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Kids, We're Getting a New EMR

August 17, 2008
by daphne
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You just put the last screw in your enterprise EMR. And the day you’re finally finished—after millions of dollars and years of 12-hour workdays – you start the process of throwing it out and getting a new one.

Wow. You must be crazy.

I thought that happened once in a blue moon--until I started writing a story about migrating a legacy EMR to a new one. Boy, was I was wrong: Once I started digging, I found more hospitals than I ever imagined springing for a new system after just getting up to speed on their old one.

And all I can think of is, how the heck do you tell hospital staff, nurses, docs and everyone else, “Kids, we’re getting a new EMR” without them turning around and shooting you?

In the process of researching the story (for October’s HCI) I talked to some CIOs who were switching out their legacy enterprise system—CIOs who’d already switched, were in the middle of switching, or just about to switch. And I talked to Jonathan Thompson of Healthia Consulting, who at least got me to understand WHY they did it (see One-on-One.) But I still can’t get stop thinking about the people who are going to actually have to use the new system. Because that’s who’s going to make or break you.

Look around your hospital and you’ll know what I mean. Here’s what you have: slim margins, overworked staff, regulatory changes, re-engineering, downsizing, all the STUFF they’ve already been asked to swallow. They went along with you once. They learned the new system, lived through the go-lives, implementation, change management, and meeting after meeting after meeting. And they all know the financial deal.

So now you’re telling them to do it AGAIN? And you’re about to spend HOW much? After everything they’ve been through, and all the industry changes they’re living with, you’re trying to get them to embrace a system that is going to cost millions of dollars and eat up huge chunks of their time?

Good luck.

Because I know, that no matter how good it looks on paper, if you’ve got a resentful nurse, flummoxed reg clerk or ED doc digging in his heels, you are in big trouble.

My old boss, Maricar Barrameda, is CIO at a hospital network in NYC’s public hospital system. She’s a great CIO, and is about to retire her legacy system and move on with a new one. And the more I learn about this process, the more I wish I was going to be there to help her get it right from the beginning. So maybe, just maybe, by writing this, and reaching out to all of you, I can.

Can we get a dialogue going? If you’re a CIO who has some ideas on this, add a comment.You’ll be helping one of your peers. Maricar, you know I’m always there for you.



Check out these interviews with HUMC --- they are going from a mix of Siemens and GE to an all-Epic shop -- a huge, multi-year project

One-on-One with HUMC's CIO Lex Ferrauiola & CTO Ben Bordonaro

Thanks for confirming the trend and elaborating the issue.

In my career, I've seen these 'Old EMR to New EMR' (O2N) migrations many times. They're very, very different from 'Paper to New EMR' migrations.

There was a wave of them in the Y2K replacement era, with the TDS 4000 systems (which did CPOE and was not Y2K compliant) to the nascent, 'modern' CPOE systems.

Those were challenging for at least 2 reasons: 1) lots of content from the TDS systems had been built, vetted, and in every day use (and didn't migrate well from the 40 character x 24 line screens, all 16+ screens flips of them) and, 2) the 'modern' CPOE systems were much slower. Lots of reasons.

Marion Ball, fifteen years ago, impressed upon me that most technology migrations require going through 3 (three) phases: Replicate, Innovate, and then, Transform. Attempting skipping phases doesn't work. It's very tempting and would seem to be more economical.

So, if for example, you're migrating from 'basic' MediTech, to one of those multibillion dollar, multinational EMR vendors, be sure, per Marion, that you replicate the basic, daily functions, closely enough so that nurses and doctors have a reasonable chance (before and after training), of finding the everyday stuff they need.

Your guidance to Maricar is right on target. Get it right from the beginning.

Homework First!

Thanks Anthony.

I've read Parts I, II, and III. Very worthwhile read. I especially liked the Rake and Garden analogy better than 'a hammer is not a house,' which I had been using to try to make the point. Less elegantly.

HUMC is a fabulous case study and it elaborates Daphne's points beautifully.

For a quick scan, go here:

There, you'll meet the CMIO that Lex and Ben refer to, Dr. Gerard Burns (now at MedStar.) Jump down the page to "A few years ago, 89-year-old Anna Terrano... " The summary is pretty good.

The $30 video is worth the time. The HUMC story is 30 minutes. I've edited it down to 14 minutes and use it to facilitate the dialogue on Physician Leadership.

Dr. Lauren Koniaris and Dr. David Brailler share several important observations.

The video also contains the Josie King / Johns Hopkins story, and the stealth epidemic story, where Dr. Jeffrey Guterman and others elaborate another powerful and relevant story for HCIT audiences.

Thanks Joe. I do remember referring to Marion's work myselfI think I had a lot of those books on my bookshelf. Workflow, those basic daily functions, it appears, are everything here.