By Don A. Solberg, MD, Kathryn L Houck and Jim Roberts

Successful electronic health record (EHR) adoption not only improves quality of care by making patient information easily accessible, it also provides valuable clinical decision support. In addition, organizations benefit from streamlined operations — enabling physicians to spend less time on charting and documentation, and more time engaging in face-to-face interactions with patients.

Despite these obvious advantages, however, many physicians are resistant to adopting EHR systems.

A number of factors account for this resistance. First and foremost, organizations are leery of the cost and disruption that can sometimes accompany the conversion from manual to automated processes. Second, a portion of older physicians — who often serve as the leaders in an organization — are typically less comfortable with new technologies than their younger counterparts. And finally, some physicians believe that taking the time to electronically document patient visits will negatively impact patient interaction because it means spending time in front of a computer screen rather than with the patient.

Kittitas Valley Community Health Information Network is an electronic information-sharing partnership linking 30 providers — about 90 percent of all primary care providers in the county — from seven locations. When we implemented our EHR system in 2007, we utilized several strategies that proved instrumental in overcoming anticipated obstacles and ensuring successful adoption:

1) Locate a physician champion. When identifying champions, we looked for those physicians who had a track record of adopting new technologies, were able to maintain positive attitudes despite occasional setbacks and, most importantly, were well-respected by their peers. These champions could clearly articulate the goals and enthusiastically promote the benefits of a fully functioning EHR system to other physicians — helping to encourage even initially skeptical providers to get onboard.

2) Set honest, realistic expectations for physicians and their staffs. The more complex and sophisticated an EHR system, the more challenges a practice might experience in the early stages of implementation. However, we found the potential productivity gains and cost savings ultimately outweighed any inconveniences. By ensuring that everyone understands that there will be a learning curve and that they will experience some growing pains on the front end, you can alleviate frustration and set a positive tone post-implementation.

3) Ask each location to designate a physician, nurse and administrative user to participate in several days of training with the EHR vendor. These “super users” were then available to help others navigate the EHR system, reducing the need for support while building staff camaraderie.

4) Prepare for the transition. In our case, each location went to an abbreviated schedule for two weeks — scaling back patient volume so that physicians and administrative staff would have adequate time to train on the new system. In hindsight, we would recommend that organizations allow a full month for staff to get comfortable and then gradually add back patient visits each week. For example, a practice might take four patient slots out of both the morning and afternoon schedules during the first week, three slots during the second week, two during the third week, and so on. Providing staff members with the opportunity to use the system while performing their daily routines enables them to learn at a comfortable pace.

5) Use a staged rollout. We did not do this during our initial implementation, but have used it several times with processes and changes adopted since. Within each location, two to three physicians, who were committed to the EHR system and willing to work through any stumbling blocks, were selected for initial implementation. Working with fewer physicians at the onset enabled the implementation staff to provide a strong support system, and helped ensure that any issues or concerns were resolved early in the deployment process. Once the first few physicians went live in each location, other providers were added two at a time. That way, each successive group of physicians could seek guidance from colleagues who were already using the system and could witness firsthand the successful utilization of an EHR system.

As an increasing number of health care organizations take advantage of the dollars offered by the American Recovery and Reinvestment Act to deploy EHR systems, it will become even more important to ensure timely and successful adoption of these systems. By setting realistic expectations among key stakeholders, identifying hurdles early and putting plans in place to proactively deal with any challenges that may occur, the likelihood of a smooth transition is significantly increased.

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