A new study done at a group of seven VA hospitals has concluded the hospitals rolled out their EMRs with far too little planning, leading to problems that tied staff members and clinicians in knots.
The study, which was published in the American Journal of Managed Care, drew on interviews with doctors, IT staffers, nurses, pharmacists and managers. The interviews were done several years after the VA had implemented its computerized patient record system (CPRS) and its bar code medication administration system (BCMA).
The respondents told interviewees that for most of them, the new technology created big difficulties. Many of the interviewees didn’t start out familiar with computer use, making the inevitable workflow disruption even worse than in other hospitals.
BCMA was a particualrly sore spot for the VA clinicians and staff, as it was phased in more rapidly and with little training for users. Staff members at the hospitals essentially had to implement and use the system on their own, according to a story appearing in Information Week.
As if this wasn’t challenging enough, the hospitals ran into major issues in selecting and rolling out hardware to support these new technologies.
For one thing, some of the hospitals had little idea how to build a wireless network capable of supporting the myriad of computer cards in use at their facility. In some cases, they faced major connectivity problems after failing to test the wireless systems prior to rollout of CPRS and BCMA. Other hospitals in the seven had great difficulty figuring out how many computer terminal to order.
As I read the situation, the hospitals’ BCMA rollout led to the biggest problems and greatest possibility for harm. All seven of the hospitals reported having major BCMA issues, including miscoded medications, empty unit-dose packages being delivered items not scanning.
Perhaps even worse, nurses sometimes had to cut the ID bands off of patient wrists just to scan them, or scan from extra wristbands in patient charts. “At some VA hospitals, staff were implicitly or explicitly permitted to use various workarounds with BCMA, such as…doing all scanning after medication administration,” the magazine reports, quoting the research report.
Not only that, many workarounds remained in place years after the BCMA rollout — a testimony, if there ever was one, to getting things right the first time.
Apparently, according to IW, BCMA is at stage 5 in the maturity scale HIMSS Analytics has established for measuring the maturity of a hospital EMR rollout. HIMSS says that 8.4 percent of hospitals are at this stage.
The thing is, a maturity scale shows its own weakness when you can laud a hospital for getting there even if their implementation has disrupted workflow greatly and even put patients at risk. And I’m not aware of any ratings scale from HIMSS (or a similar entity) that grades quality of execution.
Do you know of other ratings systems for hospital EMR rollouts that do more to adjust for poor planning or implementation problems? If you do, I’d love to hear about them. This story is pretty scary.