Rapid EHR rollouts with “compressed functionality” are commonplace today.  Many U.S. hospitals are joining the Meaningful Use gold rush hoping to qualify for Stimulus payments and should be aware that accelerated EHR implementations can also bring added risk.  They further complicate complex clinical device strategies that for Meaningful Use must take the EHR to the point of care. 

Till now, most hospital EHR deployments have been protracted; only a handful of organizations have automated all core clinical functionality.  Fewer yet have near “paperless” operations. Multi-year EMR implementations have been the norm, resulting in fragmented processes, dual electronic and paper systems and numerous workarounds in many organizations.

While mobile workstations, when implemented properly, can be very effective as the primary “point of care” device, industry analysts report that a significant number are also used in hallways as satellite nursing stations or med carts.  Data collected and documented on scraps of paper or forms at the bedside are entered manually later – or much later – into the EHR.  While this “automated process” meets Meaningful Use Phase 1 Vital Sign capture criteria, it adds errors and replicates – or worsens – inefficiencies of the paper system.  Real time clinical decision support data, such as vital signs, used by MDs in ordering decisions remain in RN’s or CNA’s pockets inaccessible to physicians performing CPOE.  

To achieve Meaningful Use, increasingly numbers of physicians and authorized providers will enter orders directly into the EHR.  What has not been clear is that safe CPOE requires nurses to enter key patient assessment data used for decision support in near real-time at the point of care.  These process changes will require culture change and a clinical device strategy that supports this critical transition.