HIMSS 2010: Lessons Learned from Developing a Premier Global EHR

Here to hear Capt Michael Weiner talk about the Defense Health Information Management System (DHIMS) and the lessons that the DOD have learned.  I have a personal interest as I grew-up in the military health system and my parents and a large number of family members are in it now.  I haven’t been posting a lot of notes as I’ve just been absorbing, but this session should has lots of good information.

  • This isn’t a technical issue.  It is a “cultural, paradigm, shift”.
  • Don’t  be HIPAA compliant for the sake of compliance.  Be compliant because it will protect your patient’s information.
  • Challenges to be faced when implementing:
    • Development of functional requirements
    • Maintainability/Interoperability
    • Acquisition Process
    • Enterprise Architecture
    • Theater Communications and Bandwidth
  • Steady and reliable network is critical
  • Buy-in from the team, physicians and support staff, is critical
  • EHR will not fix a broken process. Take time to document the workflow and understand How You Do It. Used a great analogy for that by talking about Starbucks’s great workflow and a hotel coffee shop’s poor workflow. (I had a similar bad experience at a coffee shop at the airport. Had to find the spot with the lids and crossed paths twice.)
  • Try it out first.  Pilot it and include it everyone in the office from day one.
  • New and Shiny May Not Be Best.  Test the ergonomics of the hardware.  Different participants may need different hardware options.  A tablet has to be carried, so they put a computer on wheels that let them move other things as well.
  • System needs to be intuitive.  IT guys aren’t always around.  The system needs to make it easy for the physicians that may not be technical.  Needs visual feedback mechanisms.
  • See One, Do One, Teach One: hybrid education efforts.  Classrooms, 1-on-1, over-the-shoulder, and computer-based resources for training.
  • Use the Web: Look at web hosting and virtualized solutions, especially for smaller clinical offices. (Talk of using the cloud without the term “Cloud”. Awesome.)
  • Wireless networking and no mice.  Wires are bad and cause problems.
  • Use multiple methods to input clinical healthcare data.  Use templates, auto fillers, macros, scribe, speech recognition (not everyone can type), dropdown menus.  It should support Workflow.
  • Change is not always accepted, so empowering staff to get their “buy in” will help with adoption.  The team has to be involved, though that doesn’t diminish the need for a champion.
  • Make it Personal: Patient centric care and patient portals is a shift for the patient community.  It will be a generation+ transition for the patients.
  • Sharing is Caring. The Nationwide Health Information Network (NHIN) is the “dial-tone” for the future.  Every EHR is going to have to fit in.

Captain Weiner was a great presenter.  Loved the presentation.  Lot’s of good lessons that apply to large and small facilities.  Now off to catch-up with my colleagues.


All information in this post was gathered from the presenters and presentation. It does not reflect my opinion unless clearly indicated (Italics in parenthesis). Any errors are most likely from my misunderstanding a statement or imperfectly recording the information. Updates to correct information are reflected in red, but will not be otherwise indicated.