This is the second installment of the interview conducted with Heather Haugen and Jeffrey Woodside, MD, whose book, Beyond Implementation: A Prescription for Lasting EMR Adoption, was published in May.
We continue discussing the common themes to EMR adoption barriers, which they uncovered while working with their clients, as well as solutions for breaking down those barriers.
Haugen is corporate vice president of research for healthcare IT consulting firm The Breakaway Group and co-director of health IT at the University of Colorado Health Sciences Center’s School of Medicine, and Woodside is former executive vice president and CMO for UT Medical Group.
To hear the complete interview via podcast, please go to www.healthcareitnews.com.
Workflow and culture (resistance to change) are two key barriers to adoption. What is one cost-efficient thing hospitals and healthcare systems can do to overcome these entrenched barriers?
Haugen: The first priority I think is to establish the leadership agenda. It has to be focused on the EMR adoption. It really begins with leadership. EMR adoption has to be in their top 3 priorities. It’s not unusual that organizations have a lot of priorities, even when they’re doing an EMR installation. It really has to make it to those top 3 priorities. It’s a large organizational change.
They also have to ensure that they have some kind of compelling and meaningful message that they share with the entire organization. Otherwise, people just don’t understand what the value is going forward. And although sometimes that’s shared with the leadership team, it oftentimes isn’t shared among the entire organization. It sounds very simple, but I think it’s a step that people miss oftentimes and that they really need to focus on.
Woodside: I think a particularly important part of engaged leadership is engaging the physicians on many levels – in leadership and governance. When we work with our clients, we recommend that they form a formally chartered – for lack of a better term – physician advisory group with wide representation over various clinical disciplines and that that group be empowered by the thought leadership and given the responsibility and accountability for developing and monitoring all policies and procedures governing the physician use of the EMR.
For hospitals and healthcare systems that have razor-thin operating margins and are tapped out across resources, what can they do to get on the path of EMR adoption?
Woodside: That’s a difficult question because EMRs and EHRs are very expensive applications, and are human-resource intensive in implementation and adoption. Basically, deciding whether or not to go is a top-leadership decision. And nowadays, that has to take into account the meaningful use incentives and ultimate disincentives or penalties. Many organizations that we’ve talked to simply are considering having an EMR now as a cost of doing business. There’s really not much of a choice. If the decision is made to proceed, then it’s critical that there be broad-based involvement of physicians and staff and executives in vendor selection. Leadership must be committed to engaging all levels of leadership within the organization, must have a superb user learning methodology to track the method and outcomes, and a method for sustaining the application over its lifetime in the organization.
For hospitals and healthcare systems that have already implemented EMRs but have seen low adoption, what can they do to bounce back from the time, resources and morale already spent?
Haugen: We run into this fairly often. We go in with a little bit of a research perspective around let’s really diagnose the problem because sometimes we see that adoption is low in an organization and that organization has already started to throw some almost quick-fix solutions to that problem. So first is to go in and really determine the cause or causes of low adoption. So is it a matter of engaging the leadership? Are the end users proficient in the application, or are there pockets of adoption, which we’ve seen in many places where there’s real high adoption in some areas and low adoption in others? And then do they have a plan for maintaining the value of the investment through education and leadership over the life of the application? There’s a fair amount of turnover in healthcare. So is turnover one of the things that’s leading to lower adoption at time points in the organization, whereas maybe after go-live adoption was fairly high?
We believe that metrics are the most powerful way to assess whether users are improving, maintaining, regressing in adoption over time. There’s another concept that we’ve learned through our research that was important, and that is that adoption is dynamic in an organization. So you just don’t achieve it. Over time, if you can watch the metrics you can start to get a sense in your organization as to what areas you need to continue to work on. Then it really provides a nice perspective, rather than I think or I feel like this is how we’re doing on adoption. There’s some real numbers to back it up. Physicians also love that. They’re fairly analytical folks. We find that that actually improves their overall engagement in the process.
Can you name a couple of models that hospitals and healthcare systems can look up to for best practices? What one or two things are they doing right that are replicable for others, regardless of size, type or location of institution?
Woodside: This is easiest to talk about in an example in a large multi-specialty group practice that we used our model in.... The two crucial factors in a very successful reimplementation and far down the pathway now to adoption was a very strong governance structure from top leadership right down to all the stakeholder groups in the practice. A very, very important part of that was the physician advisory group, with one representative from each specialty, that really was energized by being empowered and just did a terrific job on the physician side.
The second was a focus on end-user learning that was based on the online job- and task-specific simulator that The Breakaway Group produces. Particularly for physicians, it was very, very well received because they could do their learning online at home, sitting in an airport, without taking time away from clinical care. Those are the two major success factors in going forward.
Haugen: I have an example of a hospital. Central Washington Hospital – about 1,200 to 1,500 users of a Cerner EMR, about 400 physicians, I think – went through an implementation that resulted in pretty high adoption as measured by the knowledge and confidence of the end users. We have yet to get to clinical and financial outcomes for that organization. I don’t think that we’ve gotten to the final place, but I think two of the things that that organization did well are the leadership committed to a required compliance to education. End users couldn’t decide what they wanted to do. Literally, in order to get a password and user name to the system they had to comply with the education that was there. From that perspective, they were proficient end users; they used the system well.
The second is that they had plans around how they were going to sustain the materials that they developed. They developed quick reference guides and job aids. It wasn’t long before they realized that those actually even needed to be maintained on a regular basis. So we’re actually going back through and making sure that those match the current workflows and using a portal in order to keep all that information current and make sure that that’s available to their end users. So I think that was the two things of commitment to getting the end users proficient was really a key to their success.
Part 3 will be posted on Friday, June 25.
