Healthcare Information Technology Research & Analysis : Coplan & Company : IT Procurement Management, Project Management, System Acquisition

On March 25, 2009, the New England Journal of Medicine (NEJM) confirmed that we continue to have low Electronic Medical Record (EMR) system adoption rates in our nation’s hospitals.

I’ve posted several times about previous studies confirming this.  For example, the 2008 Annual Hospital Survey from the Leapfrog Group and the NEJM 2008 study on Electronic Health Care Records In Ambulatory Care made this same point in different care settings.  

The healthcare industry just doesn’t get it. One comment from the American College of Physician Executives 2009 Health Care Technology Survey summarizes why we are so unsuccessful:  

My physician and administrative staff has been requesting an EMR for 4 years. We are continually met with the response from IT, “it’s too hard to integrate the systems, we don’t have the resources”, I find it ironic that we continue to meet increased patient demand - efficiency and care measures - while trying to limp along with IT systems that are woefully inadequate. Those in charge of IT decisions are not involved in clinical care and are not await [sic] of the front line user problems/issues. When these issues are brought forward, the IT department appears to carry more weight than patient clinical care…

We need to combine project, technology and change management disciplines to be successful with HIT. Why do we keep missing this critical point?

 TAGS:  ACPE  American College of Physician Executives  HIT adoption  Leapfrog Group  NEJM  New England Journal of Medicine 

Reposted from Get Ready for EHR Failures, But Don't Blame the Software at Software Advice for Electronic Medical Records.

With the Economic Stimulus Bill signed and available to subsidize EHR purchases (for more information see "The Stimulus Bill and Meaningful Use of Qualified EHRs/EMRs"), we are seeing a dramatic increase in electronic health records (EHR) buyer interest. Assuming these buyers make use of the stimulus subsidy to buy an EHR, we expect to see a lot of EHR failures over the next couple years.

Don't get us wrong! We are HUGE advocates of EHR technology. Doctors should be using EHRs. The stimulus subsidy is great. EHR software programs (and software companies) are not the problem.

Our concern is that the subsidies won't change healthcare providers' late adopter mindsets about information technology. Providers may jump at "free software" and try to avoid penalties (starting in 2015), but will they:

• Truly believe in the value of an EHR over traditional paper charts?
• Take a leadership role in advocating adoption of the new EHR in their practice?
• Change their old workflows to match the best practices in leading EHRs?
• Take part in intensive training to learn the new system?
• Ride out the difficult stages of new software adoption and change management?

Traditionally, the substantial costs of EHR systems keep the luddites from buying technology in the face of these challenges. But with "free" EHR software, we expect more than a few providers to throw caution to the wind, buy an EHR and overlook the critical implementation and change management practices that are critical to success.

The best things in life are free, but that doesn't refer to healthcare IT. We think providers would be far more serious about implementation and adoption if they had to pay dearly for the technology.

Accordingly, here are our thoughts on why IT projects fail and how providers can avoid that fate while still capitalizing on this once-in-a-lifetime subsidy.

When and why do IT projects fail?
In 2007, the U.S. Office of the National Coordinator for Health IT reported that about 50% of EHR implementations failed. IT industry analysts widely agree that software implementations fail because of the customers. It's too easy to point the finger at software vendors or at the software itself, but failure usually is the buyer's fault. In a recent survey, one group identified the following top reasons for IT implementation failures:

• 40% attribute failure to poor planning and communication;
• 20% cite mismanagement and rejection by end users; and
• 15% blame overspending.

Very few doctors use EHRs. In fact, most predictions put EMR market penetration at 10%-15%. We all know why this figure is so low: doctors don't want to use them, practice staff is stuck doing things "the old-fashioned way," etc. Now that Uncle Sam is willing to pay for EMRs (and telling us we had better buy!), a lot more practices are going to adopt them. The scary thing, however, is that the same feelings that have slowed the adoption of EMRs are still prevalent.

Here let me present what I think are 5 critical steps for a smooth, successful EMR implementation:

1. Become a project manager. If you're a physician, you may not consider yourself a business person. However, for this project, you need to become a project manager. If you're lucky, you may have a staff member or consultant that can play the role for you, but don't count on it. First, create a project plan. Outline all the steps of your implementation so you know what changes need to occur by certain deadlines. Stay on top of the plan and hold your team accountable.
   
2. Rally everyone else. Recall that poor leadership and lack of user adoption are frequently cited as contributing factors to IT failures. You need to express confidence in the technology and get your staff on board before the implementation. Show how much easier their lives will be. Get them excited about it. Tell your patients that next time you see them, you will be a computer whiz with a slick EHR.
   
3. Buy the best training you can. The government is paying for it (laugh). Seriously though, you will need the help. It's too easy to skimp on adequate training and ongoing support. Don't risk failure of an investment because you want to save a few thousand bucks. It's worth it. Get trainers in the office, send the staff to training, implement a train-the-trainer program.
   
4. KISS: Keep It Simple, Stupid. No office becomes paperless overnight, so don't try to do everything at once. Ease into your new workflow as much as you can. Adopt advanced features after you learn how to turn on the computer. It is OK to implement bells and whistles after the initial dust has settled.
   
5. Be prepared to practice differently. As much as you don't want to admit it, you will need to adjust the way you meet with patients and how your practice operates. And if you can, make easy adjustments ahead of time. Start carrying a tablet PC or dictating with voice recognition software. It pays to work out the kinks early on.

If you follow these major guidelines - and a lot more small steps in between - you'll have a much greater chance of EHR success. Most importantly, wrap your head around being tech savvy and enjoying the new system. If you don't, you'll pay for it (one way or another).

 TAGS:  economic stimulus  EHR  Office of the National Coordinator for Health IT  ONC 

The Healthcare Information Systems Society (HIMSS) requested that I speak on Project Management: Ensuring HIT Sustainability Beyond "Go Live" at their 2009 Conference on April 4th. I am really excited about this opportunity to work with my co-presenters, including:

• Kim Brant-Lucich, PMP, 
Director of Process Redesign, St. Joseph Health System


• Charles Garrity, 
Senior Manager, Beacon Partners, Inc.

• Anil Jain, MD
, Managing Director, e-Research, eCleveland Clinic, Director, Quality and Research Informatics, Medicine Institute

I’ll focus on tying HIT project, technology and change management together. Kim will talk about process improvement, Chuck will tackle ROI and Anil will provide a clinician’s perspective.

I am also speaking solo on this topic for the Project Management Institute (PMI) Healthcare Special Interest Group at their March 5th Webinar.

I encourage my readers to attend these and other similar sessions to help advance these important topics and ultimately improve the success of HIT projects. Take a look at this draft and let me know what you think.

 TAGS:  Change Management  change management  HIT change management  HIT Change Management  Project Management  Technology Management 

The medical home dictates that the primary care physician manage a patient's care across multiple providers. To achieve this successfully we must help providers improve care using HIT.

For example, primary care physician cannot manage their patients effectively without a flow sheet. They need clarity as to the flow of their patients, the procedures related to each visit and the outcomes. With the medical home, the flow sheet challenge becomes exponentially more demanding due to increased scope of primary care physician responsibilities. EHRs include flowsheets, but who will identify the technology for clinicians? Who will provide the funding? Who will manage the HIT project, technology and change management? Health Information Exchange (HIE) is another critical technology for successful implementation of the medical home. The medical home will stumble without the efficient exchange of medical information amongst physicians.

Are payers willing to help clinicians with this technology? Payers have the money, but they rarely work cooperatively with clinicians. The issue comes down to payers making a long-term investment to the detriment of short-term profit. Will they make this sacrifice?

 TAGS:  Change Management  EHR  Electronic Health Record  EMR  HIE  HIT  HIT change management  HIT Change Management  Medical Home  Project Management  RHIO  RHIO HIE  ROI 

My previous posts defined specific ways to address change management. Now it's time to identify ways to integrate them into the five the Project Management Institute (PMI) Process groups so project managers can use them in HIT project, as follows:

Vision includes:

• Providing a plan for the future with the project as a strategic focal point
• Establishing stakeholder commitment before, during and after the project
• Defining objectives and measurable outcomes to be achieved during and after the project
• Assigning objectives to accountable senior executives
• Measuring executive performance by achievement of objectives

• Understanding that an organization structure is a social construct
• Knowing that people instill this structure with ethical order, e.g., rules and relationships
• Realizing people resist change to this ethical order
• Recognizing that crisis, such as a new system deployment creates an opportunity for change
• Being an ardent project supporters or champions of this change
• Focusing energy to take advantage of opportunities provided by crisis
• Offering a new ethical order facilitating change in a nonthreatening way

Consensus includes:

• Involving stakeholders from all levels of the organization
• Requiring teamwork for project tasks, e.g., scope, time, budget, requirements, issue, risk definition
• Involving members from all parts of the organization to increase their personal stake in successful project outcome

Training includes:

• Providing individualized support (e.g., designate “barrier busters” to work with those having a tough time adapting to the new system)
• Using individualized “impact sheets” showing the before and after impact of the system on a particular person’s work. This includes designing individualized impact sheets demonstrating what will and what will not change like the following:

• Creating ongoing workflow improvement teams
• Selecting improvement areas
• Conducting system demonstrations
• Preparing draft workflow improvements
• Obtaining Subject Matter Expert (SME) input
• Encouraging widespread stakeholder review to confirm SME input
• Updating and implementing the improvements
• 
  

 TAGS:  Change Management  Health Information Exchange  HIT  HIT change management  HIT Change Management  Management  Product Management  Project Management 

Successful HIT requires broadening the definition of project management to include technology and change management. The Project Management Institute (PMI) and the Institute for Electrical and Electronics Engineers (IEEE) provide industry standards for project and technology management, respectively. There are no industry standards for change management. We are on our own to define techniques for successful HIT change management.

Based on my 25+ years of experience, I created the following formulas, which I hope will help others successfully manage HIT change. These include the following:

Successful Change

Unsuccessful Change

 TAGS:  Change  Change Management  change management  Health Information Technology Acquisition  HIT  HIT change management  HIT Change Management  IEEE  Project Management