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EHR issues in Critical Access Hospitals

Implementation of an EHR is an overwhelming task no matter where it is done. However, achieving this task in a critical access hospital (defined as a hospital that provides 24-hour emergency services with less than 25 acute care and swing beds and is more than 35 miles from another hospital) with limited resources is more challenging. A recent study addressing this issue is EHR Implementation Advice to Critical Access Hospitals from Peer Experts and Other Key Informants http://aci.schattauer.de/en/contents/archive/issue/1824/manuscript/20820.html].

Methods

Participants: 16 peer experts 3 vendor representatives 7 implementation experts 6 EHR consultants 3 CAH Regional Extension Center representatives 4 researchers in clinical informatics and HIT policy 2 national EHR policy stakeholders

Questions: 1 "What are the things you'd want to know most about planning and preparation processes for EHR implementation at CAHs? Name two." 2 "What advice would you give CAHs on the planning and preparation processes for EHR implementation?"

Results

19 themes, ranked in order of number of times mentioned, from expert comments: EHR Team Communication Clinician/Physician Buy-in/Ownership Budget/Financial Resources EHR System Selection Preparatory Work Technology Optimization/Ongoing Work Outside Partners/Information Resources EHR Training/Go-live Support Workflow/Productivity Project Management Purpose/Goals Leadership Change/Encouragement Policy/Meaningful Use Governance System Install/Go-live Clinical Decision Support/Knowledge Management

Reoccuring Suggestions that Crossed Multiple Themes

Although some suggestions were specific to a theme, it is interesting that some suggestions were given with multiple themes. These included the suggestion that a group from the CAH travel to see each EHR in use at another CAH before purchase. This delegation should include key stakeholders at the institution as well as end-point users. The delegates should meet with their peers at the CAH already running the system and elicit comments about build, go-live, vendor support, difficulties, resolution of those difficulties, and ongoing use.

It was also mentioned across several themes to involve all departments including those who will use the system on a day to day basis, not just management. These employees can often give better feedback on how the system will work in the daily operations than department managers can.

Discussion