Michelle HolmesThe financial incentives for achieving meaningful use of electronic health records (EHRs), coupled with the broader need to better coordinate patient care, have generated a flurry of IT activity among physician practices. Problems arise, however, when the stated goal of the organization is to “implement an EHR.” When implementation itself becomes the goal, progress is generally slow, there can be extensive rework of failed attempts, and the frustration levels run high among both providers and managers. To avoid such frustration, implementation goals and associated metrics should focus on improving patient care, the real “prize” of a successful EHR.

Although everyone may recognize the importance of establishing meaningful clinical and operational goals for an EHR, most often organizations either have no explicit goals or settle for goals that focus on the process of EHR implementation, rather than on desired outcomes. Goals such as attaining 80 percent utilization by providers within six months may seem laudable but can be achieved without any change in coordination, quality, or cost of care. Rather than evaluate success in terms of project milestones, organizations should measure progress toward strategic priorities. Examples of goals that can provide substance and direction for the EHR include facilitating population health management, enabling the implementation of a patient-centered medical home (PCMH), and increasing patient satisfaction from operational improvements.

John WhithamAfter identifying clinical and operational goals for the EHR, the next step is to build a work plan around those goals. Regardless of what work plan methodology is used, specific tasks, timelines, and accountabilities should be developed for each goal. For instance, if facilitating population health management is a goal, the first practices to go live should include primary care, endocrinology, and cardiology. The final component to ensuring that the EHR meets organizational goals is to measure the progress and success of the EHR by clinical and operational metrics.

The important point in these examples is that an EHR is a tool to improve the patient experience in terms of outcomes, cost, and satisfaction. Therefore, the best way to evaluate the success of an EHR is to set goals for and measure improvements in the patient experience, rather than treat installation of the EHR as an end in itself.

The technical component of getting an EHR in place and functioning smoothly is of course important. It is absolutely true that the “nuts and bolts” of a timely EHR implementation or optimization initiative need attention. Timelines for data conversion, hardware installation, system configuration, and training are important, and most everyone understands these parts of the process. It is not as well understood that, although an EHR is necessary for improving patient care and efficiency, it will not result in any improvement without a specific goal-setting process and meaningful metrics of success. Establishing and maintaining a focus on better and more efficient care requires that organizational strategy drive all aspects of EHR adoption.


Michelle is a principal, ECG Management Consultants Inc., Seattle.

John is a principal, ECG Management Consultants Inc., Washington, D.C.

Publication Date: Tuesday, February 12, 2013