Sun Tzu and the Art of EHR Adoption

Four Areas of Concern in EHR Adoption

Sun Tzu in the Art of War two thousand years ago taught the importance of preparation and adaption to change and transition. With very little text modification his seminal Chapter One (“Laying Plans”) could be a guidebook for a successful EHR implementation.  Sun Tzu explores the fundamental factors and elements that determine the outcomes of military engagements (“EHR implementations”).  By thinking, assessing and comparing these points, a commander (“implementation specialist”) can calculate his chances of victory. Habitual deviation from these calculations will ensure failure via improper action. For the record, I’ve seen quite a few implementations wounded by “improper actions”.

At the recent Medical Group Management Association’s (MGMA) 2012 Annual Conference in San Antonio I attended a presentation given by Jeff Loughlin.  Jeff is the executive director of the Regional Extension Center of New Hampshire. His session was entitled “Making Meaningful Use Meaningful and Sustainable”. In a recent post I described his “Call to Action”. In this post I want to point to another of Jeff’s golden nuggets which happens to intersect with the teachings of Sun Tzu and the importance of receiving valid feedback, good and bad, from the field of battle.

What has Gone Wrong?

 In the sphere of national EHR adoption we are deep into the process. There has been enough time for reports and anecdotes to start coming back from the front lines to know what is going right, and what might be going wrong. Sometimes we can gather more from Lessons Learned that we can from Best Practices. The “early adopters” of health information technology typically embraced the New Ways of electronic health information. We are way passed that group’s adoption wave and implementations are now being focused on the “majority” where a different set of challenges rises to confuse and confound us. There is no telling what will happen when the last group, “the laggards”, tries to adopt EHRs. That is a story for another day, like maybe 2015.

Jeff in his presentation details four major areas of concern that are frequently present in EHR adoption and implementation. We ignore these concerns at our own risk. They are corrosive to the effort of a provider to delivery healthcare. They can curse a provider’s workflow and hamper the delivery of healthcare for the entire life of a medical practice. They are also avoidable. Here are four major things to think about. Don’t do these. If you are doing these, stop now. Sun Tzu says so.

  • Practices are taking paper processes and putting them in the computer. They are not working to redesign workflow to incorporate technology.
  • Practices are not effectively training and often new staff members are being trained by old staff. The recommended hours of training and learning functionality is not being done.
  • Customization is not being performed. Practices are using “out of the box” tools, alerts and clinical decision support technology without customization.  As a result, alerts and reminders are not always clinically relevant. This often leads to “provider fatigue” or simply the ignoring of system generated messages.
  • Practices continue to employ a provider centric model instead of a patient centric model. Providers are not using a care team approach to maximize efficiency and taking advantage of the opportunities afforded by their EHR.

Jim Tate is founder of EMR Advocate and a nationally recognized expert on the CMS EHR Incentive Program, certified technology and meaningful use.