Lessons Learned from Implementations of 'Open' EHR Systems

Peter GroenThe following are some of the key 'lessons learned' from various case studies about the acquisition and implementation of VistA and other 'open source' Electronic Health Record (EHR) systems in hospitals and clinics across the U.S. and around the world.  These lessons can be applied to almost any major EHR acquisition and implementation projects, whether it be in the public or private sector.

• Prepare a Strategic Plan and document the IT Architecture & Standards. These documents are essential and should be put in place before starting any major EHR or VistA system acquisition & implementation project.
• Embracing 'Open' IT Architecture and Standards that lead to systems interoperability and enable health information exchange (HIE) are key to the future of all EHR systems/vendors that intend to be around 10 years from now.
• Establish the Organizational structure and appoint the senior Executive Staff that will be empowered to make all key decisions during the project and subsequent system life cycle.
• Prepare and approve a detailed Project Plan and Guiding Policies & Procedures needed to guide the EHR or VistA acquisition & implementation project.  See map of VistA installations around the world.
• Obtain an approved budget and/or funds to acquire the resources needed to ensure the success of the project.
  • Acquire enough computing power/servers to ensure instantaneous system response time
  • Acquire and install more than enough workstations and printers for all system users
  • Acquire and install appropriate bandwidth & network stability to support the system users
  • Inadequate resources, not system functionality, are often the real cause of system failure
• Communication is key to the success of the EHR implementation project.
  • Management needs to be very visible and vocal in its support for the project
  • Clinical Champions need to be identified to lead and convince their peers to accept and use the EHR system
  • Unions need to be involved from the start to ensure workers accept and use the new system
• Training is another key to the success of any EHR implementation project. Training facilities need to be set up, training staff identified, training materials developed, and lots of hands on training needs to be provided both in the classroom and on-the-job.
• Ensure all essential functionality will be included in the initial phase of the EHR implementation project. Additional functionality can be added in subsequent phases of the project, e.g. Imaging, PHR, HIE, mHealth apps.
• The complexity of the EHR systems for hospitals is much different than that used in outpatient clinics. There are a number of open source systems that work well in outpatient settings, e.g. OpenEMR, OpenMRS, OSCAR. However, only the open source VistA system, or one of its derivatives, contains the complex functionality needed by major hospitals or a network of healthcare facilities.
• Changing EHR solutions after they have been implemented is much easier in a small practice or a larger family practice setting.
• Ensure you have an appropriate level of highly trained in-house or contract technical staff to rapidly develop, implement, troubleshoot, modify, and enhance the system as needed.
• • Using an open source product reduces risk and supports the goal of vendor independence. If a vendor is inadequate, other companies or technical staff are readily available in the community to take over and provide support.
• • Open source lends itself better to rapid agile development, innovation, and continuous quality improvement than closed, proprietary solutions.
• • It appears over time, that 'open source' or COTS solutions will merge into some form of 'Hybrid' Open Source Software (HOSS) solution. It's just the degree to which a particular system is composed of open source or COTS software components that will differ.
• • Open source EHR systems may lead to some degree of operational efficiencies, however, the real long term benefits will relate to improvements in quality of care – not to mention major long-range benefits for medical research and public health.

Please share with us any other 'lessons learned' you have from your experience with EHR acquisition & implementation projects.

Author:  Peter Groen served as the Chief Information Officer (CIO) at the Atlanta VA Medical Center for 5 years, followed by a similar 5-year stint as CIO at the VA Medical Center in Columbia, S.C.  He later served as the National Project Manager responsible for overseeing the successful implementation of the VistA Computerized Patient Record System (CPRS) at over 1000 Department of Veterans Affairs (VA) hospitals and clinics across the U.S.