How to turn around an EHR disaster: three case studies

EHR systems are the backbone of modern healthcare practices, providing crucial data storage, patient management, and decision support.

However, when these systems fail, the consequences can be disastrous: internal software crashes, external threats like ransomware that disable a practice’s EHR system, and intentional or unintentional data breaches.

These can also be less high-profile from a public relations standpoint, such as an EHR implementation causing significant financial trouble for a practice. Therefore, healthcare practices must have a strategy for damage control and recovery.

These case studies highlight how to turn around an EHR disaster, demonstrating the importance of stakeholder engagement, contingency planning, and realistic implementation timelines.

1. Involving key stakeholders after a failed EHR rollout

Robert Wood Johnson University Hospital in New Brunswick, N.J., had a disastrous EHR implementation because front-line nursing staff weren't involved.

This led to widespread dissatisfaction and impacted patient care. After a leadership change, the hospital reevaluated its approach, deeply involving nurses in the new EHR's planning and implementation.

The result was a successful system rollout and improved quality-of-care metrics. This case highlights how crucial it is to include front-line staff in every stage of EHR implementation; their insights are invaluable for successful technology adoption.

How can key stakeholders impact EHR implementation?

Key stakeholders, such as front-line staff, provide critical insights into the daily use of EHR systems. Their involvement in planning and implementation ensures that the system meets practical needs and improves overall efficiency and care quality.

2. Responding to a 10-day EHR outage

In the era of paper records, a complete practice-wide outage of clinical data was nearly inconceivable unless records were physically destroyed or lost (an exceedingly rare occurrence); with the shift to electronic records, the risk of losing access to critical patient information increases due to potential system failures or cyber-attacks.

Guide: Avoid common pitfalls with this six-step guide to EHR implementation success

A 2013 case at Boulder Community Hospital in Colorado involved an EHR that could have crippled the nonprofit health system. However, the hospital managed to avoid a catastrophic failure by implementing an extensive contingency plan for system outages and data loss.

Linda Minghella, the hospital's Vice President and Chief Information Officer, described the organization’s preparedness:

“We had an organizational commitment to maintain continuously updated paper records that could be used at a moment’s notice. Additionally, we regularly trained our staff, especially new team members, to ensure they were familiar with our paper systems.”

This proactive approach kept operations running, though at a reduced pace, until the system was restored. It highlights the critical need for backup systems and staff preparedness to manage patient data effectively during outages.

What contingency plans are there for EHR outages?

A common contingency is to use updated paper records to access patient information in the event of a system failure. Staff training on this workaround is key to ensuring seamless care during outages.

3. Letting unrealistic deadlines dictate the implementation process

In 2016, NYC Health + Hospitals faced significant negative press after Dr. Charles Perry resigned.

As associate executive director and Epic project liaison for Queens and Elmhurst Hospital Centers, Dr. Perry cited a rushed EHR implementation that prioritized deadlines over patient safety.

Following public backlash and executive changes, the organization delayed the next phase of its $764 million Epic system rollout. This incident highlights the need for implementation deadlines to align with real-world conditions and key stakeholder buy-in, rather than arbitrary timelines.

Why is flexibility important in EHR implementation timelines?

It allows organizations to adapt to real-world conditions, ensuring that the system is deployed safely and effectively. It also helps in gaining buy-in from key stakeholders, which is essential for a successful rollout.

How can a healthcare organization prepare for a potential EHR disaster?

These three EHR case studies vividly demonstrate the importance of proactive planning, stakeholder involvement, and realistic timelines in avoiding and recovering from unforeseen disasters:

• At Robert Wood Johnson University Hospital, including front-line nursing staff in the EHR implementation process was the key to overcoming a failed rollout.
• Boulder Community Hospital's robust contingency planning helped it weather a 10-day EHR outage with minimal disruption.
• NYC Health + Hospitals’ experience highlights the critical need for flexibility and stakeholder buy-in when establishing implementation timelines.