Implementing a new electronic health records (EHR) system to replace manual records is an extremely complicated task. EHRs use complex algorithms to exchange patient data among different physicians and departments such as a pharmacy and laboratory. EHRs are becoming popular because employees and patients can access records anytime and anywhere. Patient drug alerts are also part of the system to warn emergency room and intensive care nurses about potential drug reactions. A needs assessment is a systematic procedure to determine what components are required for EHR implementation to prevent failure of the highly costly investment. Although EHR systems have been shown to dramatically reduce human error, proper assessment before undergoing the implementation process is critical or errors and costs could actually increase.
An EHR assessment must be completed before the software packages can be selected to ensure it is conformed perfectly to the specialized needs of the hospital. According to the California Medical Association the assessment has two steps: 1.) Readiness Assessment; and 2.) Work Flow Analysis (Ginsberg et al., n.d.). The assessment should be done by a seasoned group of engineers, physicians, lab workers, billing staff, pharmacists, and nurses to collaborate so that each department increases patient safety and efficient care. The assessment should include a web-based demonstration that allows all stakeholders to identify gaps that would hinder their job responsibilities.
Once the needs assessment has been done and vendors chosen as potential suppliers, the readiness assessment should begin. One of the most important data to collect is financial resources. Are more physicians going to be hired that will increase training costs? Can the organization truly afford the upstart investment and ongoing computer support? Space considerations are also critical to evaluate because most closets are too small for the new EHR platforms that have huge servers. High-speed internet capabilities are a must for EHR data exchange between stakeholders. Moreover, are existing medical records planned to be thinned to put the data into the new system? If so, data needs to be destroyed according to HIPP protocol to protect patient confidentiality.
The work flow analysis portion of the needs assessment looks at step-by-step procedures. Examples are scheduling, diagnostic tests, and reviewing tests, prescribing medication, clinical notes, and billing data (Ginsberg et al., n.d.). Other data to be analyzed for the EHR system should be medical history forms, lists of current medications vital signs, insurance, and referrals. The flow of steps in this planning process involves network upgrades, expanding server room space, a Medicare fraud plan, selection of three EHR vendors, visiting other hospitals using the systems, negotiating, and finally select the model that is best suited to all stakeholders.
A 10-year study done by the Canada Health Info way about who should be consulted during adoption of an EHR system looked at 29 key stakeholders involved in establishing policy (Rozenblum et al., 2001). They found that stakeholders should be consulted from a bottom-up, clinical needs approach first because they will be the heaviest users of the system. This means physicians, nurses, certified nursing assistants, billers, lab workers, and pharmacy employees need to have significant input into selecting what aspects are most important. The number one reason for implementation failure is inadequate involvement of line-worker clinicians (Rozenblum et al., 2001).
Therefore, the informatics team must work very closely with these stakeholders. Other critical stakeholders to consult are the finance department to ensure how much funding is available. Patients are also important stakeholders because no one wants their health information linked to a huge system that is insecure and prone to hacking confidential medical records. Policy makers at the executive organizational and governmental level also have powerful sway over which EHR is chosen. Lack of collaboration among these diverse groups can delay implementation of the system for decades.
Appropriate needs assessment provides relevant feedback to upper management. This helps these higher-ups make wise decisions based on financial resources, training needs for staff, vendor choice, and whether or not EHR is even necessary (Hartzler et al, 2013). Upper management is also provided with the ability to analyze which employees should have access to the system (or what parts of the system) to complete their designated tasks. Gaps between “wants” and “needs” can also be identified so that valuable resources are analyzed in cost-benefit analysis. Training needs or additional hiring of employees can also be anticipated to prevent glitches in the system due to human error. EHR systems can increase profit margins and protect patients from human error if assessed closely prior to purchase and implementation.
Ginsberg, D. (n.d.). Successful preparation and implementation of an electronic health records system. Best Practices: A guide for improving the efficiency and quality of your practice. Retrieved December 26, 2014 at https://www.cmanet.org/files/pdf/ehr/best-practices-7.pdf. Hartzler, A. et al. (2013). Stakeholder engagement: A key component of integrating genomic information into electronic health records. Genetics in Medicine, 15, 792-801. Rozenblum, R. (2001). A qualitative study of Canada’s experience with the implementation of electronic health information technology. CMAJ, 183(5), E281-E288.
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