Establishing a best practices planning model for EMR implementation

The Obama stimulus package has earmarked a substantial sum of funding to advance technology within health care services in an effort to improve health care quality while controlling costs. The diffusion of the electronic medical records (EMR) and electronic health records (EHR) within health care settings holds considerable promise in achieving the quality assurance goals of the IOM, as well as managing costs. However, adoption of EMRs/EHRs within health care organizations has been slow over the last decade, with only about 20-25% of US hospitals in 2005 either using or developing EMRs (Ash, et al., 2004; Bert, et al., 2005; Fonkych & Taylor, 2005). One of the factors related to slow diffusion is the initial failure rates in EMR implementation. It is estimated that up to 80% of initial attempts at EMR implementation are met with failure (Brailer, 2004). Furthermore, after successful launch, health care organizations can anticipate a substantial reduction in the initial productivity of the organization's end users (i.e., clinical staff) as they adapt to the new electronic system. While significant attention has been given to software and hardware issues, the majority of implementation failures and lost productivity can be attributed to organizational resistance, ineffective change management, and lack of sufficient technical support and assistance to end users. Similar to planning models that drive effective public health practice, this presentation posits there are significant opportunities for development of specific EMR planning models that assess and address organizational systems and end users' needs to improve efficacy of the EMR/EHR implementation process. Policy formation is discussed identifying theoretical elements of organizational change management, reducing staff resistance through increasing staff supports, and tailoring technical assistance efforts based on EMR needs assessments conducted prior to implementation.