Guest Columns

Electronic Health Records: It's not you, it's me?

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Adam Arker, Hartman Executive Advisors
Adam Arker, Hartman Executive Advisors

In recent years, the number of long-term and post-acute care providers who use electronic health records has grown rapidly in response to increased regulations, additional data requirements, and downstream pressure from acute care partners and accountable care organizations.

When implemented effectively , an EHR can not only help achieve compliance and deliver on partner expectations, but can produce lasting process improvements for an organization by increasing access to critical information, reducing medication-related errors, and reporting better clinical documentation. However, when organizations don't see their expected results after implementing a system, they can be quick to assume the problem is solely with the vendor they selected, and either start looking for another vendor or move on to other initiatives. The cost of switching, as well as the timeline for doing so, is likely substantial, and has an exponential impact on the ability to compete in today's marketplace.

The issues raised with difficult EHR implementations vary depending on the organization's experience, but almost always fall into the following three buckets:

  • Technical difficulties: Common complaints are that EHRs run very slowly, freeze and crash. End users question the overall reliability of the technology, and generally feel that paper systems are easier to use.
  • Lack of ownership: It's never as simple as just purchasing the “right” software. A major issue occurs when appropriate owners and subject matter experts are unavailable to support the system, govern its needs, configure it appropriately, manage the implementation and continually assess the evolving needs of the organization. In addition, if no one owned the processes pre-implementation, it may be difficult to translate them into processes for use by the EHR. 
  • Change management: When staff are not adequately communicated to, have a hard time using the platform as anticipated, or don't see the benefits of implementing the system, they often refuse to use the new system, sticking to what worked best for them in the past, and not understanding their role in the bigger picture.

Before going back to market

While the tendency is to assume the limitations are software-related, organizations should take steps to assess their current structure in detail, looking for issues, gaps and vulnerabilities, before jumping to that conclusion. Leaders should ask themselves, “Will any of these issues still exist with a new vendor?” This exercise involves making a detailed list of business and functional requirements, and deciding what the EHR must be able to accomplish to meet these requirements.  

Often, thinking through the requirements will reveal that the software is not the problem, but rather, that something went wrong during the implementation process. In this scenario, LTPAC leaders need to act quickly and build a team of both internal stakeholders and external, unbiased advisors to assess the situation and develop a plan with the following attributes:

  1. Accommodation for business process changes
  2. Communication and change management plans

  3. Specific metrics in which to measure the success of the project

  4. Remediation of technical infrastructure

  5. Ownership structures throughout the project and post-implementation

In many instances, the EHR system in place is already the one to best meet the needs of staff, residents and partners. However, it may sometimes be determined that the current system is not the best fit for a particular organization. When this happens, it's important to understand any gaps against the current vendor and possible adjustments that could be made before returning to market and spending a lot of money, time and human resources to switch systems. Especially because, due to market consolidation, the number of viable alternatives is limited.

It's common for LTPAC leaders to become disenchanted with their existing EHR and assume that the system itself is the problem, instead of clarifying how it operates against their existing internal structure. Without a deep review of the organization as a whole, it's all too easy for providers to end up in the exact same spot over an over again, at significant cost, regardless of which EHR is used to meet regulatory and partner requirements.  


Adam Arker is an executive IT advisor in  the healthcare practice at Hartman Executive Advisors, an independent, strategic technology advisory firm based in Baltimore, Md. He can be reached at aarker@hartmanadvisors.com.



Guest Columns

Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.

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