One of the most significant challenges for EHR newbies is navigating the bedside experience with a computer in the mix. If you have never documented at the point of care, it can be a stressful experience in the beginning.

In general we focus on how workflow changes will affect the physician, clinician or nurse. We don't focus enough on how to incorporate this change into the patient experience. Often, new users are so focused on using the system, their well-honed listening and empathy skills take a back seat.

New-user anxiety generally falls into two categories: a) I'm going to do something wrong and b) I will not be as good as everyone else. Both of these feelings can be very distracting for new users and can ultimately affect the patient. The documentation can be perfect, but the patient can feel neglected. It does not have to be this way!

Preparing for an EHR seems like an exercise in learning software, and it is. However, it is also an exercise in how to incorporate technology into a very personal and often profound relationship. Senior leadership at the hospital needs to talk openly about these changes and how to navigate them. I have seen roundtables and focus groups used as effective communication mechanisms during implementation. Most hospitals now have nurses and physicians who have used an EHR in the past. Their lessons learned are invaluable.

Technology enables better patient care, and that is an undisputed fact. Balancing the human factors is a key element to success for both the patient and the provider.

I like to say that adopting an EHR is a journey and not a destination. While vendors like HMS focus on a specific go-live event to signify that our products are in use at a hospital, it’s just the beginning of the journey toward improving patient care and safety. Having a committee of clinical experts to govern and advise on standards and a roadmap is an essential part of EHR adoption. Products like HMS Patient Care Documentation are feature-rich and have tremendous flexibility and capabilities. Gaining the most benefit from an EHR takes strong leadership, collaboration and a focus on improving outcomes. While the IT team plays a critical role in implementing the technology, a committee of physicians, nurses and other clinicians can help to make key decisions and continue to evolve and optimize the use of an EHR. Some hospitals call this committee the EHR Advisory Committee. Others may call it the Clinical Governance Committee. Whatever the name, the concept is one that works very well.

Initial implementation of an EHR creates a great foundation from which to grow. However, almost immediately there will be requests for tweaks, changes and new content. The Clinical Governance Committee ensures that these requests are evaluated as a part of the overall vision of the EHR. Having documentation standards and following those standards will ensure that the appropriate content is developed and that it follows specific guidelines, not user preference. When conflicting opinions arise within the user community, it is helpful to know that an appointed group of peers will evaluate and decide how to proceed, not just a single IT informatics person.

Beyond the first few months of tweaking content, having an EHR opens up a world of opportunity to capture and measure data to improve outcomes. The Clinical Governance Committee should lead the evolution of the EHR, so it continues to have more meaningful data. As new product releases roll out, the Clinical Governance Committee should ensure that the hospital takes advantage of new capabilities, not only to meet future stages of meaningful use, but also to continue the evolution of the EHR’s capabilities.

I find that the most successful and satisfied users of an EHR have invested in clinical governance. I love to see our customers embrace the journey and take advantage of the powerful clinical tools that HMS has to offer.

Even though electronic health record (EHR) systems have been around in some form for almost 40 years, it still feels somewhat “new” to see clinicians and physicians interacting with computers at the point of care. Learning to use an EHR system is a challenge in itself, but dealing with computers can present an entirely separate challenge. Unfortunately, it is often hard for new users to make that distinction between hardware or network issues and the actual learning curve with the software itself. If the hardware doesn’t work, then the perception is “this new software doesn’t work.”

It is imperative that hardware and network struggles are conquered well before the EHR is launched so that the challenge for the users becomes patiently learning the new way of documenting—not struggling to find a working PC, having constant wireless drops or other myriad problems that can occur. These issues are completely preventable with good planning and testing. Unfortunately, all too often I have seen hospitals still un-boxing computers and setting up printers the day before the go live.

A thorough hardware assessment and walk-through are essential at the very beginning of the implementation process. (HMS offers this service.) Unless major renovations are in progress, it’s fairly straightforward to assess the hospital floor plan and make decisions about the quantity and placement of computers. Choosing the type of devices is more difficult. Options include wired PCs in the patient rooms, laptops attached to rolling carts (also known as workstations on wheels or WOWs) and wireless tablet computers. Each of these devices has a raving fan base and comes with pros and cons.

PC workstations in the patient rooms have the advantage of being wired directly to the hospital network. However, space, privacy and the feeling of being “tethered” to one location are typical concerns. WOWs and tablets offer a great deal of mobility but are very dependent on a highly reliable wireless connection that provides the appropriate speed to make the performance of the EHR software similar to performance on a wired PC. Often the users get busy and forget to charge the battery-powered WOWs or tablets, and a sea of dead devices leads to extreme frustration. It’s important to consider these factors early and make a decision within the first 60 days of the implementation. Then, get the hardware ordered, in place and tested well before the go live.

Removing all roadblocks to adoption of an EHR should be the mission of any hospital that is taking on a clinical implementation. Hardware and connectivity should be the last things to worry about on go-live day.