Implementing Electronic Health RecordsMy own experience, as a patient, with electronic health records (EHR) here in Massachusetts has been positive, which inclines me to think that the push to expand use of EHR is, generally speaking, well-advised. However, it is essential to understand that implementing EHR effectively is a multi-faceted proposition.
As Julia Adler-Milstein, a doctoral student at Harvard Business School, explains in a brief article in the April 2009 issue of the Harvard Business Review, introduction of an EHR system at a healthcare organization must be accompanied by organizational changes:
- increased individual decision-making authority
- comprehensive training
- flattened hierarchy
- more use of skilled workers
- decentralized teams
- incentives for team performance
After adopting an EHR system, Geisinger ... gave nurses additional authority to respond to medical issues they saw cropping up in the patients' records and made better use of their skills by automating mundane tasks. The organization also created financial incentives for team performance, particularly in areas such as diabetes care, and developed an extensive training curriculum that included close observation of physicians as they used the system.For a fuller description of Geisinger's innovation strategy, you can look at an article published last year by Geisinger's chief technology and innovation officer, Geisinger's CEO, and the president of the Commonwealth Fund, which provided funding for the study: "Continuous Innovation in Health Care: Implications of the Geisinger Experience" (Health Affairs, Vol. 27, No. 5 (Sept-Oct 2008), pp. 1235-1245).1
1 If you have trouble accessing the Health Affairs article, you can read a summary at the Commonwealth Fund website.