Many hospitals implement health IT as enterprise-wide efforts because the process can be more efficient in the long run, especially for electronic health records, meaningful use and certain software upgrades. While it is quite an under-taking, the enterprise-wide approach often works best for many organizations. However, this does not mean that the adjustment to the technology and possible changes to workflow will be seamless for hospital employees and physicians. Most likely, there will be challenges and a little push back. Here are six practices to alleviate potential difficulty.
1. Build a strong vision around the initiative. Mike Detjen, vice president of service offerings for Arcadia Solutions, a healthcare consulting company, believes that success in health IT initiatives, especially those related to meaningful use, comes from vision and clarity around where that initiative is going. Staff need to understand why the hospital is pursuing the HIT initiative — that it is a means to an end, not an end in itself.
"It is much more powerful if you speak to the bigger story. It comes down to the questions of: Why we are doing this? Why should I care? If you can create a vision and clarity around where the initiative is going, it makes a big difference in how successful the initiative is with staff," says Mr. Detjen.
A strong vision is important because individuals have a hard time supporting something they do not understand, according to Chris Fox, CEO of Avantas, a healthcare consulting and software services provider specializing in labor management. For this reason, encouraging transparency around the vision for the HIT initiative is important. "Everyone — the executive leadership team to the managers and staff — needs that shared vision. They need to clearly understand their role and how a successful implementation impacts outcomes," says Mr. Fox.
2. De-emphasize "meaningful use." Meaningful use is an initiative hospital staff and physicians may have a hard time supporting because it can increase work load without immediate benefits. For this reason, administrators and executives should strive to focus on the benefits to patients from being true meaningful users of technology.
"We do not talk to our physicians, clinicians or nurses about implementing an electronic health record system so we can meet meaningful use and receive incentives. We talk about it for the patient. If we have a successful adoption and happen to receive incentives, that is great. It is really more about how to succeed for the best patient experience," says A.J. Patefield, MD, senior vice president and CMIO of Novant Health.
For example, in order to focus more on its patients, Novant Health put together its own vision elements using the information technology lever for support. As Novant Health centers its activities around those vision elements, it may meet meaningful use but that, in the minds of the executives, is not the primary goal. Rather, it is the remarkable patient experience.
"We are not in a mad dash to get the money and meet the meaningful use standards. We've identified many things that are important for patients well beyond meaningful use. If we happen to meet meaningful use, that is great," says Dave Garrett, senior vice president and CIO of Winston-Salem, N.C.-based Novant Health. "We are more focused on our strategy and our approach to deliver a system that will work best for our patients. Our goals and strategies just happen to align very nicely with stage 1 and stage 2 of the meaningful use changes."
3. Give staff a voice. Success in HIT often depends on the amount of involvement by staff and physicians. According to Dr. Patefield, giving staff a voice through workgroups and councils may be difficult but is integral to successful implementations.
Mr. Fox agrees, adding that all relevant departments should be involved. "Sometimes we find that operational folks or the finance group should have input into the project, but they are brought in too late. The IT department alone does not always have the operational empathy or the financial perspective to complete the full implementation puzzle," says Mr. Fox. This idea demonstrates the importance of expanding HIT implementations beyond the IT department.
"It cannot be the world according to IT. They are just one voice at the table. Albeit, an important voice, but you need others to create the best approach," says Mr. Garrett.
4. Require a high-level of engagement from the C-suite. According to Dave Vreeland, a partner at Cumberland Consulting Group, a health IT project management firm that helps healthcare providers with EHR implementation projects, C-suite executives need to be involved in HIT initiatives. If executives are not involved they may not understand the project enough to be the final word on questions and issues.
"I've seen situations where C-suite executive involvement and engagement was low, and it was much harder to accomplish projects. There were more problems, issues and false starts. When participation was high, there were fewer hiccups and fewer misunderstandings," says Mr. Vreeland. "My favorite example is with a hospital that had a broad HIT implementation with a large revenue cycle segment. The CFO spent one day a week on the project. He left his office and immersed himself in the initiative. When we had challenges, his perspective was grounded. He knew how to solve the problems because he had involvement and engagement," Mr. Vreeland adds.
5. Use in-house training experts. With HIT initiatives, there is often a great deal of change that hospital staff, nurses and physicians must learn and adopt. In order to assuage the learning curve, Carole Norton, CNO of Stonewall Jackson Memorial Hospital in Weston, W.Va., recommends using in-house training experts or "super users" as she calls them. Super users are hospital employees with a knack for technology who are specially trained to teach other staff. "You should have super users in the hospital around the clock during implementation. While we had mandatory training, the super users really helped nurses and clinicians troubleshoot their problems, and having a dedicated vendor like veEDIS who had nurses, physician and technicians on site for the go-live weeks. They answered questions and eased the transition," says Ms. Norton.
6. Recognize staff, physicians as leaders. According to Mr. Fox, in order to prevent HIT projects from stalling, the hospital needs to identify a few "champions" of the project. "I haven't been on a project yet where there weren't challenges. It really takes a visionary leader with the drive and ability to push forward at those points in time to keep the initiative moving forward," says Mr. Fox.
"Champions" should be selected to represent all segments of the hospital — executives, nurses, clinicians and physicians, etc. For Novant Health, it was especially important to identify a strong physician leader to help in the challenging moments. "Executives need to bring physicians into leadership roles. It doesn't work coming from administrators. Physicians will speak, understand and respond to other physicians much better," says Dr. Patefield.
Mr. Detjen agrees, especially when the projects are implemented in the ambulatory environment. "In the ambulatory environment there is a lot of skepticism because HIT projects usually force a significant amount of change in those areas. For the most part, you are adding work to everyday tasks without an immediate return. It is important to have physician champions because you need someone who can carry the vision with conviction — someone who is believable," says Mr. Detjen.
At end of day, the hospital needs to encourage the medical staff to lead in a way that encourages the process and helps other staff members understand where the hospital is headed. Although adjustments to workflow may represent a challenge initially, if hospitals remember to focus on their staff as an integral piece in the HIT initiative, the overall implementation may be more successful.
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1. Build a strong vision around the initiative. Mike Detjen, vice president of service offerings for Arcadia Solutions, a healthcare consulting company, believes that success in health IT initiatives, especially those related to meaningful use, comes from vision and clarity around where that initiative is going. Staff need to understand why the hospital is pursuing the HIT initiative — that it is a means to an end, not an end in itself.
"It is much more powerful if you speak to the bigger story. It comes down to the questions of: Why we are doing this? Why should I care? If you can create a vision and clarity around where the initiative is going, it makes a big difference in how successful the initiative is with staff," says Mr. Detjen.
A strong vision is important because individuals have a hard time supporting something they do not understand, according to Chris Fox, CEO of Avantas, a healthcare consulting and software services provider specializing in labor management. For this reason, encouraging transparency around the vision for the HIT initiative is important. "Everyone — the executive leadership team to the managers and staff — needs that shared vision. They need to clearly understand their role and how a successful implementation impacts outcomes," says Mr. Fox.
2. De-emphasize "meaningful use." Meaningful use is an initiative hospital staff and physicians may have a hard time supporting because it can increase work load without immediate benefits. For this reason, administrators and executives should strive to focus on the benefits to patients from being true meaningful users of technology.
"We do not talk to our physicians, clinicians or nurses about implementing an electronic health record system so we can meet meaningful use and receive incentives. We talk about it for the patient. If we have a successful adoption and happen to receive incentives, that is great. It is really more about how to succeed for the best patient experience," says A.J. Patefield, MD, senior vice president and CMIO of Novant Health.
For example, in order to focus more on its patients, Novant Health put together its own vision elements using the information technology lever for support. As Novant Health centers its activities around those vision elements, it may meet meaningful use but that, in the minds of the executives, is not the primary goal. Rather, it is the remarkable patient experience.
"We are not in a mad dash to get the money and meet the meaningful use standards. We've identified many things that are important for patients well beyond meaningful use. If we happen to meet meaningful use, that is great," says Dave Garrett, senior vice president and CIO of Winston-Salem, N.C.-based Novant Health. "We are more focused on our strategy and our approach to deliver a system that will work best for our patients. Our goals and strategies just happen to align very nicely with stage 1 and stage 2 of the meaningful use changes."
3. Give staff a voice. Success in HIT often depends on the amount of involvement by staff and physicians. According to Dr. Patefield, giving staff a voice through workgroups and councils may be difficult but is integral to successful implementations.
Mr. Fox agrees, adding that all relevant departments should be involved. "Sometimes we find that operational folks or the finance group should have input into the project, but they are brought in too late. The IT department alone does not always have the operational empathy or the financial perspective to complete the full implementation puzzle," says Mr. Fox. This idea demonstrates the importance of expanding HIT implementations beyond the IT department.
"It cannot be the world according to IT. They are just one voice at the table. Albeit, an important voice, but you need others to create the best approach," says Mr. Garrett.
4. Require a high-level of engagement from the C-suite. According to Dave Vreeland, a partner at Cumberland Consulting Group, a health IT project management firm that helps healthcare providers with EHR implementation projects, C-suite executives need to be involved in HIT initiatives. If executives are not involved they may not understand the project enough to be the final word on questions and issues.
"I've seen situations where C-suite executive involvement and engagement was low, and it was much harder to accomplish projects. There were more problems, issues and false starts. When participation was high, there were fewer hiccups and fewer misunderstandings," says Mr. Vreeland. "My favorite example is with a hospital that had a broad HIT implementation with a large revenue cycle segment. The CFO spent one day a week on the project. He left his office and immersed himself in the initiative. When we had challenges, his perspective was grounded. He knew how to solve the problems because he had involvement and engagement," Mr. Vreeland adds.
5. Use in-house training experts. With HIT initiatives, there is often a great deal of change that hospital staff, nurses and physicians must learn and adopt. In order to assuage the learning curve, Carole Norton, CNO of Stonewall Jackson Memorial Hospital in Weston, W.Va., recommends using in-house training experts or "super users" as she calls them. Super users are hospital employees with a knack for technology who are specially trained to teach other staff. "You should have super users in the hospital around the clock during implementation. While we had mandatory training, the super users really helped nurses and clinicians troubleshoot their problems, and having a dedicated vendor like veEDIS who had nurses, physician and technicians on site for the go-live weeks. They answered questions and eased the transition," says Ms. Norton.
6. Recognize staff, physicians as leaders. According to Mr. Fox, in order to prevent HIT projects from stalling, the hospital needs to identify a few "champions" of the project. "I haven't been on a project yet where there weren't challenges. It really takes a visionary leader with the drive and ability to push forward at those points in time to keep the initiative moving forward," says Mr. Fox.
"Champions" should be selected to represent all segments of the hospital — executives, nurses, clinicians and physicians, etc. For Novant Health, it was especially important to identify a strong physician leader to help in the challenging moments. "Executives need to bring physicians into leadership roles. It doesn't work coming from administrators. Physicians will speak, understand and respond to other physicians much better," says Dr. Patefield.
Mr. Detjen agrees, especially when the projects are implemented in the ambulatory environment. "In the ambulatory environment there is a lot of skepticism because HIT projects usually force a significant amount of change in those areas. For the most part, you are adding work to everyday tasks without an immediate return. It is important to have physician champions because you need someone who can carry the vision with conviction — someone who is believable," says Mr. Detjen.
At end of day, the hospital needs to encourage the medical staff to lead in a way that encourages the process and helps other staff members understand where the hospital is headed. Although adjustments to workflow may represent a challenge initially, if hospitals remember to focus on their staff as an integral piece in the HIT initiative, the overall implementation may be more successful.
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