Strategies For Evaluating The Implementation Of The Electronic Health Record

Strategies for Evaluating the Implementation of the Electronic Health Record

Nowhere Medical Center implemented the electronic medical record, and the staffs as well as the doctors are actively engaged in using it. There as been many suggestions from the staff, doctors, and business units, which were looked into and many changes were made. According to Spector (2010) Effective change efforts are firmly rooted in that focused drive to achieve outstanding performance. Our physician champion, his staff, and management want to evaluate the effectiveness of the implementation. In phase one of implementation, we looked at the external and internal forces for implementation of the EMR and became aware of the importance of the needed change. In step two the perceived triggers the initiation of the change and step three the change was implemented.

Effectiveness of the Organizational Change

Nowhere Medical Center physician and staff, managers along with the information technology department did a statistical analysis to measure the effectiveness of the implementation of the EMR by developing a pre and post electronic medical record implementation evaluation; our process of measurement was six month before the implementation, three months, nine months, and 18 months after implementation (Keshavjee MSc, MD, CCFP, 2010). According to McGowan, Caitlin, and POON, MD, MPH (2008) evaluation pre- EMR implementation is important because it can help to engage the user in the process of implementation because the managers are receiving feedback and even acting on some suggestions.

The entire organizational employee population who would be responsible for using the EMR went through training. Some employees had to have basic computer training whereas; others only needed training on the use of the EMR. Training sessions were held weekly, and because each employee learns differently we had super users from each department who could assist the employees in his or her perspective departments. We have made some changes because of some suggestions from the staff. There was ample opportunity for the staff to practice using dummy patients during his or her workday; we also had after-work tutorial classes. We believe that successful implementation of the EMR is a team effort. Having super users available can back up any organizational change, also having a staff-training program such as on and off the job training. Managers are just as much involved in the change as his or her staff so they need to "develop new skills in analyzing industry dynamics, evaluating technological trends, and understanding the customer's needs" (Phillips, 1990, p. 5)

Outcome Measurement Strategies

As mentioned previously a statistical analysis was performed at Nowhere Medical Center to measure the effectiveness of the implementation of the EMR by developing a pre and post electronic medical record implementation evaluation. Our process of measurement was six month before the implementation, three months, nine months, and 18 months after implementation (Keshavjee MSc, MD, CCFP, 2010). The following questions asked on the staff survey were time spent charting, time spent reviewing labs, and time spent doing patient care. Questions for the medical record department were time spent searching for and pulling charts, and time spent filing. For the business units, time spent doing billing. Questions asked of the physicians were time spent finding, and documenting in the chart, time spent reviewing labs, writing prescriptions as well as reviewing consults. Each department staff completed the survey/evaluation pre-EMR implementation, as we expected our numbers were high because the staff as well as the physicians and business unit spent more time either looking for the chart, documenting in the chart, checking for labs, and doing paper billing.

As with any organizational change process there is a potential of draining emotional and physical energy away from the primary goal of implementing the change and there will be employees who will try to block every avenue for the change. At the three month pre survey/evaluation, employees complained about how long it would take them to do any charting, find information, they wanted to remain with the status quo, but we had employees eager for the change. Management would verbalize to the employees how it takes time to adjust to any new technology. At nine months there was an increase in charting time but that was because the employees were still on the learning curve. At the nine and 18-month survey/evaluation there was a decrease in the amount of time in the instance of chart pulls because the patient information was electronic and could be seen from any workstation. Charting time was decreased for the nursing staff as well as with the physicians.

The pre-survey can help to identify any potential roadblocks, which can block a successful implementation process. The questionnaires/survey/evaluations given to the entire employee population who would be responsible for the use of the EMR is a method of collecting information from a large group and provide anonymity to quantify and analyze information (Borkowski, 2005). Another method of outcomes measurement are the use of interviewing randomly, which can be used to follow up on the results of the questionnaire to help capture information that was not captured on the questionnaire. Speaking face-to-face the manager can delve into any issues and get to the heart of the issues identified.

Another method of outcomes measurement is observation (Borkowski, 2005), which would help the manager, information technologist of physician champion and his or her staff to see firsthand what is occurring, how the staff is using the EMR and can reveal a lack of teamwork. The strengths, weakness, opportunities, and threats (SWOT) are also a form of measurement. By using Nowhere Medical Center's mission as a context, managers assess internal strengths (distinctive competencies) and weaknesses as well as environmental opportunities and threats. The organizational strengths are the skill and capabilities that enables the health care organization to conceive and implement new technological advances. The distinctive competencies are an ongoing measurement of the employee's knowledge after training for the EMR uses. Evaluating the organizations weakness are looking at the skills and capabilities that do not enable the health care organization to choose and to implement the EMR.

Measuring Quality,