By Chuck Campbell
Now that VA has purchased the same Cerner EHR system as DoD, Government employees and contractors can begin to assess expectations regarding their implementation of the system. We know the system is backed by a strong, stable company; it’s a certified EHR system; it’s scalable; and it has been implemented in other large-scale organizations. As a sole source purchase, acquiring the system was relatively painless.
But acquiring a new EHR system and successfully implementing it, require very different mindsets. Two things we all know will happen: it will cost more than planned, and it will take longer than expected to implement. Setting unrealistic timelines for full or even initial operating capability will unnecessarily result in the appearance of delays. Further, not considering at the onset how to acquire more resources will lead to last minute pleas to Congress for a larger budget.
EHR Lessons Learned
So how can VA practically prepare for the implementation and the inevitable hiccups they will encounter along the way? They can begin by looking to the past for lessons learned to understand what worked well (and what didn’t) with other large-scale EHR implementations in both the Federal Government and in commercial Healthcare organizations. The devil is in the details, and we can cover those in future posts, but from a high-level perspective, here are 5 EHR implementation lessons learned.
1. Start with a Plan
Like all large-scale multi-billion dollar projects, start with a strategic plan…and then stick to the plan. Understand the ultimate purpose and goals of implementing the new EHR system. While that may sound simplistic and intuitive, it becomes essential to keep the purpose and goals in mind once things don’t go as planned. And they won’t. If one of the overarching goals is better patient care, how does the VA get support from its providers if, out of the box, the new system doesn’t provide at least the same capabilities as the current system? My hope is that VA already has a strategic EHR plan, otherwise why cancel numerous EHR modernization projects and acquire a new commercial system?
To help build the plans, VA should tap into the reservoir of Government and commercial executors to understand what it’s really going to take to make it work. While there are countless strategists each with their own theories of what needs to be done, focus on the how, by getting help from executors who have actually implemented similarly large EHR projects.
2. Create a Flexible Tactical Plan
Implementing the new EHR system will require continuous course corrections throughout its lifecycle to ultimately be successful. Build a team that includes Healthcare providers, technologists, Healthcare business leaders, patients, trainers, researchers, resource managers and others to create the initial plan, or to revise the current plan. Include Government contractors, commercial vendors, and civilian Healthcare leaders for assistance. This is a once-in-a-lifetime opportunity for VA. Tap into experienced executors, get their input, discuss options, make decisions, and move forward.
3. Make Patient Safety the Number One Goal
All goals for implementing a new EHR are important, but VA must guarantee patient safety throughout the entire lifecycle of the new system. Nothing should compromise patient safety…not unrealistic timelines, not shortage of funds, not new technology, not inexperience. Much of patient safety, as it relates to the EHR, is about data. VA needs to ensure all patient data is accurate, timely, complete, and secure. There are already many civilians and contractors in VA and DoD who are experts on getting the right data to the right place at the right time. VA should get them working collaboratively with Cerner to make sure this most important aspect of implementing the new EHR is done right, the first time and every time. If a patient is harmed through incomplete or inaccurate data, they may not have a second chance.
4. Train, Train, Train
Patient safety can also be greatly affected by training. Whatever the current training budget is…triple it. The VA may end up with the best, most comprehensive EHR system in the world, but if their Healthcare professionals don’t know how to use it well, mistakes and omissions may occur. Experience has shown that providers who aren’t well trained will see fewer patients, leading to longer wait times and decreased patient satisfaction. Inadequate training also leads to user frustration and decreased VA employee satisfaction.
Look at it this way, the VA can pay more for initial and ongoing training, or they can risk paying a lot more for sending their patients out to the civilian market when they can’t be seen by their in-house VA professionals. Use a combination of different training modalities including train the trainer, over-the-shoulder, web-based, classroom, etc. Overcompensate on training…leave training experts onsite in a Healthcare organization and have traveling experts to react to “hot spots” of insufficient learning. Hire the best that money can buy. This is not an area where VA should try to save dollars by going the LPTA route.
5. VA business and Healthcare…take the lead
Implementing a new EHR system in VA/VHA is not just about getting the newest technology, it’s about improving the business of Healthcare and taking the best care of patients for which VA is responsible. The people leading this effort should be VA business and Healthcare leaders, not the technologists or the acquisition specialists. Each has a role, and all need to participate at every level throughout the entire project lifecycle, but in the end, who has the most skin in the game? Who gets the calls from the disgruntled Healthcare providers, the patients, the Veteran Service Organizations, Capital Hill, etc.? Who has to fight to get more resources when the budget explodes? VA business and healthcare leaders, if they aren’t already involved, need to immerse themselves in this project now to ensure the focus remains on getting patients get the best care possible.
This is one of those rare opportunities in the Federal Government where all stakeholders need to put their own preferences aside and work collaboratively for the good of the VA and the millions of patients they support. There are many people who believe this EHR implementation is going to fail. But I believe it can succeed. However, it will take unprecedented amounts of support from Cerner, large, medium and small contractors, consultants, and VA/DoD leaders and experts to make it work. Now’s not the time for the “it’s not made here” approach. Take the best that everyone can offer and work as one team to move this implementation forward. To paraphrase a former DoD/ASD regarding contractors/vendors…don’t bring your “A” team salespeople and “C” team implementers. Bring your best at every level. And if you don’t have the best, team with companies that have them. Our millions of VA beneficiaries deserve no less.
Chuck Campbell is the CEO of IT Partner Consulting LLC where he provides advisory services regarding the implementation of electronic health record systems to the Federal Government and commercial partner organizations. He is an experienced Healthcare management and Health IT leader who understands how IT can successfully support and enable the business of Healthcare in the Federal Government. Chuck is a 30-year retired Air Force officer, a former Military Health System CIO, and Veterans Health Administration Deputy CIO. His experience includes large-scale electronic health record system implementation, IT and business strategic and tactical planning, world-wide IT operations management, and business and organizational reengineering.