Federal stimulus incentives included in the 2009 ARRA HITECH act have prompted healthcare providers nationwide to accelerate their adoption of electronic health records (EHRs). However, despite the inevitability of an electronic healthcare environment, this often divisive question remains: What’s the most efficient – and effective – EHR implementation approach?

Like most questions, the answer depends on who you ask. Key hospital decision makers may advocate for or against a certain implementation approach, as they give priority to enterprise-wise EHR objectives relating to Meaningful Use, quality initiatives, regulatory reporting and interoperability. Those working on the front lines, including health information management (HIM) professionals, may have a completely different opinion, reflecting their focus on functionality needs, ease of use, and speed of implementation.

Understanding the unique needs of each function in the hospital makes for a more effective overall EHR implementation. In particular, HIM and its operational needs, which are the focus of this article, should be carefully considered prior to the selection of an EHR vendor and implementation approach.

Health Information Management functions underlie every critical hospital activity. As the facility’s information experts, HIM professionals typically know what data is coming into the hospital, what needs to be reported, and what information needs to be made available for clinical care, for regulatory compliance and for accurate reimbursement. For example, unless HIM is functioning optimally, facilities will see a growing list of “discharged-not- final-billed” accounts and corresponding delays in reimbursement. Ensuring that HIM is able to run efficiently – and that its workflow isn’t interrupted or negatively affected by EHR implementation decisions – is not simply a matter of convenience. It’s a necessity.

Current approaches

In today’s competitive health information technology market, hospital executives find themselves facing a confusing array of EHR and health information system (HIS) vendors, each of which is vying for their attention and budget dollars. In the interest of perceived cost efficiency and ease of implementation, some hospitals may ultimately choose one core EHR/HIS vendor in the hopes that this “one-stop shop” will meet all of their clinical and non-clinical needs.

A second option is to choose a core vendor while also acknowledging that best-of-breed add-ons may be necessary in the future to enhance workflow. In this scenario, best-of-breed solutions are not initially incorporated into the facility’s strategic implementation plan. Rather, this technology is an afterthought, implemented only when the need for additional solutions becomes apparent.

A third, and increasingly more common, approach is to choose a core vendor while also planning in advance to strategically deploy best-of-breed technology. Hospitals pursuing this strategic best-of-breed approach give priority to end-user concerns, understanding that one vendor can’t be expected to provide the full spectrum of functionality required. Those charged with vendor selection assess each facility’s operational needs up front, and then select the appropriate mix of best-of-breed solutions to complement a core vendor’s product. This approach can help to ensure that a facility’s total EHR solution accomplishes institutional objectives while meeting the specific needs of its key stakeholders.

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Strategic “Best of Breed” Approach Ensures EHR Success

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