A popular question in our HIT community is “why do EHR implementations fail?”  Obviously the easiest response is to state that there are a multitude of complex reasons – blah blah blah.  I personally do not see it that way.  Besides mismanaging finances, I do not subscribe to the outcome of implementation failure.  Rather I believe implementations are exercises in achieving success through painful (and often expensive) experimentation, and require continual redress, much like the freeways that most of us drive every day.  Sure there are culture issues, vendor issues, IT issues, turnover issues, government issues, training issues, and a multiplex of issues and hindrances that prevent implementation success.  However, these issues stem from somewhere, and I do not believe vendor design, administrative motives, or physician/clinical resistance at any level really hits the actual problem.

In my opinion, the perception of implementation failures eludes to the simple fact that PURPOSEFUL goals are not appropriately defined and agreed upon. Until one or more are, further efforts will continue to appear as failures. Selecting HIT vendors, implementation methodology, resource allocation, etc. are secondary to carefully designing a responsible, achievable and specific project charter. This charter must contain clear goals, each with a very specific purpose that can enable managers and leaders to make not just good, but the best choices when designing the overall scope of the project. Coincidentally, this enables better promoting these decisions with clear and consistent messaging to their audiences, stimulating positive changes in culture that are so critical to perceived and realized implementation success.

First, a quick overview of how I define the following terms:

• Project Charter – A document that is a compilation of history (current state), goals, and expectations that is endorsed by key stakeholders and leadership.  It is to outline scope, necessary benchmarks, selections for outside necessities (vendors, hardware, and resources), implementation methodology, internal marketing, training management, and finally the hand-over process to on-going supporting services.
• Implementation – Execution of the project charter in order to meet or exceed the projects goals.

Here is an example of a poorly defined goal:

• Implement an EMR to have electronic data that we can use to generate reports and to determine if we are profitable.

So what’s wrong here? In my opinion:

1. The goal is too general
2. It has two very fuzzy proposes – generate reports, and check profitability
3. This goal does NOT include even a hint of explanation as to why it’s necessary

The single most important fact is that this goal lacks an absolute purpose. It's too broad to achieve anything truly MEANINGFUL.  Even if I outlined my expected outcomes after this goal

Here is how I would re-word our goals from above to be more acceptable:

• Implement an EMR that will capture 100% of discrete data elements for the PRQI measures that need to be submitted per CMS requirements.
• Develop a profitability study that can be used either weekly or monthly from the integrated database utilizing data from the new EMR and the existing electronic patient-accounting system to make appropriate management decisions.

These goals have (more) clear objectives. The fallout from goals such as these is that everyone who collaborates on them knows exactly what the expected outcome has to be – All measure for PRQI come from the EMR, and second, a report for profitability from the new and old data.  Furthermore, the separation makes more clear what each may really entail in terms of resources.  So go ahead, review the charter that drives your implementation.  When you’re satisfied with updated goals, you may discover you will also need to update (or finish) your expected outcomes, timeline and benchmarks for the rest of your project charter.

To learn more about how Santa Rosa Consulting can assist you with a successful EHR Implementation, contact us at contactus@santarosaconsulting.com.

Kevin Desai
Santa Rosa Consulting