In my post about the common EHR implementation problem of EHR slowness, I mentioned that I’d follow up with a post on how you can avoid the EMR slowness issue altogether. It’s better to avoid than fix problems.

The best way to approach EHR performance issues is to make them part of your EHR selection process. EHR performance issues could and should be a deal breaker for you when you’re evaluating EHR companies. How then can you identify EHR software that might have these performance issues?

Red Flag #1 – EHR Demo Slowness – Bring a red pen to your demo and every time they say something like, “It’s not usually this slow?” or “It must be slow because it’s running on my laptop.” make a BIG RED mark on your paper (or tablet if you’re advanced like that). Even one red mark should be cause for concern and investigation.

Certainly there are situations where environmental issues can cause slowness to an EHR. So, you can’t completely rule them out completely for this, but this is their demo. This is there one time to shine. If they can’t get their EHR demo running at full speed, what makes you think an EHR production environment will be much better?

You can make an extra red mark if it’s a SaaS EHR that’s providing the demo. They might say it’s just “the internet connection.” Well, guess what? Soon, that’s going to be you using that EHR and often on similar internet connections.

Of course, the message to EHR vendors is to make sure your demo runs as fast as your production system.

Red Flag #2 – Site Visit Slowness – While the demo can tell you a lot about an EHR software, it can’t necessarily tell you the speed of the EHR software. Just because the EHR is fast during the EHR demo, doesn’t mean that same EHR software will be fast in a production environment. Add this to the multitude of reasons why a site visit to a current user of that EHR is so important.

Make sure to do that site visit at one comparable in size and users to your clinic. You don’t want to look at the EHR responsiveness of a solo practice if you’re going to be a 6 provider multi clinic setup. Size matters when it comes to EHR speed.

Once on site, you can get an idea of the speed and responsiveness of the EHR software in two ways. First, observe the users of the EHR in the clinic. See if they exhibit any of the systems listed in the first section of this post. Another observation is to see how quickly they’re clicking around the EHR. If you see a lot of clicks in a row with little waiting in between clicks, that’s a great thing. If you see them click, wait, click, wait, click, click , wait. Be afraid.

The second way is to ask the EHR users. The problem with doing this is that only one response has value. If they say the EHR is slow, then you’ve gleaned some important information that’s worth checking on. If they say the EHR is fast, then you don’t necessarily know. The problem is that you don’t know what the user considers fast. What’s their frame of reference for saying it’s fast? Do they know what fast is? Have they just been using the EHR software so long that they’ve hit a rhythm that makes it feel faster than it really is? It’s a good sign if they say that it’s fast, but take it with a grain of salt.

Red Flag #3 – Use A Demo EHR System Yourself – Most EHR vendors will provide you a way to demo the product yourself. This isn’t a fool proof method to test EHR slowness, but it’s another decent test of the EHR’s responsiveness. Try it out using your internet connection and your computer hardware. Nothing like first hand experience documenting some patient visits to learn about the speed of an EHR.

EHR Speed Suggestion – Don’t Skimp on Hardware
Far too often I see a clinic skimp on the hardware requirements and regret it later. In fact, they often end up spending the money twice since they have to buy new hardware since they skimped in the beginning.

Of course, this suggestion can be taken too far as well. The computer and laptop manufacturers will try to sell you the whole kitchen and you might only need the stove and refrigerator. To put it in more practical terms, you’re going to want plenty of RAM, but do you really need the webcam, Blu-ray player, and special 100 in 1 media device?

Just because an EHR vendor says their EHR software can work on a certain hardware configuration doesn’t mean it should be used on that hardware configuration. In the middle there’s a spot between can and overkill that’s called optimal. Find that hardware configuration and you’ll be a much happier EHR user.

Conclusion
Don’t accept an EHR that’s slow. Make sure that the EHR performs at a satisfactory level. I know of nothing that frustrates a clinic more than a slow EHR.

We’re back again with our ongoing series on Common EMR Implementation Issues. Seems like readers really liked my first entry in the series about Unexpected EHR Expenses. To be quite honest, I was really happy with how that post turned out myself. It’s one of the most comprehensive and useful posts I’ve written in the 5.5+ years I’ve been writing about EMR and EHR. Hopefully we can continue that trend.

Today’s Common EMR Implementation Problem: EHR Performance Issues

I have to admit that this is a really tough problem to crack. However, it’s also incredibly common. The symptoms for this problem usually are described as, “THIS EHR IS SOOOOOO SLOW!” (This is appropriate use of ALL CAPS since they are often yelling this.) Followed by a *huff* and an angry doctor or nurse leaving their computer in a fit of rage. Other symptoms might include drumming fingers on the desk while staring blankly at the screen, lots of mouse clicks that get progressively longer and more emphatic, or the sitting back in your chair staring at the screen hoping that something will happen.

Once you’ve identified that there’s a problem with EHR slowness, then begins the fun and exciting (that was written in the sarcasm font) journey to identify the real issue. The biggest challenge with identifying the slowness is that there are a multitude of places that could be the bottleneck that’s causing your slowness. Some of which you can fix, and others you have to rely on your EHR vendor to fix.

To assist you in the ugly process of improving EHR performance issues, here’s a list of possible reasons you could have a slow EHR.

EHR Slowness You’re Responsible For
Slow Computers and/or Laptops – I’ve heard of a few EHR vendors offering free iPad’s with their EHR, but for the most part, you’re responsible for buying the computers and laptops for your EHR implementation. See my “EHR Speed Suggestion – Don’t Skimp on Hardware” below for more info on buying the right hardware. Needless to say, I’ve seen many slow computers be replaced and the EHR went a lot faster.

Slow Local Internet – Your local internet (or LAN as it’s often referred) could be the cause of your EHR slowness. I could have split this point into a half dozen possible issues. Some of them might include: Bad network card, bad cabling, bad switch, bad router, bad routing configuration, bad DNS configuration, overwhelmed network, etc etc.

Of course, in most cases you’ll probably have to call your IT service provider to solve these issues. They should be able to easily test most of the above issues and prove that it works for other internet applications and so it must be some other issue causing your EHR slowness.

Slow ISP (external internet connection) – If you’re using an in house EHR server, you won’t have to worry about this as much (except for interfaces, or EHR updates). If you’re using a SaaS EHR, then this could be a major bottleneck. Good thing is that it’s easy to test your ISP speed. If you’re speed is great to other sites, but not your EHR then you can move on to another issue. If you’re speed is bad for all sites on the internet, you need to see if your ISP can make some changes to provide the speed you’ve purchases from them. Otherwise, you might just need a bigger ISP connection than you have and you’ll be able to get your EHR running much faster.

Also, be sure you don’t have employees using up all your bandwidth downloading illegal (or legal) music or videos. That can eat up your bandwidth really quickly. There’s a reason Netflix uses up 20% of bandwidth on the internet. Movie downloads/watching might be using up your internet connection as well.

Memory on Server – I see this issue most often when a clinic tries to re-provision an old server for their new EHR or when they don’t follow the suggested specs of their EHR vendor. It can also happen when you start your EHR with 1 doctor and then grow your practice to 5 doctors. More users usually requires more memory on the server. There are good tools on servers for analyzing how much memory is being used so you’ll know if this is the problem or not.

Hard Disk Space on Server – This definitely shouldn’t happen in a fresh EHR install, but often can happen over time. Servers don’t like to run out of hard disk space and can do all sorts of crazy and unexpected things if they do. Other things that cause a hard disk to run out space might be backups or large log files. I’ve also seen where the IT administrator takes a 500 GB hard drive and divides it into multiple partitions. One partition for the O/S and one partition for the data. Often they misjudge how much to give to one partition versus the other. So, the one partition runs out of space while the other one has TONS of space left.

Good planning and regular maintenance will avoid these issues.

CPU on Server – I believe this is pretty rare these days since memory is usually the bottleneck instead of CPU. However, if the EHR software isn’t written correctly, this could be an issue. Particularly on older boxes.

Complex Workstation Setup – Your IT service provider might have told you all the great benefits of a thin client setup or some sort of virtualized desktop software solution. When done right, these solutions can work fantastic and save you a LOT of money. When done wrong, they can cause you all sorts of slowness and heartache.

EHR Slowness Your EHR Vendor Must Fix
Slow Server Configuration – There are lots of ways to tweak a server to go faster with less resources. Unfortunately, most of these tweaks are likely going to have to come from your EHR vendor. In a larger hospital implementation, you might be able to work with your EHR vendor to implement some of these tweaks. In a small clinic, you’re basically at the mercy of your EHR vendor to configure the server to run fast.

Slow Server (SaaS EHR) – Yes, SaaS EHR vendor servers can go slow too. The good thing is that your EHR vendor likely has monitoring tools that are watching for any slowness so they can proactively fix it. The problem is that then you’re at their mercy to fix the slowness. Needless to say, an EHR vendor’s server support staff rarely feel the end user pain of EHR slowness. At least the pain isn’t nearly as poignant.

Of course, a chorus of calls from EHR users to the EHR support line will help them understand better and fix the slowness. One call about your in house server doesn’t resonate quite as loud.

Slow or Overwhelmed Data Center Connection – Data Center internet connections are generally quite robust and built with a lot of redundancy. However, since data centers usually host many many different systems, they can also get overwhelmed. Sometimes through spikes of traffic, but more often through other nefarious attacks on the systems in the data center. Often, it’s not even your EHR software that’s causing the issue, but it might suffer the consequence. Not very common, but possible.

A little more common could be an EHR vendor that’s growing so rapidly that they can’t keep up with the demand for their EHR software. Other times the EHR vendor just did a poor job planning to expand their EHR data center services.

Poor EHR Code – Not all code is created equal. Some programmers are good at creating code that will execute quickly, but most are not. Fixing speed issues aren’t trivial. Particularly if you have a large code base that’s been created over a long period of time.

Poor EHR Design – The design of an EHR software often determines how fast it work. Designing for speed from the beginning is crucial. Otherwise, a poorly structured EHR can almost never be made fast.

Related to this is EHR software built on old technology. To use a car analogy, you can only make a pinto go so fast without gutting the engine. Too many EHR vendors are built on engines that can only go so fast. They can keep squeezing a bit more speed out of the engine, but eventually you have no other speed benefits because of the legacy technology limitations.

I’m sure there are other possible bottlenecks. Let me know of any I missed in the comments and I’ll add them to the list.

EHR Performance Finger Pointing
Another big problem with the complex list above is that it often leads to a bunch of finger pointing. Yes, sometimes it will feel like you’re back in Kindergarten again. Your EHR vendor will point the finger at your IT setup. Your IT service provider will point the finger at the EHR vendor. Then, the EHR vendor will point the finger at the hardware vendor. You’ll never be able to talk to a person at the hardware vendor and so you’ll have to use other tricks to prove it’s not them.

Needless to say the finger pointing can get really tiring really quick. Not to mention it can be very expensive as you spend money proving to your EHR vendor that it really is their problem and not your setup.

I’ll follow up this post with another on how to avoid EHR Performance Issues during the EHR selection process. I’ll link to that post once it’s up.

Side Note: This post was much longer than expected. I guess I did have a lot to say about this issue.

I recently had the great opportunity to go to breakfast with Valerie Migliore and Karin Eichler during my visit to my in-laws in the upstate New York area (Rochester specifically). Despite being very pleasant ladies I was also happy to see they could speak EMR speak with me. I’ve met a whole lot of different people over the years and far too often I go and meet with someone who is just getting into the EMR world and so they’re still learning the ways of the EMR (excuse the Star Wars reference). I still enjoy those types of visits, but I really enjoy meeting with people like Valerie and Karin who can share with me some other EMR perspectives. In fact, they often show me new ways that I hadn’t looked at something before.

Turns out Val and Karin recently did a presentation about EMR, EHR and meaningful use in Syracuse, NY. They shared their slides with me and I thought they provides some interesting roadmaps and perspectives on EMR selection and implementation. I particularly liked the 17th slide where they show 2 staff involvement pie charts (between leadership, business, clinical and IT) for a successful EHR project and an unsuccessful EHR project (requoted from Shahid Shah’s http://www.slideshare.net/EHRoutlook/guaranteeing-successful-ehr-implementations).

I’d have liked to have been at the presentation to hear what they said with the slides, but I’ve embedded their slides below so you could learn from these smart people as well.

As a side note, I believe Valerie and Karin are working to build their EHR consulting clients in upstate NY. So, if you’re in that area and looking for someone to work with I can put you in touch with them.

This is the start of a new series of posts that I plan to do over the next week or two. I’ll probably try and space them out so that they don’t overwhelm anyone. However, it’s going to be a series of common EMR implementation issues that I hear over and over again.

This series was prompted by a post on HIStalk by Inga where she talked about her visit to the doctor and his complaints about his EHR implementation. As I read through the list of complaints, I realized that they were all complaints that I’d heard before. If I’ve heard them all before, then they must be pretty common and worth talking about more.

Ideally the discussions in this EMR implementation series will help practices and doctors that are implementing an EMR to avoid these issues. I also know that I don’t necessarily know all the answers to avoiding these problems. So, I welcome others feedback on ways to avoid these problems in the comments as well.

Today’s Common EMR Implementation Problem: Many Unexpected Expenses

I can’t tell you how many times I’ve heard a doctor or medical practice talk about all the hidden expenses that they incurred during their EHR implementation that they didn’t plan for. Here are 3 tips to help you avoid this situation.

Unexpected EHR Expense Tip #1 – Plan for hidden expenses. Add $5000+ to your budget for hidden expenses. Hopefully you won’t have to use it, but if (and likely when) you need to use it you’ll already have it in your budget.

Unexpected EHR Expense Tip #2 – Get your EHR vendor to outline everything and anything they could charge you for. Once they’ve done that, consider putting the list of expenses in your EMR contract so that new expenses from your EHR vendor won’t appear. Here’s just a few EHR expenses that you might incur (and may not expect):
-Up front fee (almost everyone just focuses on this)
-Maintenance Fees (monthly, annually, etc)
-Upgrade Fees (to update your software…these are sometimes called Hot Fixes)
-Interface Fees (both sides of the interface..ie. lab and EMR company)
-Device Integration
-Training Fees
-Support Fees
-Licensing Fees (to license their various databases and/or clinical content)
-Install Fees
-Other non-standard modules – You mean you didn’t realize that the patient portal was an extra $150/month?
-EHR or PMS data migration Fees
-Template Creation Fees
I’m sure there are others that I’ve missed. I look forward to seeing the comments on this. I’ll update the post with other suggestions as they come in. As you can see, EHR vendors can charge you in lots of interesting ways.

Unexpected EHR Expense Tip #3
While EHR vendors can often throw unexpected fees at you, it’s probably even more likely that the other outside purchases you have to make during your EMR implementation will be a surprise. Here’s a list for you to consider the other EMR implementation related fees that might come unexpectedly:
-Server cost (almost everyone focuses on this)
-Software cost (including the operating system or third party software your EHR vendor might require)
-New Desktop/Laptop Costs
-Upgrading Desktop/Laptop Costs – You might find that your existing computers aren’t powerful enough to run the EHR you chose. This is particularly true if you’re using something like voice recognition with your EHR.
-Fax Server
-Fax Server Software
-Scanners – Yes, that is plural and people often start with one scanner and then have the unexpected cost of another scanner because they could really use 2+ scanners. Other times people use a cheap all in one scanner which quickly dies after they start scanning in bulk and they realize they need to buy a $1000+ scanner that can handle the required scanning
-Printers – You’ll likely need a few of these to print our prescriptions, patient education, etc etc etc. Plus, you’ll often need a better printer than the one you have.
-Dragon Medical Voice Recognition – The software, the mic (spend extra for a great one), etc. Some don’t realize all of this costs and doesn’t usually come with the EHR software.
-New Network Ports – You could go wireless, but many like the reliability of a wired connection. This costs to run the lines and cut out new internet connections
-Bigger Internet Connection – This is particularly true with a SaaS EHR setup. You think your current internet connection is enough and then you realize you need to pay for a bigger pipe (internet connection) or possibly even a second “backup” internet connection
-Backup Software
-Backup Hardware
-Off site Backup Service
-Cables – Lots and lots of cables required. Sometimes you even have the cable, but then realize you want a longer one. Unexpected expense!
-Power strips and other peripherals – $10 here and $10 there. This stuff starts to add up. Plus, get ready for things like your mouse to start breaking now that you’re using it a lot more.
-UPS (uninterruptible power supply)
Chip Hart added the following suggestions (Thanks!):
-Practices should purchase 25-50% more laptops/tablets (and/or batteries) than they expect.
-All those laptops and tablets will need a SECURE storage and recharge barn.
-You may be paying a carpenter and electrician.
-Integration fees? Data conversion fees?
-Will you need hands-free headsets for your staff, now?
-Maybe it’s time to get bigger monitors.

Hopefully the above lists will help you plan for all of the various fees that are associated with an EHR implementation. Many of these EMR costs are necessary, but end up being really annoying when you didn’t know they were coming. Check through this list to see if you’ve planned for all the EHR costs.

In a future post, I’ll see if I can’t take the above list and give you some ideas on how you can save on some of the costs above.

Once in a while, I run out of Big Ideas to share and resort to a rundown of short items. This is one of those times. Often, though, that approach turns out to be more interesting than a well-thought-out commentary. (Thus, the popularity of Twitter, right?)

Speaking of Big Ideas, I’m thinking that the age of the massive EMR project may be coming to an end. You may have seen my piece in InformationWeek today about the reported end of the national EMR in England. London’s The Independent reported earlier this week that the Cameron government will announce next month that it will scrap the national strategy in favor of allowing local hospitals and trusts to make independent EMR purchasing and implementation decisions.

This news comes on the heels of a decision by the government of Ontario to give up on hopes for a single EMR for all of Canada’s most populous province.

On the other hand, here in the States, we’ve seen a lot of consolidation among healthcare providers, but I’m guessing that has more to do with administrative Accountable Care Organizations and the prospect of bundled payments than any desire to build a more unified EMR. Though, consolidation does make health information exchange somewhat easier, and that’s going to be key to earning “meaningful use” dollars beyond 2013.

On a somewhat similar note, doesn’t a headline like, “Positive Outlook for Small Practice EHR Adoption” sound like a no-brainer? I mean, isn’t that the segment of healthcare providers that historically has had the slowest adoption rates? More than anyone else, small practices—particularly small, primary care practices—are the intended target of the federal EHR incentive program. And most of the news from health IT vendors of late has been about how they are going after this long-neglected market, right? The innovation seems to be happening in ambulatory EMRs, as evidenced by DrChrono’s newly certified iPad EHR app, aimed squarely at independent physicians.

That said, vendors and publicists, please do not start inundating me with news about other EHRs getting certified. There are hundreds of certified products out there now, and I cannot and will not write about, oh, about 95 percent of them.

While you’re at it, please stop using the word “solution” as a synonym for “product” or “service.” Tech journalists hate this trite, lazy and, frankly, inaccurate term so much that I’ve been instructed by the editors of InformationWeek not to use it, except in direct quotes. In fact, I get reminded not to use it pretty much every time I’m forwarded a press release laden with news about someone’s “solution.” Solution to what? I’ve been seeing that term since I started covering health IT more than a decade ago, and I still don’t see much getting solved in healthcare. With all the “solutions” out there, you’d think that healthcare had been fixed by now.

I could get a whole lot more curmudgeonly on you, but I think I’ll stop now and await your comments.

In my interest of highlighting more EHR bloggers, I found this post by Ron Sterling on EHR Outlook quite interesting. In his post, Ron highlights a number of questions a clinic should ask itself to know if it’s ready for an EHR implementation. Here are the questions he lists:
* Does your EHR effort have physician support?
* Are you prepared to address ongoing problems?
* Is your budget practical?
* Does your EHR support your current workflow and operations?
* Will your existing computer Infrastructure support an EHR?
* Have you gotten your paper records ready?

Check out the original post for Ron’s thoughts on each question and why that question is important. I think it’s a pretty good list to consider. I especially like the second question that addresses whether you’re willing and able to address ongoing problems. That’s a hard one to evaluate, but understanding how your organization addresses issues is very important. You don’t want to start thinking about that once you’re in the heat of an EHR implementation.

I’d also suggest a couple more questions:
* Why are you implementing an EHR?
* What are your plans for your medical practice and will the EHR you choose be impacted by those plans?

Making sure that a clinic is EHR ready is brutally important. Trying to implement an EHR in a clinic that’s not ready almost always turns into a nightmare experience for everyone involved.

I can’t remember exactly where I saw someone talk about the “WIIFM” (What’s in it for Me) principle, but it really is an important principle that when understood can have an amazing impact for good. This post isn’t about whether you should live a life asking WIIFM. I’ll leave that question to people much smarter than me. Instead, I want to look at how applying the WIIFM principle to others can help those working on a successful EHR implementation.

In most cases I’m talking about, the WIIFM should be changed to “What’s in it for Them?” Understanding the answer to this question can help you as an EMR consultant, an EMR vendor or even a practice manager or doctor that’s trying to work through an EMR implementation.

One of the first things I cover in my e-Book on EMR selection (It’s free, check it out) is the idea of getting buy in from those that will be affected by the EHR implementation (that’s usually everyone). One of the best ways to get EHR buy in from people is to understand the WIIFM. It’s not fool proof, but it’s one good strategy for getting people on the same bus, going the same direction.

Let me tell you that there’s always a way to find a WIIFM in an EHR implementation. This list of EMR and EHR benefits is a great place to start. However, many of those benefits can be extrapolated in ways that will show what’s in it for every person in the clinic.

Let’s say for example, that your goal for implementing an EHR is to increase clinic revenue by freeing up chart storage space so you have an extra exam room for another provider. You can then talk about what that new revenue can be used for to improve the clinic. Maybe it could include bonus checks or other incentives. These become tangible things that staff can use to better understand WIIFM in an EHR implementation.

I’m sure many of the nay sayers out there are thinking, but an EHR doesn’t provide those benefits. That’s why it’s so important that you define which benefits your clinic is striving to achieve before you select or implement an EHR. The list of benefits you use to show WIIFM ends up being your goals for your EHR implementation. They can be used to define your EHR selection process. They can be included in the EHR contract so you have some assurance or protection if the EHR vendor can’t deliver on their sales promises. Not to mention, after the EHR implementation you have a way to measure if it was a success or not based upon those goals.

Test the WIIFM principle. Not from an arrogant Me Me Me approach. Instead, step into the other people’s shoes and ask WIIFM. This approach can really help improve any EHR Implementation if applied correctly.

When I learned that HITECH included funds setting up the regional extension center system to support small medical practices in implementing EHRs, I thought, well, that sounds OK.

I wasn’t thrilled, mind you, as I wasn’t optimistic that a government-sponsored organization would produce the quick EHR adoption process HITECH demands, but it wasn’t a bad thing.

Since then, I’ve gone from mildly interested to downright irritated.  While I wasn’t expecting the RECs to blaze a path to glory, I thought it would be nice if they produced great educational materials and sessions, made themselves highly accessible to physicians and offered clear guidance on vendor selection. As far as I can tell, we’re largely zero for three.

Yes, as a recent a recent study notes, the RECs are doing better at some of these things of late. According to a recent study by the eHealth Initiative, they’ve now reached most of the 100,000 PCPs they’d hoped to enroll, and they’ve developed better vendor specifications.

That being said, they really don’t seem to be that focused. Hey, if a privately-funded organization took this long just to begin to get started with their work, they’d already be out of business.

Not only that, when I made one completely unscientific mystery-shopper call to a REC, the staff member I spoke to didn’t seem to have much on the ball. He didn’t have anywhere to direct me for further information, didn’t have any informational meetings pending, couldn’t define clearly what his group could do for me and didn’t even bother to get my contact information.

Of course, that may have been a freak instance, but I’m beginning to doubt it. The buzz I hear is that the RECs have barely a clue as to how to reach their target population, and don’t really speak their language. Some of my EMR-savvy buddies think they’re just about useless.

I do truly hope that the RECs get their act together — maybe all they need is better marketers — but I’m not holding my breath.  My advice to doctors: Keep pushing on your local medical society, your IPA, your hospital partners and your practice management consultants to shed some light on the EMR adoption process. You’ll get further, faster.

I know I’ve written about ERP and EMR before, but the more I think about the EMR selection and implementation process, the more I see the same issues that are experienced with an ERP implementation.

The one issue that is a bit different about EMR versus ERP is that there are only a small handful of ERP vendors to choose from. However, we have 300-600 to choose from in the EMR world. That’s an important and challenging difference.

However, the similarities to ERP are many. One of the most striking is how the EMR like the ERP is something that’s going to be used and have an effect on the entire organization. As such, the need to manage the participation of multiple stakeholders is so key.

The key to a successful ERP implementation is to have a great project leader.  Someone who is great at working with various departments. They are great listeners who hear and understand each departments needs. Then, they have to be great at making the case for each depaartment’s needs.

The same is true for EMR. You need an EMR implementation champion who is great at listening to all areas of the clinic: nurses, doctors, front desk, billing, medical records, etc. Sometimes this can be done well by a physician lead, but is more likely to be a practice manager, IT support (if they have project management skills), or an outside consultant. 

It’s easy to underestimate the challenge of “herding sheep.” Done right, it can work very well. Done wrong and your clinic is likely going to have the opportunity to try again after the failed EMR implementation.

There are other comparisons worth considering, but this one was striking me today. I’ll be interested to hear stories and experiences from those who have implemented an EMR. Did you have a strong leader to help pacify the different stakeholders in your clinic? 

Two articles I’ve written in the last 24 hours have gotten me thinking that we’ve already entered the post-implementation era of EMRs, even as implementation remains in progress at so many healthcare organizations. While the vast majority of hospitals and physician practices in the U.S. still don’t have full-featured EMRs in place, many are already looking well into the future.

As you may already know, HIMSS on Tuesday released its first-ever survey on “clinical transformation.” According to HIMSS and survey sponsor McKesson, “Clinical transformation involves assessing and continually improving the way patient care is delivered at all levels in a care delivery organization. It occurs when an organization rejects existing practice patterns that deliver inefficient or less effective results and embraces a common goal of patient safety, clinical outcomes and quality care through process redesign and IT implementation. By effectively blending people, processes and technology, clinical transformation occurs across facilities, departments and clinical fields of expertise”

As I reported for InformationWeek, 86 percent of organizations surveyed had a plan for clinical transformation in place or at least under development, and just 12 percent of respondents called organizational commitment a barrier to reporting on quality measures. And though nearly 8o percent indicated that they still gather quality data by hand and 60 said they don’t capture data in discrete format, more than half already had software specifically for business intelligence. This tells me that analytics is here to stay.

I kind of knew that anyway, since the bulk of the program at last week’s Wisconsin Technology Network Digital Healthcare Conference was devoted to BI, data governance and advanced analytics tools, even in the context of Accountable Care Organizations. (My story about this for WTN News appeared this morning.)

“I’m ready to declare the era of business intelligence,” said Galen Metz, CIO and IS director for Madison-based Group Health Cooperative of South Central Wisconsin. Though he criticized the proposed ACO rules for being too “daunting” for the average provider, Galen and other speakers said that it’s time to harness all the new, granular data being generated by EMRs and, soon, ICD-10 coding.

It may seem “daunting” now in the midst of all the preparations for ICD-10 and meaningful use, but it’s good to know that many healthcare organizations see a light at the end of the tunnel and know that the future bring better healthcare information in exchange for all the hard work and investment today.