Rose RohloffThe Health Information Technology for Economic and Clinical Health (HITECH) Act-part of the 2009 American Recovery and Reinvestment Act-has spurred the expedited purchase and implementation of electronic health records (EHRs).

There have been numerous reports from the College of Healthcare Information Executives (CHIME) and other organizations regarding the lack of qualified personnel to implement, train, and maintain EHRs. Hospitals have tended to overlook one important question: What is the definition or characteristics of a qualified person? Do hospitals know to ask for the right people?

Hospitals have historically placed clinicians in IT roles for implementation and training of documentation and tracking systems. In many instances, the clinicians are mired in current processes, which may or may not be optimal approaches. The automation of bad or outdated processes ultimately leads to poor adaptation with poor reporting and analysis. Automation alone will not enhance processes, avoid or reduce costs, or improve care delivery. Without proper implementation, decision-makers will receive and act upon bad or incomplete information, often leading to corrective actions that address only symptoms and not the underlying issues.

Larger organizations frequently outsource system implementation functions, but smaller facilities are more likely to hire or mentor current employees for ongoing, in-house expertise. A typical job posting for a clinical information specialist might include the following details, which are extracted from several actual postings:

        The Clinical Information Specialist is a licensed clinician to assist with
        the planning, implementing, testing, training and support of assigned
        clinical information systems. This person will develop project plans, 
        provide training, and collate clinical data required to monitor patient 
        outcomes and improve clinical performance. 

        Required Minimum Education:
Licensed clinical practitioner, RN Licensure, BSN preferred. 
        Bachelor degree in a health-related field preferred.

        Required Minimum Experience: 
        Minimum five years of experience preferred in clinical practice at the 
        bedside and/or information systems related activities. Prefer experience 
        combination of clinical practice and information system
        implementations. Training in clinical systems applications is desirable. 
        Experience in nursing management is also desirable.
        Required Minimum Skills: 
        Requires advanced computer skills including a good understanding of 
        software systems. Interpersonal, communication, and organizational 
        skills required; must be proficient in the use of Internet browsers and 
        Microsoft Office products.

So what is missing?

Understanding optimal processes for data entry and operational efficiency does not require an active clinical license. Preferably, personnel qualifications for successful EHR implementations should include:

  • Project management experience and certification preferred
  • Understanding of workflow analysis and facilitation skills in change management, process improvement, and cross departmental coordination
  • Understanding of data and use of information in decision making for optimized patient care
  • Ability to bring industry standardization to data setups, and ability to use data for process analysis

EHRs are multimillion dollar investments for hospitals. Obviously, it is important to select the right system; but it is also just as important to invest in the necessary personnel for proper adaption to optimized workflow for meaningful-use reporting based on best practices, and for optimized data entry processes with full system utilization. The project lead for successful system implementation and-more important-for adoption and ongoing sustainability needs to know when workflow optimization is required and coordinate the effort, to bring key stakeholders together for change management, and to understand how data are to be used for decision making to ensure appropriate linkage and standardization.

A successful EHR implementation requires much more than a narrow focus on simply getting the technology installed and implemented.  Broadening the focus to also include bringing in or mentoring the right people is the best way to ensure that the hospital's long-term investment in the information system tools and resources will effectively support the essential goal of achieving ongoing continual improvements in patient care.

Rose is executive director at The PARC Group LLC, Chicago.

Publication Date: Monday, November 26, 2012