A new case study published by the Commonwealth Fund reveals several lessons for healthcare organizations and providers, especially those working in rural communities, to increase and improve their adoption of EHR and health information exchange (HIE). Highlighting the activities of the Colorado Beacon Consortium (CBC), authors Douglas McCarthy, MBA, and Alexander Cohen, MPH, MSW, point to a handful of factors determining whether a care setting will succeed in the clinical transformation made possible through EHR and HIE.
The CBC is one of 17 communities selected by the Office of the National Coordinator for Health Information Technology (ONC) through its Beacon Community Program that are to serve a models (i.e., proof-of-concept) for improving care coordination, patient outcomes, and costs of delivering healthcare. A beneficiary of close to $11.9 in funding over three years, the CBC comprises partnerships with Mesa County Independent Physicians’ Practice Association, Quality Health Network (QHN), Rocky Mountain Health Plans, St. Mary’s Regional Medical Center, Mesa County Physicians IPA, and University of Colorado Department of Family Medicine.
So what lessons has the CBC learned through its efforts adopting EHR technologies and HIE capabilities?
Primary role of clinician engagement: Unsurprisingly, no factor is more important than clinician buy-in in determining a successful adoption.
Chief among these has been physician engagement in leading change, both at the community level and within their own practices. One physician noted that it can be painful to shift from an authoritative leadership style to a more team-oriented approach […], but the rewards in better productivity and the capability for improvements make this change worthwhile
Building support for HIE takes time: If last week’s Information Management Network (IMN) Hospital Cloud Forum were any indication on the progress of HIE adoption throughout the country, plenty of work needs to be done before healthcare organizations and providers can fully benefit from the exchange of health information. McCarthy and Cohen note that
it can be difficult initially for hospital leaders to appreciate the value of participating in a health information exchange, which represents a new way of thinking about the hospital’s role within a medical community. These relationships can often be nurtured or brokered through the influence of other community stakeholders, such as physicians and employers. Because of the time required to plan and gain support for HIE implementation, patience is necessary to stay the course, as some physician leaders may be eager to begin the work sooner than may be feasible.
Adopting a culture of change, collaboration: Much of EHR and HIE adoption has to do with cultural rather than technical barriers to change. Change management has emerged as its own activity, requiring leadership to dedicate considerable resources to helping clinicians embrace changes to their workflows. And because having the right culture for adoption is a necessary for a successful health IT implementations, fostering the former can and should precede the latter. Effecting change and ensuring that problems will be resolved require “identifying key stakeholders and bringing them to the table to define and solve collective problems, while acknowledging that it may take time to build trust and find common interests.”
Web-based EHRs as a stepping stone toward full EHR adoption: Although only in passing, McCarthy and Cohen reveal how web-based EHR solutions can in fact facilitate full-fledged adoption among providers later down the road. “On average, QHN found that physicians used the portal for about two years before transitioning to their own EHR; this time shortened to about a year for more recent adopters. Physicians using the portal could qualify for the first stage of federal meaningful use incentives,” they write.
Be honest about expectations, goals: Anyone charged with managing a project knows all too well the importance of establishing and communicating deadlines. EHR, HIE, or health IT adoption is no different. McCarthy and Cohen emphasize the need to “set realistic expectations of the time required for planning and build-out based on task complexity” as any project’s success “requires agreeing on milestones to reach end goals, while also expecting some setbacks along the way.” And doing so from the get-go helps mitigate hiccups further down the line.
Be honest with providers and patients: This level of transparency, moreover, should not be exclusive to the clinical side of things considering that any health IT adoption is going to affect provider and patient alike. “Finally, to gain their understanding and support, the CBC’s leaders advised educating health care providers and the community, including consumers and employers, early on about the purposes and value of the initiative,” write the authors.
Read the complete case study for more details about the CBC’s progress.