Consultant Becky Quammen of Quammen Health Care Consultants works with hospitals to implement electronic medical records systems, most recently taking Faith Regional Health Services in Norfolk, Neb., live on an EMR within six months. Here she talks about her streamlined implementation methodology and offers guidance to hospitals planning to implement an EMR.
Q: What advice would you give to hospitals about to choose a vendor and start their EMR implementation?
Becky Quammen: The most important thing in EMR implementation is to keep a clear-headed vision about what you're trying to accomplish operationally with the software. Instead of having implementers from a vendor come through and define rote steps for the product, you want to focus on your needs and the end solution. Stay vigilant to that end solution.
I no longer believe in doing things in stages. I've learned through the years that when you take things in stages, you break process, so you're constantly spending time trying to fix what you just broke, as opposed to taking a whole process electronic at once. I have a problem with the way a lot of vendors do an implementation — the slowness of the pace, the way things are broken down. When you send out a pharmacy resource and then send out a documentation resource, you end up with a siloed build.
Q: How do you initiate and maintain high morale in the hospital staff and administration?
BQ: It's all about pulling together a clinical steering committee from the very beginning that is immersed in the dialogue, so they're walking and talking through the implementation process and every decision. It is scary, and I face discussion where folks want to create their own barriers. They say, "We've always done it this way, we can't do that, it's a patient safety requirement." The biggest thing is listening to what people and getting to the root cause of what they're saying. There will always be naysayers, but you have to find people who won't be change averse just for the sake of being change averse.
Q: How do you train a hospital's staff on the EMR before and during go-live?
BQ: I have a very unique premise there. It's somewhat controversial, but it's becoming much more accepted. Lately the [EMR] products are making it easier because they're more oriented toward web design and the kind of websites people have already seen, so it makes training a little less difficult. Basically I follow these steps:
1. I do a general session for everyone involved. For a hospital in Nebraska I worked with, I took over 550 people and put them in two-hour sessions, where we gave general information that everybody needed to know: the goal, the expected outcome and the timeline.
2. Instead of a talking head instructor, I put staff members into a proctored laboratory session. The room is structured so that the devices are around the wall, and the student is facing the computer and the proctor can see everybody's screen. I use scenario-based exercises and put people's hands on the system early on.
3. I schedule open lab time. In scheduled lab time, we place departments together so that people can learn with similar people. But we also have open sessions, so anybody can wander into the training lab.
4. I put a lot of training dollars into surrounding [staff members] at a go-live. The real learning happens when you've got the patient and the clinician and the computer in the same room — before that, everything is just simulation. In heavy training models, you spend a lot of money, time and energy up front, and then you still spend a lot of money, time and energy when you go live. I prefer to put the greatest portion of the money around the live-date and post-live.
Q: How do you save money for smaller hospitals that don't have the same funding as large, academic medical centers but still have to meet the same requirements?
BQ: When I'm helping an organization, if I've gotten involved in the early stages of the game, I don't allow them to pursue a canned approach. I use an hourly approach so they can use what they need and buy what they need. If I wasn't involved in the contract negotiations, and I'm just being called in to help implement, I work to make my resources more full-bodied. I don't need to bring in five people, each with a specific area of knowledge, if I can bring in two people who have broader knowledge across the board.
I work in every process of the implementation plan to streamline activities, streamline the education approach, and streamline testing. It's so important to design and configure and build correctly the first time. There's usually a tremendous amount of rework because everyone races into it; everybody jumps into the product and wants to get their hands dirty. I'm currently working with a hospital in Denver, and they're chomping on the bit to get on the product, but I'm making them do the design work around their orders catalog. It's boring, it's an Excel spreadsheet, and they thought they'd be in the product at this point. But when we finish designing, we'll know that it's right and we've got all the medications in there, so we won't have a lot of rework to do when we start testing.
Read more recent coverage on healthcare IT.
-Study: EHR Implementation Tops Healthcare IT Priorities
-Government Allocates $144M to Train Healthcare IT Workers
Q: What advice would you give to hospitals about to choose a vendor and start their EMR implementation?
Becky Quammen: The most important thing in EMR implementation is to keep a clear-headed vision about what you're trying to accomplish operationally with the software. Instead of having implementers from a vendor come through and define rote steps for the product, you want to focus on your needs and the end solution. Stay vigilant to that end solution.
I no longer believe in doing things in stages. I've learned through the years that when you take things in stages, you break process, so you're constantly spending time trying to fix what you just broke, as opposed to taking a whole process electronic at once. I have a problem with the way a lot of vendors do an implementation — the slowness of the pace, the way things are broken down. When you send out a pharmacy resource and then send out a documentation resource, you end up with a siloed build.
Q: How do you initiate and maintain high morale in the hospital staff and administration?
BQ: It's all about pulling together a clinical steering committee from the very beginning that is immersed in the dialogue, so they're walking and talking through the implementation process and every decision. It is scary, and I face discussion where folks want to create their own barriers. They say, "We've always done it this way, we can't do that, it's a patient safety requirement." The biggest thing is listening to what people and getting to the root cause of what they're saying. There will always be naysayers, but you have to find people who won't be change averse just for the sake of being change averse.
Q: How do you train a hospital's staff on the EMR before and during go-live?
BQ: I have a very unique premise there. It's somewhat controversial, but it's becoming much more accepted. Lately the [EMR] products are making it easier because they're more oriented toward web design and the kind of websites people have already seen, so it makes training a little less difficult. Basically I follow these steps:
1. I do a general session for everyone involved. For a hospital in Nebraska I worked with, I took over 550 people and put them in two-hour sessions, where we gave general information that everybody needed to know: the goal, the expected outcome and the timeline.
2. Instead of a talking head instructor, I put staff members into a proctored laboratory session. The room is structured so that the devices are around the wall, and the student is facing the computer and the proctor can see everybody's screen. I use scenario-based exercises and put people's hands on the system early on.
3. I schedule open lab time. In scheduled lab time, we place departments together so that people can learn with similar people. But we also have open sessions, so anybody can wander into the training lab.
4. I put a lot of training dollars into surrounding [staff members] at a go-live. The real learning happens when you've got the patient and the clinician and the computer in the same room — before that, everything is just simulation. In heavy training models, you spend a lot of money, time and energy up front, and then you still spend a lot of money, time and energy when you go live. I prefer to put the greatest portion of the money around the live-date and post-live.
Q: How do you save money for smaller hospitals that don't have the same funding as large, academic medical centers but still have to meet the same requirements?
BQ: When I'm helping an organization, if I've gotten involved in the early stages of the game, I don't allow them to pursue a canned approach. I use an hourly approach so they can use what they need and buy what they need. If I wasn't involved in the contract negotiations, and I'm just being called in to help implement, I work to make my resources more full-bodied. I don't need to bring in five people, each with a specific area of knowledge, if I can bring in two people who have broader knowledge across the board.
I work in every process of the implementation plan to streamline activities, streamline the education approach, and streamline testing. It's so important to design and configure and build correctly the first time. There's usually a tremendous amount of rework because everyone races into it; everybody jumps into the product and wants to get their hands dirty. I'm currently working with a hospital in Denver, and they're chomping on the bit to get on the product, but I'm making them do the design work around their orders catalog. It's boring, it's an Excel spreadsheet, and they thought they'd be in the product at this point. But when we finish designing, we'll know that it's right and we've got all the medications in there, so we won't have a lot of rework to do when we start testing.
Read more recent coverage on healthcare IT.
-Study: EHR Implementation Tops Healthcare IT Priorities
-Government Allocates $144M to Train Healthcare IT Workers