CDS is an important tool because it can assist with the diagnosis of patients, reduction of medical errors, and help with providing safer care. Menachemi and Collum (2011) cited that practitioners who have access to CDS tools have an increased adherence to following evidence-based clinical guidelines which leads to more effective and safer patient care. Decision support tools also contribute to increased efficiency, which is the avoidance of wasting resources. Resources can be classified as supplies, equipment, ideas, energy, or duplicate testing (Menachemi & Collum, 2011).

Although the adoption of a single vendor EHR system has numerous advantages, there are also some constraints to this technology that may inhibit an organization from adopting a single vendor IT architecture. Meanchemi and Collum listed some of the disadvantages of a single vendor application as financial issues, changes needed in workflow, temporary loss of productivity associated with EHR adoption, and privacy and security concerns (2011). The financial concerns associated with the adoption of a single vendor EHR may include the costs for adoption, implementation, maintenance, and loss of revenue for training and work interruptions during the EHR change (Koppel & Lehmann, 2014). Single vendor EHRs are typically more expensive than multiple vendor EHRs. This cost may prevent an organization from being able to adopt a single vendor architecture. Therefore, an organization needs to be aware of their IT budget and it may be necessary for a cost-benefit analysis to be performed. Another disadvantage of a single vendor system is that a vendor’s decision to update its system and features are based on the market and not on patient or clinician needs. The unwillingness of the EHR vendor to build new functions for a single organization may lead to the providers to devise workarounds or perform activities outside of the EHR (Koppel & Lehmann, 2014). Additional difficulties in the utilization of a single vendor EHR results when the system needs to be updated. Upgrades needed to one part of the EHR system may require the entire system to be interrupted or down for the process to be performed.

Implementation

The Watson clinic providers are currently using a system that was chosen without their needs in mind. An important aspect of an EHR is that it should assist in improving workflow and providing comprehensive care across the organizational setting, and that is not the case right now for the Watson clinics. In order to enhance efficiency, optimize the flow of information, and improve patient care, the project steering committee should elect to adopt a single vendor EHR. The implementation and adoption of a new EMR system is time-consuming and expensive. Therefore, a proper plan is vital to ensure success. As stated by Mcgowan, Cusack, and Poon (2008), if an institution chooses an EHR based on the needs and goals of the organization and it includes its end-users in the selection process, there should be no reason for the failure of the EHR implementation. The Watson steering committee has a well laid out plan to ensure an effective EHR implementation that includes project scope and objectives, communication, plan of work, and a timeline. The plan of work includes key steps for successful project completion including identifying possible vendors, establishing system requirements, and completing a request for proposal (Wager, Lee, & Glaser, 2013, p. 632). Drees (2019) suggests that organizations who are looking to change EHR vendors should also consider whether the organization’s goals align with the technology and services provided by the vendor. 

An additional approach to ensure EHR success is for the organization to conduct a workflow and process analysis; this evaluation can help the organization identify any barriers to implementation. The organization should also identify any additional issues that may affect the successful implementation of the EHR. For example, a potential issue could be the readiness of the staff to adopt new technologies (Mcgowan, Cusack, & Poon, 2008). A study conducted by Nancy M. Lorenzi and Robert T. Riley found that the biggest problem when implementing a new EHR comes from employee resistance toward the new system (as cited in Høstgaard & Nøhr, 2004). Therefore, before implementing the new system, the organization should examine the possible factors that may lead to resistance. To assist the organization in assessing the aspects of resistance, Lorenzi and Riley developed a method for examining change readiness (CRR) that can aide an organization in having a successful implementation of its new IT system. The CRR is a questionnaire that is divided into four main categories that cover different aspects of resistance that may lead to employee resistance towards the adoption of new technology (as cited in Høstgaard & Nøhr, 2004). Utilizing the CRR will help engage the end-users early in the planning stage which will help ensure a successful conversion to a single vendor EHR for Watson Community. It is also important for the committee to develop a good communication plan to emphasize to all members of the organization that the EHR change is not just an IT initiative, it’s an enterprise initiative that requires everyone to work together and it will benefit everyone in the end (Martin, 2017). This can be achieved by soliciting feedback from the end-users and acting upon the suggestions received. The last step in ensuring a successful conversion to a single vendor EHR is for the Watson steering committee to have a way to establish that the chosen vendor meets the organization’s goals and system objectives. Therefore, the hospital should identify measurable outcomes in order for the organization to determine its success in meeting those goals (Drees, 2019).

Conclusion

 To assist in the adoption and selection of a new EHR system, Watson Community Hospital

To make the adoption of EHR systems successful in hospitals, it is important to look at the benefits, risks, and barriers based on the size of the hospital. Evaluate the risks, benefits, and barriers to implementation

In order to assist Watson Community Hospital to achieve their goal of enhanced provider efficiency and productivity, ensure patient safety, and deliver higher quality care

References

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• Drees, J. (2019, June 25). More than a vendor: What hospitals should consider when forming new EHR partnerships. Becker’s Hospital Review. Retrieved from https://www.beckershospitalreview.com/ehrs/more-than-a-vendor-what-hospitals-should-consider-when-forming-new-ehr-partnerships.html
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