If healthcare IT were golf, CIOs would take a few mulligans.
Choosing and installing an EHR is often one of the biggest, most complicated decisions IT leaders will ever make, and some executives told Becker’s they would do things differently if they could go back in time.
“It’s impossible to implement EHRs for 14 years without encountering some challenges, right?” said Amy Trainor, BSN, RN, senior vice president and CIO of New Orleans-based Ochsner Health.
When Ochsner Health was converting a community health system to its EHR, it decided to switch from mandatory in-person training to a web-based program that employees could complete on their own time. Within a week, it became clear it wasn’t working. Ochsner, a 47-hospital network, pivoted quickly, bringing in a training team to conduct face-to-face sessions with physicians.
“While we recognized the benefits of online training, we learned that it wasn’t suitable for new EHR deployments,” Ms. Trainor said. “Now, for facilities that are already live and need training, they can choose asynchronous web-based training. However, for new clinics or hospitals going live, in-person training is mandatory. We also discovered that those joining an established practice learned the most from their peers, which wasn’t the case for new go-lives.”
Health systems often try to limit customizations during EHR implementations but over time tend to permit them, whether to accommodate staffers’ personal preferences or because of entrenched habits, said Jonathan Manis, senior vice president and CIO of Irving, Texas-based Christus Health, which has over 60 hospitals.
“With well over 150 EHR implementations across three very large provider systems under my belt, I have yet to experience a case where we did not regret the number of customizations that were allowed,” Mr. Manis said. “Customizations are risky. They add significant cost and complexity, and they are difficult to test, difficult to manage, and difficult to upgrade.”
“We can change the system, or we can change our workflows and processes,” he added. “In all but the rarest justifiable exceptions, it is best to change workflows and processes and allow the EHR software to function as designed.”
Lisa Stump, now the executive vice president and chief digital information officer of New York City-based Mount Sinai Health System, said she would take back a past decision to make revenue cycle a parallel function.
“That choice seemed pragmatic at the moment, or at least seemingly manageable, but it created long-term consequences,” she said. “And ultimately, we made it harder to pivot when the organization needed more agility.”
Her health system at the time became dependent on multiple third-party tools and complicated workflows for capabilities the EHR could have handled, introduced unnecessary interfaces and manual validation steps, and experienced slower capture and avoidable leakage of revenue because processes weren’t aligned, Ms. Stump said.
“That missed opportunity underscored that the EHR should be treated as an enterprise platform, not a collection of departmental tools,” she said. “When we design with that mindset from the start, we avoid unnecessary complexity and unlock far more value for the organization.”
Sunil Dadlani, executive vice president and chief information and digital transformation officer of Morristown, N.J.-based Atlantic Health, a seven-hospital organization, said he would reconsider allowing so many bolt-on solutions to coexist alongside the EHR instead of evaluating and adopting native capabilities first.
“Investing early in strong governance and treating implementation not as a technical rollout but as an enterprise operating-model transformation dramatically increases clinical and operational excellence,” he said. “It drives higher adoption, more consistent workflows, better data integrity, and ultimately stronger outcomes across the organization.”
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