EHRs, technology upgrade or culture change? (Part 1)

The question of moving from paper charts to EHRs is by now a rather old one. Whether or not you've done it, you've at least considered it. A colleague recently shared with me a worthwhile read about selecting and implementing EHRs in small ambulatory practice settings. That setting fits for most optometry and many ophthalmology practices. See the full report here. 


One of the primary takeaways is that implementing EHRs is a culture change in the practice and requires a definitive change management strategy. As we sometimes say in our work, "You're not plugging in a new TV." 

EHR implementation means both benefits and barriers but you only get to the benefits once you've overcome the barriers. Yes, there are many technical aspects to the transition but if it were just technology, it would be simply plug 'n play like a new TV. TVs don't require change management planning and execution; EHRs do. Particularly in today's transforming healthcare environment, implementing change is complex and entails a steep learning curve at the people level.

So what do we mean by change management? Notice how these steps are essentially non-technical:

1. Start with a vision for the benefits to be gained.
2. Understand the impact on current workflows. What will this culture change really look like in your practice?
3. Anticipate the barriers. Prepare the team to absorb shocks.
4. Choose a champion, someone with pull not push, a leader whom staff and doctors will follow. (This doesn't have to be a doctor, or the doctor.)
5. Create buy-in during the selection process. Involve all stakeholders. A "complete EHR" will get into everyone's business.
6. Choose for the long haul not today's feature list.
7. Work with your vendor to create a clear project plan. Good vendors should be able to help you a lot here. We do this stuff every day whereas you do it once in a blue moon.
8. Prepare thoroughly and implement rapidly.

You've seen such lists before - and the linked article above goes into much greater detail. I'd like to comment on point #6, "Choose for the long haul not today's feature list". Herein lies one of my personal passions. We'll need to make this discussion, Part 2. 

Alistair Jackson, M.Ed.