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Underestimating the scale of change

Introducing a new EMR is as much a change management project as it is a software project. A new EMR can affect the work processes of nearly everyone who works in the health system. Each design decision about how to configure and use the EMR can have both upstream and downstream impacts on other systems, processes and workflows. Not recognizing the substantial end-to-end process impact of the implementation risks can create further stress on staff, who are often already struggling with existing workloads. It is important to help staff embrace, rather than reject, the change. These projects provide an opportunity to engage clinicians and staff to redesign core business functions to improve their workflow. But mismanaging the scale of change could result in major disruption and organizational risk.

Thinking in silos

Approaching an EMR implementation as a department-by-department software configuration project will likely result in significant complications to processes upstream and downstream. These risks are real, as they can impact the speed and quality of care to patients.

An EMR implementation is an opportunity to radically improve value streams that bind the organization. Organizations should maintain a customer-focused lens when thinking about the end-to-end patient journey and how information needs to flow among clinicians and staff, and across, as well as within, departments, applications and external partner organizations.

Insufficient training

Many healthcare organizations do not pay adequate attention to planning for, delivering and reinforcing training of the EMR in the context of “day-in-the-life� workflows, which can result in diminished adoption results. Ideally, didactic training sessions should be reinforced with one-to-one follow up and strong “at-the-elbow� support at go-live. However, since the pandemic, we have seen an over-reliance on virtual training methods with minimal at-the-elbow support, and sometimes not even making the training mandatory. In our view, training should be treated as a priority and be mandatory � no training, no login. Other important training-related considerations include replacement coverage when clinicians are in training, having a sufficient number of trainers, accommodating all work shifts, and having a mix of training channels and facilities to accommodate the different needs of clinicians and staff.

Misjudging the technology and data uplift

Healthcare organizations should not underestimate the application modernization, data management, reporting and data governance implications of these changes. A new EMR may need to interface with hundreds of other legacy systems both internally and externally to the organization. If it isn’t set up to share data with other systems both within the healthcare system and with trusted partners, the value of the EMR-enabled transformation can be reduced. Another shortcut that many organizations take is to “lift and shift� existing reports into the new system. Just as clinical workflows need redesign, so too do the (typically) thousands of legacy reports and the data architecture underpinning them. When an EMR becomes the new single source of truth for an enterprise, it provides an opportunity to rationalize reports and redefine the operational metrics by which leaders and departments are held accountable. Data governance policies and processes, particularly focused on data quality and integrity, should also be examined as they can create a foundation to accelerate advanced analytics later.