Implementing an EHR in any setting comes with a series of challenges specific to the tools, governing structures and personnel involved. While there are commonalities to be found between U.S.-based installs and those occurring in international markets, there are also variations that groups managing these critical projects must prepare for.
Here are four key differences between international EHR implementation projects and those based in the U.S.
Key Difference #1: Hospitals Working Together for the First Time
With many public or government-run procurements, hospitals often must join together through strategic partnerships. The reasons for this decision can be driven by political or regulatory considerations (i.e. ICS in the UK), a desire for increased purchasing power to fund an EHR, and/or other financial or clinical benefits as part of consolidation.
From a U.S. perspective, this may be reminiscent of a trend that was seen in our own local markets several years ago. Merger and acquisitions or a consolidated EHR platform across multiple groups (i.e. Community Connect) are still quite common in the United States, but many groups are often starting an EHR implementation by moving all of their hospitals from one system to another. Some groups are even in a stage where they’ve merged or consolidated on a single instance, and now they are beginning to separate their EHR instance. One could speculate that separation could be a post-consolidation trend seen internationally soon, as well, if these consolidations are not planned and managed effectively.
As these partnerships form, there are a variety of considerations for success factors, such as shared governance and decision making models, consolidation and separation of workflows and data, ancillary and third party system architecture, and more. International groups that find themselves in this situation have the unique opportunity of networking with experts in the field and/or forming a peer group of other healthcare systems. These outside voices can bring fresh perspectives on how to approach projects differently.
Key Difference #2: Systems of Record
Next, pay attention to differences in digital maturity between U.S. and international markets. Generally speaking, the stage of digital maturity that organizations are often coming from internationally tends to be less than what is seen currently in the U.S. Here, many healthcare systems are often transitioning from one consolidated EHR platform to another or transitioning from best of breed. Abroad, it’s more common to encounter a much larger ecosystem of healthcare software systems, less sophistication in the digital maturity of those platforms, or groups may even be starting out with no systems at all in several areas of their healthcare delivery system.
This often means that the value that a group can have in bringing on a consolidated EHR platform can be even more impactful to a hospital’s users and patients, as well as overall efficiency and outcomes. It also means that working on a project of this size which can require cross-functional teams may be something that the hospital has never truly experienced before. As such, there is more time and focus needed to really get ready for an implementation of this scope, including during the pre-tender, in-tender, and early stages of implementation.
Leveraging peer groups or other experts for advice in steering the project is key here. Types of areas that are critical to get right up front include practice decision-making, practice risk-management and examples of implementation risks, formation of governance and organization communication, and change management tactics.
Key Difference #3: Regulatory Considerations
Often, groups will need to address a variety of regulatory considerations and requirements when working abroad. Similar regulatory oversight exists in the U.S., but international groups are more commonly tasked with managing a variety of reporting bodies and agencies. If there has been a similar implementation in that region or country previously, there may be a blueprint to work from. However, a strong partnership from all parties working on the install is critical to ensure requirements are understood and met. Open dialogue is often needed between the healthcare organization and governmental or regulatory bodies. Sometimes, regulations may be set that may have made sense with old systems of record or ways of delivering care, but now their new EHR can and should achieve something better.
Sometimes, these regulations are changed with minimal time to react and achieve compliance. Whereas this may be more practical in a limited time frame when an organization is not also consumed with the largest project they’ve ever embarked on, this can present many organizations challenges in the midst of their project. When these changes are introduced, there may be configuration or development considerations. By establishing healthy communication, the healthcare organization(s) moving to a stronger state of digital maturity can work with regulatory and governmental agencies to shape those regulations before they are released and to set timelines to achieve compliance without risking the success of other critical deliverables for their EHR project.
Key Difference #4: Media Presence
Finally, international EHR implementation projects must grapple with the effects of local media presence. As noted, this may be the largest project a healthcare organization has taken on to this point. When this is coupled with governmental oversight, many international installs become very public implementations. Groups that succeed under this sort of pressure and scrutiny start by developing a plan.
Acceptance is always the first step. There’s no way around it; the media will be a part of the implementation. The groups that are successful in handling this pressure develop a plan. They keenly understand any public or political priorities as part of their implementation (i.e. investment in local economy, expected advancements in care, expected digital benefits for patients, etc.) and have individual(s) within the healthcare system manage that with the media. They help the media understand what to expect, focus on proactive coverage and develop a strong two-way dialogue between parties. This is another area where having a relationship with other organizations that have managed a media presence previously can prove very helpful.
Shared Lessons Learned
While there may be differences between EHR implementation projects in the United States and those that occur in international markets, groups with experience in a variety of settings often begin to recognize shared challenges between projects. By recognizing key lessons learned from these experiences and sharing takeaways, all parties can provide a smoother experience from pre-implementation to launch and optimization.
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David Fraser is Head of Implementation Planning at Medix Technology. After starting his career at Epic, he gained experience working with a variety of global health systems going to procurement or implementing an EHR, including work in the UK, Nordic countries, Singapore, Australia, New Zealand, Saudi Arabia, Kuwait, Vietnam and UAE.
 suggested that actions are needed to make the EHR decision process easier for practices, such as certification for EHR vendors and educational programs on how to select and implement an EHR system. This systematic review adds to the current evidence that individual, human, and organizational barriers remain challenges that must be addressed in an innovative manner, according to the particular needs of each implementation project and each user group. Active participation of end-users in EHR implementation is a promising strategy since it allows decision-makers to consider users’ perspectives, gain their support, and adapt the technology to users’ needs .