Continuous Quality Improvement: The 'Unintended' Consequence of EHR Implementation

In a previous article ("Keys to EHR Team Success," Healthcare IT News; January 12, 2009) we detailed a number of governance structural components which are key to successful electronic health record (EHR) implementation.

In that article we emphasized that active involvement by both senior healthcare administrators and clinicians is essential to the successful planning, selection, and implementation of an EHR. We noted that it becomes rather tempting for both administrative and clinical leadership to view conversion from paper to electronic records as an information technology project. Conversely, we concluded that the ideal approach recognizes the essential role played by IT but acknowledges such activity is in fact best viewed as an operations effort supported by IT.

It is worth noting that the EHR implementation governance structure must be well delineated at the outset; however, at some point near the “go-live,” the organization must begin the process of conversion to an EHR management and maintenance structure. The entity that performs this role will go by varieties of names but often results from a morphing of the EHR Steering Committee. The timeline when this transition occurs is somewhat blurred and will be related to multiple factors including the autonomy and effectiveness of the project leadership; but for optimal functioning of the EHR, it must occur. Ideally, this entity will be quite active with adequate time prior to “go-live” to address issues such as risk identification and management with some level of facility.

When considering the precise role of this management/maintenance structure it is worth reviewing the rationale for implementing the EHR in the first place. With rare exception, this rationale will have at its core, the goal of optimizing the quality of care delivered by the healthcare organization. It is well recognized that increasingly clinicians and providers are challenged to monitor, and thereby manage, an apparently limitless array of measures while at the same time being expected by patients, payers, and regulatory bodies to spend more time documenting the care they deliver.

In an attempt to address these often conflicting expectations, substantial effort has supported health care organizations implementing an EHR. Moreover, in addition to the considerable governmental, payer, and regulatory pressure on EHR utilization, quality studies are beginning to demonstrate considerable justification for such support. A recent multi-hospital Texas study identified a 15 percent drop in mortality among hospitals going from paper-based to electronic health records (Amarasingham R et al, Arch Int Med, 2009). In addition, in this study, those hospitals with increased computer provider order entry (CPOE) adoption documented decreased overall complications.

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