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Health care experts propose 6 principles to follow when switching electronic health record systems

Photo of person looking at computer. (Photo by Getty Images)
When switching electronic health record systems, researchers recommend health care providers follow six key guidelines for an easy and safe transition. (Photo by Getty Images)

As health care evolves over the next 10 years, many providers will switch out their current electronic health record (EHR) system for a new one due to health system mergers or to keep up with the trends. Because EHR switches can cause care disruptions, researchers with The University of Texas Health Science Center at Houston (UTHealth Houston), U.S. Department of Veterans Affairs, and Baylor College of Medicine suggest following six key guidelines for an easy and safe transition.

The paper was published in the Journal of the American Medical Informatics Association.

“When organizations decide to switch their EHRs we want to make sure it is done in a safe and effective manner,” said Dean Sittig, PhD, professor at UTHealth Houston School of Biomedical Informatics and lead author on the paper. “If it is not done correctly, it can lead to substantial loss of health information like someone’s medical history, medication lists, and so on.”

Researchers recommend health care providers take these steps:

  1. Implement a proactive leadership structure that values communication – This means creating a team of experts in technical and clinical operations to plan and monitor activities to oversee the EHR transition and intervene as issues arise. Leaders should also encourage EHR users to speak up if they perceive something is wrong and ensure that management takes them seriously. Frequent communication and feedback will help ensure the EHR content meets clinician needs, thus improving their experience and understanding of their new workflow.
  2. Implement proactive risk assessment and testing – Health care organizations should develop robust plans to identify risks before they occur and determine what needs to be modified before making the transition. This preparation helps them get ahead to prevent mistakes before risking patient information.
  3. Anticipate and reduce unwarranted variation – Health care organizations should standardize as many EHR settings and clinical workflow processes as possible. This will reduce training costs, increase interoperability, and improve overall quality.
  4. Establish a culture of conscious inquiry with routine monitoring – It is difficult to know whether the new EHR is working as designed, being used as expected, or leading to unintended adverse clinical events. In an effort to monitor these outcomes, organizations should monitor key metrics related to safety and take actions when performance raises concern.
  5. Foresee and reduce information access problems – Organizations just starting a new transition should participate in regional and/or national groups to facilitate sharing of information to ensure their patients’ information can be accessible to all of their health care providers.
  6. Support the EHR user workforce – Change can often be difficult to navigate. Health care organizations should be prepared to offer support to users in all areas to help with performance and eliminate any frustrations that may occur. Examples include dedicated “protected time” away from clinical duties and to attend required training, encouraging clinicians to practice using the system before go-live, and providing additional 1-on-1 support to clinicians who continue to struggle.

“These are great lessons everyone can follow. Switching EHRs is a big deal. It takes a lot of time and planning, but if it is done right, health care organizations and their staff can avoid costly mistakes,” Sittig said. 

“The six guidelines increase our ability to anticipate what might go wrong and re-imagine a better way for the system to work before it is implemented,” said Hardeep Singh, MD, MPH, co-author on the paper, a professor of medicine at Baylor College of Medicine and researcher at the Center for Innovations in Quality, Effectiveness and Safety and Michael E. DeBakey VA Medical Center. “Leaders of health care organizations can use these guidelines to create ownership, resilience, and trust needed to safeguard the universally difficult EHR transition process.”

“Having a structure that includes communication, conscious inquiry and user support is key to success in a time of transition,” said Priti Lakhani, DPM, health system physician specialist with The MITRE Corporation and co-author on the study.

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