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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

These groups were split into CAH peer experts and all experts.

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

Ranking of comments generated by CAH peer experts vs. all experts shows a different order of importance, showing that either CAH peer experts or non-CAH experts have a knowledge gap.