Key strategies for EHR success, beyond implementation

Epic Emeritus CMIO physicians can play a valuable role when it's go-live time for health systems transitioning from legacy systems to the Epic EHR. But while a successful go-live is an important and impressive achievement, it is just the starting line.

To realize lasting ROI from new implementations, health systems would do well to take advantage of an array of Epic-specific programs to help physicians and promote EHR success – for example, its Gold Stars evaluation framework and its Diamonds recognition program. 

Another valuable resource, of course, is the array of HIMSS Maturity Models, especially the Electronic Medical Record Adoption Model, or EMRAM. (HIMSS is the parent company of Healthcare IT News.)

Dr. Michael H. Zaroukian is an Epic Emeritus CMIO who in addition to his MD holds a PhD in cellular and molecular immunology and is co-chair of the Health IT Commission in the Michigan Department of Health and Human Services. Additionally, he serves as a professor emeritus in the department of medicine in the College of Human Medicine at Michigan State University.

Further, he is retired from his position as vice president and CMIO at Sparrow Health System and is a past chair of the HIMSS Board of Directors. He has a history of assisting with HIMSS Maturity Model development and has been a reviewer for Stage 7 validation site visits, especially with EMRAM and its outpatient counterpart, O-EMRAM.

A virtuous cycle of change

Zaroukian stresses frameworks and approaches that promote a virtuous cycle of change that enables clinicians and health systems to keep improving using information and technology are key to success beyond EHR implementation. 

While EHR technology is essential, frameworks that involve people, relationships, conversations, culture and approaches to change are just as important, he said.

"First, let's talk about the importance of trust," he stated. "Stephen's Covey's '7 Habits of Highly Effective People' provides an insightful, practical framework for effectiveness, which is foundational to relationships with patients and colleagues.

"Without trust, there is no foundation for effectiveness, so demonstrating trustworthiness and building trust are vital for leading change," he continued. "Covey's three habits of personal effectiveness, combined with his three habits of interpersonal effectiveness, and sustained by the habit of self-renewal, are powerful effectiveness tools."

Next, change conversations often reveal differences in opinions and strong emotions, so, for difficult conversations, Zaroukian often turns to the framework and approach in the book by Kerry Patterson and colleagues, "Crucial Conversations: Tools for Talking When Stakes are High."

"In crucial conversations, opinions differ, emotions run strong and the stakes are high," he explained. "They can suddenly emerge from what started as a simple meeting or conversation, so recognizing when you are in crucial conversations and handling them well can mean the difference between effectiveness and disaster. Learning and effectively practicing these skills can be a superpower.

The forces exerted by group culture

"Another important change consideration is organizational culture," he continued. "Daniel Coyle's 'The Culture Code' examines the characteristics of highly successful organizations and the powerful forces exerted by group culture, which can have a greater impact on success than even well-constructed plans."

Zaroukian finds these three questions from the book helpful in getting a sense of how people view their organization's culture and whether it supports their success:

• Do you feel safe?
• Do you feel connected?
• Do you see a future together?

"Understanding the organization's culture can help assess change readiness and inform next steps if there are important barriers to change," he said.

There are many benefits health systems can expect from these helpful frameworks and approaches for building on initial success, he continued. Health system leaders who effectively apply these frameworks and approaches can expect several benefits that will help create a virtuous cycle to foster continued success, he noted, including:

• Increased trust.
• A culture with a greater sense of safety, connection, belonging, future-orientation and a growth mindset.
• Better recognition and handling of crucial conversations, with stronger relationships, mutual purpose and shared solutions.
• Lower resistance to organizational change with more engagement and support.
• More effective action plans for leading organizational change.
• Greater sharing of ideas by frontline caregivers for ongoing organizational improvement.
• Increased participation in, or even championing of, change-related activities.

The power of HIMSS Maturity Models

While Zaroukian has many Epic-specific ways to work toward EHR success, he is a big supporter of the HIMSS Maturity Models, including HIMSS Stage 7 and EMRAM.

"My enthusiasm for the HIMSS Maturity Models starts with my own journey from practicing physician, medical educator and clinical informaticist to becoming vice president and CMIO of the health system in my community," he explained. "In this role, I was charged with providing physician executive leadership to advance the digital transformation our health system needed to support highly effective healthcare and organizational success in the 21st century.

"The HIMSS Maturity Models, particularly the hospital and ambulatory EMR Adoption Models EMRAM and OEMRAM, respectively, were key to this effort," he continued. "They provided our health system with externally validated roadmaps and blueprints for this work, along with definitions of and metrics for achieving the highest recognized level of EHR adoption, for things like clinical documentation, computerized provider order entry, interoperability, device integration and bedside bar code medication administration, just to name a few examples."

The maturity models enabled Zaroukian to provide the health system with a so-called "destination postcard" for clinicians, IT staff and operational leadership, making it clear what exemplary EHR use looked like, what needed to be implemented to achieve Stage 7, how staff would measure success, the benefits the health system could expect, why staff should take pride in this achievement, and how achieving Stage 7 would be a springboard to the even higher achievement that the HIMSS Nicholas Davies Award represents, he added.

Digital maturity few have achieved

"Even in 2025, HIMSS EMRAM Stage 7 validation reflects a level of digital maturity that fewer than 10% of hospitals in the U.S. have achieved, representing both a marketing opportunity and a potential competitive advantage," he noted.

"Additionally, HIMSS Stage 7 EMRAM and OEMRAM validation required not only that we have all of the advanced tools in place and become a virtually paperless system, but that we also develop and present case studies of how we used our advanced EHR to improve care and system performance," he continued.

The process, Zaroukian explained, included putting together clinically impactful and financially beneficial examples of, in order:

• How EHR data were used to identify a problem or opportunity for improvement, such as immunization rates, sepsis detection or emergency department throughput.
• Development and implementation of a solution.
• Measuring results.
• Demonstrating sustained improvement.
• Sharing lessons learned and next steps that other organizations can use in their improvement journeys.

"You can see how the case study requirement for HIMSS Stage 7 validation aligns with the types of activities that can help health systems continuously improve, building on their initial success and maximizing their EHR and digital transformation ROI," he said. "As such, I recommend health system leaders make HIMSS Stage 7 validation a goal and milestone in their digital transformation journey."

Seeking expert help

Epic Emeritus physicians and other experts familiar with the HIMSS Maturity Model criteria and successful validation for health systems can assist health systems achieve Stage 7 and clinical, financial and other associated benefits.

"Most Epic Emeritus physicians – particularly those with a history of serving as a CMIO, CHIO, CIO or CNIO – are familiar with the HIMSS Maturity Models, such as the ones I just discussed," Zaroukian said. "Emeriti may have even led achievement of HIMSS Stage 7 validation in their own organizations and participated as volunteer validators on Stage 7 site visits.

"These individuals will have great insight into how to achieve Stage 7 and why it is worth striving for," he continued. "Their guidance can range from how to implement a specific EHR functionality and achieve pervasive use – such as bedside blood specimen scanning – to identifying and mapping out potential HIMSS Stage 7 case studies the health system would like to pursue as part of its improvement journey, such as decreasing length of stay or readmissions, which can have both quality and financial benefits."

So, all this being said, what are the end goals of having the most successful EHR deployment possible? This is the important question, Zaroukian said, and it aligns with one of the Covey "7 Habits" he alluded to earlier: "Begin with the end in mind."

What does 'the end' look like?

Since every health system will have its own goals and aspirations for success, in the end the organization will need to answer this question, he advised. But he offers some EHR-related goals that a health system might prioritize, such as:

• EHR functionality and use consistently supports the health system's mission, vision and values.
• EHR implementation enhances the health system's ability to measure what it values, advances its analytics capacity and improves performance.
• Clinicians use the EHR with effectiveness, efficiency and satisfaction – regardless of specialty, context, roles or goals.
• Real-time clinical decision making is enhanced through EHR-integrated clinical decision support.
• Health information intra-operability and interoperability improve timely access to complete patient data wherever it may reside.
• EHR use improves patient safety and decreases the risk of errors, including those from health IT itself – which can be assessed using the CMS Safety Assurance Factors for EHR Resilience, or SAFER, Guides.
• Clinicians view the EHR as improving their ability to provide high-quality care, support health system goals, decrease unnecessary burdens, focus on their patients, restore the joy of practice and feel supported by the health system.
• Patients appreciate and enjoy benefits from EHR implementation, such as better access to care, timelier access to their health information, tools that help them more actively participate in their own care, greater connectedness with their clinical teams, higher satisfaction, and greater loyalty to the health system.
• Clinicians are more confident in the health system's ability to effectively lead and manage change going forward.

Click here (or on the video below) to watch a brief video of Bonus Content where Dr. Zaroukian offers tips for CIOs, CMIOs and other health IT leaders at hospitals and health systems preparing for the post-go-live period of EHR implementation, and more.

Follow Bill's health IT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.

WATCH NOW: Details on managing the EHR post-go-live period from an Epic Emeritus CMIO