ADAPTED FROM CASE STUDIES IN HEALTH INFORMATION MANAGEMENT 2ND Editiоn Finish аll yоur оther test questions before reаding this cаse. You have the potential to earn some extra points with novel and insightful responses. CASE 11-1 Failure of an Electronic Health Record (EHR) System Elizabeth Moorhouse Hospital implemented an EHR about six months ago. You just got hired as a health administration intern. As an entry-level health care professional, the expectation is that you have a basic knowledge of EHRs and health informatics. Since you are a UF graduate with some exposure to health informatics and emerging health technologies, the chief information officer (CIO) requested that your first assignment be to assist the new health information management (HIM) director. Your new title is Assistant HIM Director. Your first week on the job, you find out that the CEO of the hospital decided to pull the plug on the project a week ago because of all the problems that the hospital was experiencing. Many physicians refused to use the system. They made the nurses print out everything so they could review the patients’ medical records. The physicians would write orders on a piece of paper and ask the nurses to enter them into the order entry system. Understanding all the handwritten was difficult, resulting in a near-death allergic reaction. The few physicians who did try to use the system properly were still having problems. The system was down at least 2 hours a day, and many days for 4 to 5 hours. When the HIM Department printed out reports to satisfy the release of information requests, what they received was more like screen prints than forms. This system was the brainchild of Dr. Anderson. He is a retired transplant surgeon whose name is on the new transplant center building. He and a small group of his cronies were the ones who picked and controlled the implementation of the system. There was no input from anyone else other than the information technology (IT) staff. The screens are cluttered and difficult to use and do not have data quality built-in. The system does not meet all state licensing, and privacy requirements. The HIM director, physicians, nurses, and other staff learned about the system three weeks before implementation. The HIM director was so angry at being left out of the loop that she took early retirement and left with only two days' notice. Physicians' training on the new system consisted of a demonstration of the system at the quarterly medical staff meeting. Nursing and other staff were given only 1 hour of training. Two senior nurses Andee McFarr and Rylee Morning, were particularly negative during the implementation process. One of the most influential medical coders at the hospital, Ben Key, who has been instrumental in ICD-10 training for newly hired coders, was upset about the lack of communications about the new EHR system. In a recent meeting, you heard him say that if he knew that the new EHR would change the billing process before going live, he could have easily written programming code in Python that would have corrected backend issues that caused numerous billing bottlenecks. In the notes written by the last HIM director, she laid out a four-week software beta test process supported by numerous peer-reviewed articles about successful EHR rollout. The first two weeks, she identified specific staff, standard admissions staff, emergency department staff and first responders that handle the initial input of medical data that should beta test the software with the IT staff present for feedback. Week three, she recommended beta testing with medical coders, registered nurses, and nurse practitioners. Week four included working out the bugs that were found during the beta testing and meeting with the nurse unit managers that run the wards. In the second month, she planned to start introducing the physicians to the new and improved EHR as well as begin their training. She had also gotten hourly rates for programming changes to the software from the software company and time requirements by in house IT staff. The programming changes were more cost-effective for working with the software company than doing the work in-house. Since the implementation of the system, there has been turnover in the hospital administrator position and a new HIM director has been hired. What failures can you identify from the history of the EHR implementation? What should the hospital have done to prepare the staff for the EHR implementation? The hospital wants to salvage the system if possible. They have decided that you will be assisting the HIM director and that you will be the project manager to lead the re-implementation of the system in the next three months. What would be your initial steps to change the culture and stem the turnover? What are your ideas for improving the process and controlling implementation costs? You are leading the EHR Rollout Project. What milestones would you set over the next three months? Who will you assign to the milestones? How will you communicate the expectations and accomplishments during the project? As a leader, how will you establish trust and promote engagement while leading the EHR Rollout Project?
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