Comprehensive methodology to monitor longitudinal change patterns during EHR implementations: a case study at a large health care delivery network

Colicchio, Tiago K.; Fiol, Guilherme Del; Scammon, Debra L.; Facelli, Julio C.; Bowes, Watson A.; Narus, Scott P.

doi:10.1016/j.jbi.2018.05.018

Cited by 11 publications

(31 citation statements)

References 23 publications

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“…Physicians' apprehension about learning new processes and workflows can pose a barrier to effective EHR use. 48,49 As would be the case for anyone undergoing major transitions, physicians approach migration to a new EHR with expectations, hearsay, prior experiences, and a desire to ensure patient safety. 26,40,44,50 In ►Table 4, we provide guidelines for including physicians and other staff in the process.…”

Section: Provider Expectationsmentioning

confidence: 99%

Transitions from One Electronic Health Record to Another: Challenges, Pitfalls, and Recommendations

et al. 2020

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Objective We address the challenges of transitioning from one electronic health record (EHR) to another—a near ubiquitous phenomenon in health care. We offer mitigating strategies to reduce unintended consequences, maximize patient safety, and enhance health care delivery. Methods We searched PubMed and other sources to identify articles describing EHR-to-EHR transitions. We combined these references with the authors' extensive experience to construct a conceptual schema and to offer recommendations to facilitate transitions. Results Our PubMed query retrieved 1,351 citations: 43 were relevant for full paper review and 18 met the inclusion criterion of focus on EHR-to-EHR transitions. An additional PubMed search yielded 1,014 citations, for which we reviewed 74 full papers and included 5. We supplemented with additional citations for a total of 70 cited. We distinguished 10 domains in the literature that overlap yet present unique and salient opportunities for successful transitions and for problem mitigation. Discussion There is scant literature concerning EHR-to-EHR transitions. Identified challenges include financial burdens, personnel resources, patient safety threats from limited access to legacy records, data integrity during migration, cybersecurity, and semantic interoperability. Transition teams must overcome inadequate human infrastructure, technical challenges, security gaps, unrealistic providers' expectations, workflow changes, and insufficient training and support—all factors affecting potential clinician burnout. Conclusion EHR transitions are remarkably expensive, laborious, personnel devouring, and time consuming. The paucity of references in comparison to the topic's salience reinforces the necessity for this type of review and analysis. Prudent planning may streamline EHR transitions and reduce expenses. Mitigating strategies, such as preservation of legacy data, managing expectations, and hiring short-term specialty consultants can overcome some of the greatest hurdles. A new medical subject headings (MeSH) term for EHR transitions would facilitate further research on this topic.

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Section: Provider Expectationsmentioning

confidence: 99%

Transitions from One Electronic Health Record to Another: Challenges, Pitfalls, and Recommendations

et al. 2020

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“…48 It is true that achieving nationwide adoption by relying primarily on homegrown systems would likely be unattainable, as the infrastructure needed to share functionality developed locally is still under development. 49,50 However, it is also true that the expected benefits of a digital health system 51 have not yet materialized through commercial EHR adoption [52][53][54][55][56] ; 4 years after becoming a commercially based digital health system, the U.S. health system continues to be the most expensive and lags behind other developed countries in some quality outcomes. 56 The collective experience of the surveyed organizations indicates that while the migration to a commercial system may facilitate implementation or maintenance of terminology and knowledge management solutions, it also introduces important gaps.…”

Section: Discussionmentioning

confidence: 99%

Twilighted Homegrown Systems: The Experience of Six Traditional Electronic Health Record Developers in the Post–Meaningful Use Era

Colicchio

Cimino

2020

Appl Clin Inform

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Objectives This study aimed to understand if and how homegrown electronic health record (EHR) systems are used in the post–Meaningful Use (MU) era according to the experience of six traditional EHR developers. Methods We invited informatics leaders from a convenience sample of six health care organizations that have recently replaced their long used homegrown systems with commercial EHRs. Participants were asked to complete a written questionnaire with open-ended questions designed to explore if and how their homegrown system(s) is being used and maintained after adoption of a commercial EHR. We used snowball sampling to identify other potential respondents and institutions. Results Participants from all six organizations included in our initial sample completed the questionnaire and provided referrals to four other organizations; from these, two did not respond to our invitations and two had not yet replaced their system and were excluded. Two organizations (Columbia University and University of Alabama at Birmingham) still use their homegrown system for direct patient care and as a downtime system. Four organizations (Intermountain Healthcare, Partners Healthcare, Regenstrief Institute, and Vanderbilt University) kept their systems primarily to access historical data. All organizations reported the need to continue to develop or maintain local applications despite having adopted a commercial EHR. The most common applications developed include display and visualization tools and clinical decision support systems. Conclusion Homegrown EHR systems continue to be used for different purposes according to the experience of six traditional homegrown EHR developers. The annual cost to maintain these systems varies from $21,000 to over 1 million. The collective experience of these organizations indicates that commercial EHRs have not been able to provide all functionality needed for patient care and local applications are often developed for multiple purposes, which presents opportunities for future research and EHR development.

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“…Care measures more likely to detect the impact of HIT interventions have been identified in the literature and combined with interviews and national surveys with subject‐matter experts . These measures assess care outcomes of quality, productivity, and safety and have already been tested in a large‐scale EHR implementation for identification of changes introduced immediately after the EHR go live or with long lasting effects . That evaluation detected a significant impact attributable to the commercial EHR implementation in 40 (98%) measures monitored .…”

Section: Hit Impact and The Learning Health Systemmentioning

confidence: 99%

Health information technology as a learning health system: Call for a national monitoring system

Colicchio

Fiol

Cimino

2019

Learning Health Systems

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After over half a century of computer application development in medicine, the US health system has gone digital with an enthusiastic confidence for rapid improvements in care outcomes, especially those of quality of care, safety, and productivity.The bad news is that evidence for the justification of the hype around health information technology (HIT) is conflicting, and the expected benefits of a digital health system have not yet materialized. We propose a national system for monitoring HIT

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Comprehensive methodology to monitor longitudinal change patterns during EHR implementations: a case study at a large health care delivery network

Abstract: Our results and methodology can guide the broader medical and informatics communities by informing what and how to continuously monitor EHR impact on quality, productivity, and safety.

Cited by 11 publications

References 23 publications

Transitions from One Electronic Health Record to Another: Challenges, Pitfalls, and Recommendations

Transitions from One Electronic Health Record to Another: Challenges, Pitfalls, and Recommendations

Twilighted Homegrown Systems: The Experience of Six Traditional Electronic Health Record Developers in the Post–Meaningful Use Era

Health information technology as a learning health system: Call for a national monitoring system

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