The successful implementation of electronic medical records cannot be completed overnight. Planning and implementation work is very complicated, and there may be problems such as poor management. Not all electronic medical records can be successfully implemented, which is not surprising. When the implementation of the hospital informatization project fails, how can the hospital move forward and find the right direction with the mentality of "failure is not what we want"?
It is difficult for us to determine the exact failure rate of implementing electronic medical records. Data show that the failure rate of the implementation of electronic medical records hovered around 50%, while another report found that 19% of electronic medical records failed to install successfully. In 2009, a report by a medical information technology consulting company, AC Group, pointed out that due to difficulties encountered in the use of electronic medical records, the failure rate of electronic medical records implementation should be as high as 73%.
Despite the differences between the numbers, the failure to implement electronic medical records is indeed a serious problem. Medical institutions are reluctant to discuss the issue of failure. No one wants to let others see their poor organizational skills, especially in the form of public exposure.
However, some industry experts encourage hospitals to share failure experiences in order to promote the further development of the medical industry. "Except for the medical industry, all other industries recognize that true learning comes from failure," said Jonathan A. Leviss, MD, Chief Medical Officer, Rhode Island Quality Institute, Providence, Rhode Island, USA. Can be impressive.
He pointed out that summarizing the four major factors leading to the failure of medical information technology is more useful and more impressive than summarizing the four major methods of success. "When I undertake medical information technology projects at the institute, I pay special attention to avoiding the four major factors that cause failure. At the same time, we may only use three of the four successful methods."
Leviss pointed out that it is essential to constantly evaluate electronic medical record procedures. "Part of the project management is to often ask 'what problems are present'. The problems may include exceeding the budget, the software provided by the manufacturer lacks important functions, or there is no suitable doctor to participate in the project, etc.," he said.
HIT implementation failure case 1: Washington Endocrine Center abandons old electronic medical record system
Due to the limited function of electronic medical records or other reasons, the clinical director of the Washington Endocrinology Center, Michael J. West, MD, and his first electronic medical record supplier were terminated. West opened the clinic in 2009 and purchased an electronic medical record system for $ 10,000. After studying the system for two months, he put the thin client server in the clinic. Technical problems ensue, for example, the system has many broken software links. Once one software is fixed, other software will stop running and wait for the bug to be fixed.
"Since the electronic medical record has never worked properly, we have never carried out complete training," West recalled. He originally planned to conduct remote training, but due to improper software installation, he could not conduct comprehensive electronic medical record training.
There are problems with electronic medical records almost every day, and providers of electronic medical records always promise to repair them immediately. West said that the format of the medical record card is very strange, and it cannot visually show the doctor's way of doing medicine. "For the family history of the patient, if the mother died of heart disease at the age of 65, I must know what the ICD-9 code for heart disease is, and the drop-down menu is endless-does the patient drink alcohol? What is the amount of alcohol consumed in a day? What type Alcohol? Weekly drinking? Daily drinking? Electronic medical records can recognize the billing language, but the documentation is not meaningful. I did not use part of the electronic medical records, and most of the time I used free text boxes to record text. "
West added that part of the reason was that the hardware recommended by the electronic medical record provider to his clinic was inappropriate and did not achieve the maximum functionality. The provider provided two specification sheets, one to the IT staff and the other to West. West and the technicians found that the hardware recommended above was different when comparing the two instruction sheets. Not only did the provider ignore the related issues when he bought the server, but he never gave West a reasonable explanation for suggesting that they buy two different servers.
For three months, West has been told that the electronic medical record system can be customized, but with little success. In February 2010, West terminated the contract with the provider. Because the information of the product was not true, he requested a full refund, but in the end only got a partial refund.
With this experience, West vowed to never purchase a stand-alone electronic medical record technology in the hospital, but choose network software that can log in and work online. "If the service is not normal, we can immediately cut off and rent another network. I will not buy any more hardware." He is now using online software at no cost to make electronic charts in free text format. In this way, they can write medical record cards in their favorite style and language. He has recently put the server on the shelf.
HIT implementation failure case 2: Detroit Medical Center terminates CPOE implementation
Change is not easy. Hospital information managers know that it is more difficult to change the way doctors behave. A major failure of information technology in 2003 is the earliest example. The Los Angeles Times reported that about 400 doctors at the Cedars-Sinai Medical Center in Los Angeles expressed strong dissatisfaction with the hospital ’s CIO ’s cancellation of the Computerized Physician Order Entry (CPOE) system. For this reason, the explanation given by the hospital administrator was for system security (Charles Ornstein, The Shatter Times published on January 22, 2003). There are rumors that the CPOE system cost $ 34 million. The Cedars-Sinai Medical Center leader did not confirm this number in an interview with Clinical InnovaTIon + Technology. He said:
"Implementing the CPOE system is very difficult and complicated. The Cedars-Sinai Medical Center failed to try the CPOE system for the first time. One of the reasons is that we have to understand how to create and deploy CPOE early on. Recently, we are redeploying CPOE , Cedars-Sinai is currently undergoing a strict internal review. "
Detroit Medical Center (Detroit Medical Center) Chief Medical Information Officer, MBA, MD, Leland A. Babitch also suffered a defeat implementation of CPOE. In 2004, before he took office, the Detroit Medical Center chose a smaller mental health department to implement CPOE. Babitch said that after the IT department complete the setup, implementation and training systems, the system was put into use the initial situation is very bad. "The doctor's order catalog is neither intuitive nor scientific in design," he recalled. "The amount of training received by doctors and the technical support received are not great, and there are no other important matters such as nursing records or electronic medical management records during the implementation Function formation and integration. "
The nurses complained about the new tool from the beginning and thought it was a burden rather than a weapon. Babitch stressed that the lack of medication errors during system or application of medication to the patient may forget the evidence of injury, the user very unhappy, so the Detroit Medical Center to immediately terminate the implementation of CPOE.
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