Lessons learned from an EHR implementation (and my wife)

While IT implementation challenges may seem similar across industries, it often takes a deeper dive into a profession’s nuances and specific constraints to fully understand potential barriers to success. I was reminded of this recently at home during dinner.

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Healthcare and IT professionals tend to have different skills, goals, and jargon. This becomes particularly evident during dinner table conversations with my wife Elena, an OBGYN practitioner. Our jobs seem to be on the opposite ends of the spectrum as we discuss work-related complaints and our viewpoints on whether digital transformations or the miracle of life are more exciting. A few nights ago, however, our worlds merged as Elena shared her frustrations with the new Electronic Healthcare Record (EHR) system she was using in her office. As an end-user, Elena shared four fundamental complaints:

  • Unclear distribution of user responsibilities
  • Gaps in training and adaptation
  • Morning after system personalization
  • No clear application ownership

In my view, the above issues are quite typical to any type of technology implementations, so I jumped at the chance to offer solutions, such as adopting Agile methodology, or change management protocol. Elena quickly shut me down. The common problems she shared are intensified by the nature of healthcare and cannot be treated with out-of-the-box solutions or methodologies for three major reasons:

  1. Life and death: No such things as “fail fast”
  2. No power users: Medical staff don’t have the time to become power users
  3. Evolving tech: Best practices for previous versions don’t apply

After Elena explained why my suggested solutions didn’t fit, we dug a little deeper into the EHR nightmare her office was experiencing:

Distribution of responsibilities

“The system doesn’t give me required visibility.”

In the previous version of EHR Elena was able to see what was in a queue for other care providers. This allowed her to manage the flow of patient activity. Moreover, she could take on other providers’ tasks, such as review of test results, if patients needed an expedited answer. Now Elena can only see what is in her queue and feels powerless. In an attempt to match medical staff with their specific responsibilities, the new EHR actually made things less clear as care providers are unsure of who is working on what.

Another example of unclear responsibility distribution is billing. The new EHR allows my wife to perform the billing function but because the hospital has a separate billing department, my wife assumes they will figure out complex situations.  For example, when it comes to costly procedures, Elena worries that billing will miss a charge and the hospital will lose money. On the contrary, when Elena bills patients for expensive IUD devices, which can cost $1000 each, she fears that some patients could inadvertently get billed twice.

It looks like there were gaps in the requirements definition phase of the EHR implementation, whereby Elena or her coworkers never got a chance to describe all critical system functions required to help them provide the best quality care and remain fiscally responsible.

Training and adoption

“No one took the training seriously.”

After the go-live date, productivity dropped significantly as Elena and her team stumbled their way through the new system. Change management and training were not taken seriously. Convincing doctors and other medical staff to allocate time to learning a new system rather than care for patients that need them is not an easy battle. Rather than formal training, the staff wanted an intuitive, easy to use system. However, as I know from implementing countless change management programs, no matter how intuitive the system, proper training (and commitment from top to bottom) is the only viable option.

Those who were designated as super users did receive more training, but they had not fully participated in the project. Therefore, their “super” knowledge was superficial, without much buy-in. As a result, after switching to new EHR no one was truly equipped to lead the support efforts.

My take on it is that users in every operation are busy with activities. Medical or not, those operational activities always seem more important than initiatives, such as adaptation to new technologies. To be successful, EHR implementations need to include a reduction in patient care hours to carve out time for comprehensive training. Super users need to be involved in project phases beyond just training to be effective change agents.

System Personalization

“This system gives me so many options it makes my head spin.”

EHR systems must be flexible and Elena’s new system is exactly that. It can be adjusted for use by OBGYN, pediatrics, sports medicine, and so on. This kind of flexibility is crucial due to the complexity of medicine and the human body. EHR systems must also have the capability to focus. In this case, focus and flexibility were out of balance, as the system was not personalized to the OBGYN practice until after it went live. Elena needed to create and/or adjust countless templates, drop-down lists, interdependencies and other custom options to fine tune EHR efficiency. In the beginning it would take her 30-45 minutes to record a 15-minute visit. Even now, as my wife continues to personalize the application, she finds new available features on a weekly basis and wonders why she had not been shown this shortcut before.

Personalization cannot be an afterthought. To ensure that productivity is minimally affected, implementations need to include a well-organized personalization activity, where care providers can fine tune the application for optimal performance.

Ownership

“No one took charge of support”

As experts, the EHR consultants initially took ownership of the EHR implementation. These expensive external resources were utilized for about a month after go-live before the cost became prohibitive. After their departure, internal resources did not take over the ownership role and system support was almost nonexistent. Elena would seek help from her peers with functionality questions, but they rarely knew any more than she did. She tried calling IT and had even less luck there.

Again, this is not a unique problem and there can be simple solutions, like assigning a power user or subject-matter expert (SME) to obtain intensive training and then be the go-to person for questions. However, in a hospital or healthcare setting, it’s often not easy to delegate a medical professional to be a power user due to the nature of work hours and the prioritization of tasks. These constraints highlight the importance of support and continuous improvement functions to be set up outright.

Takeaways

The medical field requires a little extra care when it comes to solutioning for common IT problems. Long after the kids’ bedtimes and the dishes had run all the way through the dishwasher cycle, Elena and I came to these conclusions:

  • Distribution of Responsibilities: Be sure to capture both critical and non-critical requirements as well as who is responsible for which step. These non-critical requirements can turn into logistical hurdles that affect quality of care.
  • Change Management: Don’t listen to the operational excuses. Losing time that can be utilized for patient care must be minimized. An effective change management campaign may take time away from patient care upfront, but if properly implemented, the system will eventually pay dividends in enhanced quality of care and cost savings.
  • System Personalization: This cannot be an afterthought, but rather a pre-go-live activity so productivity does not suffer.
  • Ownership: Medical professionals are often too busy to be power users, but ownership of new systems must still be assigned to ensure effective support and continuous improvement.

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