EHRs and the Long Road to Quality Excellence

Terry Hill, Executive Director

(This content was originally published for the Texas Organization of Rural & Community Hospitals)

My mom often told me, “The road to hell is paved with good intentions.” Her words come to mind now, as I consider rural hospitals’ long, bumpy road to meaningful use of electronic health records (EHRs).  In the past several years, our National Rural Health Resource Center has worked with dozens of rural hospitals across the United States. Almost all have struggled to meet the challenging deadlines, with insufficient resources and inadequate understanding of how it’s all going to work. Rural hospitals started out in EHR adoption significantly behind their urban counterparts, and they continue to trail in the race to meaningful use and the associated financial incentives.

Many of the obstacles and breakdowns are beyond the control of individual hospitals. National legislation locked in some of the deadlines, incentives and processes, and federal agencies such as the Office of the National Coordinator (ONC) have good intentions, but limited understanding of rural hospital circumstances. We should all be used to this by now. Health policy makers have historically overlooked rural in most of their major plans and policies.

Instead of lamenting the unfairness of the circumstances, let’s look instead at what rural hospitals can control with EHR implementation. At the top of the list is the crafting an inspiring vision as to why all of this disruption is necessary. And, this must be developed and communicated by top leadership, and cannot be delegated to others. Ultimately, EHR implementation has to be about quality and patient safety, not technology. At its best, an EHR system can hardwire quality. Paper medical records have proven to be dangerous and inefficient, and are archaic holdovers from the twentieth century.  Almost all other industries have moved on to electronic records because they are more accurate and provide vastly superior information for decision making. Health care is not an exception; numerous studies have shown the benefits of EHRs, and their role in improving quality and safety is no longer in question.

After leadership develops the compelling EHR vision, it is necessary to plan the road from where the hospital is now, to where it wants to be. This strategic plan for EHR implementation must include improving clinical quality processes, providing education, and communicating to staff why this difficult change is eventually going to be worth the time and effort.  In short, IT HAS TO BE ABOUT QUALITY!  In most hospitals we’ve worked with, this key message is not adequately communicated. The road to meaningful use, to financial incentives or to some techie’s vision of nirvana, does not inspire the staff, nor does it enlist the physicians.

Determining the inspiring destination, charting the course and getting the right people on the bus does not mean that the road will be easy, but it will mean that arrival at the final destination will be worth the long trip, and you may enjoy yourself more along the way.  In this approach to EHR adoption, technology will be appropriately used as a tool and not as a destination. Improved patient care will be the big payoff, and staff and leadership will look back proudly at having survived the turmoil and making their local health care system safer and more efficient. With this approach my mom’s road to hell will turn out to be the road not taken.