Essential Steps for Successful Implementation of the EHR to Achieve Sustainable, Safe, Quality Care

Essential Steps for Successful Implementation of the EHR to Achieve Sustainable, Safe, Quality Care

Bonnie Wesorick (Elsevier CPM Resource Center, USA)
DOI: 10.4018/978-1-4666-2657-7.ch003


This chapter provides the foundational steps for successful implementation of the EHR that will achieve sustainable, safe, quality care. The focus is on the point of care, where the hands of those who give and receive care meet. The billions of dollars spent to automate, regardless of vendor, bring no assurance to reach the desired clinical outcomes to become the best place to give and receive care. The process begins with leadership’s commitment to transform culture and practice coupled with clarity on the role of technology to achieve that end. The fundamental elements that must be addressed and the strategies to achieve sustainable outcomes will be based on the nature of the work, the lessons and outcomes of the Elsevier CPM Resource Center International Consortium of over 346 rural, community, and university settings at various levels of EHR implementation.
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Billions of dollars are being spent on the purchase and implementation of technology in healthcare. The call to automate healthcare has been driven by diverse stimuli. Two of the major stimuli are the concern for patient safety and the growing cost of health care. (IOM, 1999, 2001, 2011; Blumenthal, 2009; Braithwaite et al., 2009). There is no quick fix or one approach to address the safety and financial concerns of the healthcare system but technology holds a promise to positively impact both concerns. Initially healthcare technology focused on admission, billing and laboratory processes. In the more recent years the focus shifted to point-of-care solutions to help address patient safety, especially the errors associated with medications and medical treatments, omissions, and other adverse events and errors that put both patient and care providers at risk while negatively impacting the cost of healthcare. (Dick et al., 1997; Gebbie et al., 2003).

The realities every healthcare organization face are more readily understood in the face of one of the most significant national issues, the call for a healthcare system. America is the only industrialized country who does not have a healthcare system. (Reid, 2010). Few would argue that the quality of life is impacted by the quality of one’s health. Having access to a healthcare system from pre-birth to death is a major commitment of an advanced society to support the health of its citizens. In this evolving process to achieve such an end, it became apparent that there is much work to be done just to address the present healthcare inefficiencies and lack of quality. (IOM, 1991, 2001; Reifsteck, et al.; 2006, Kenny, 2008; Baker, 2004).

The need for transformation of practice and evidence-based practice at the point of care that ensures safety and quality for both those who give care and receive care is rarely disputed. The safety issue became a major focus when two Institute of Medicine reports (IOM, 1999, 2001) brought it to the forefront . The six IOM aims: safety, effectiveness, patient centeredness, timeliness, efficiency and equity became a mantra in the healthcare settings. The Institute for Healthcare Improvement (IHI) focused on specific safety issues and established the “No Needless List “ including deaths, pain or suffering, no helplessness in those served or serving, no unwanted waiting, no waste and no one left out.” In their focus on reducing defects and errors, reducing needless deaths and preventing harm from care they became world recognized in their 100, 000 lives campaign, 5 million lives campaign and now the Triple Aim: better care, better health and lower cost.

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