For those opposed to EHR adoption and meaningful use in particular, EHR backlash stories and hashtags must give them a sort of pleasure akin to schadenfreude, further fueling their belief that their opposition is justified. However, a closer look at these instances of EHR backlash generally reveals one or more failures on the part of healthcare organizations or providers to approach the task of adopting various EHR systems and functionalities.
What emerges from interactions and interviews with CIOs, CMIOs, and other health information managers who have overseen successful implementations of EHR systems are lessons capable of helping others nip EHR backlash in the bud. Here is a series of tips for avoiding EHR backlash.
Communicate with the entire organization, especially the clinical staff: People tend to fear what they don’t know. Why shouldn’t clinicians be any different?
“One of the things we wanted to do was create this transparency for the provider,” says Greg Wolverton, FHIMSS, CIO at ARcare/KentuckyCare. “We wanted them to know what the bottom line was, but we didn’t want to inundate them with what’s in the numerator and denominator because the truth of the matter is that all it does is tend to overwhelm.
Moreover, the adoption of EHR and health IT systems is disruptive to providers and what leadership needs to recognize is the role change management in easing this changeover. “Change management is a big piece and really listening to the providers. I know it does bring a lot of change to their lives. And also be honest and transparent about what you’re going to be reporting,” advises Shashi Tripathi, Vice President & CIO at Facey Medical.
Develop a rollout strategy that accommodates the needs of clinicians: Big bang might be a great implementation method for getting results, similar to pulling off the bandaid quickly. The problem is that this widespread change at one fell swoop can be seriously off-putting.
“There are certain processes or applications that you might want to pilot first and then roll out to the masses,” explains Charlotte Wray, MSN, RN-C, MBA, NE-BC, Vice President, Clinical Operations and Information Systems/Chief Clinical and Information Officer at EMH Healthcare. “Closed-loop medication management is a good example of this as it a very high-risk process. It requires labor-intensive education and clinically significant changes to the workflow of nurses and doctors.”
Paraphrasing Shakespeare, suit the implementation to the level of the technology. And that’s just what Wray recognized before choosing appropriate rollouts for various technologies:
We purposefully had a more staged and structured rollout for that project. Other roll outs like CPOE are also high risk. You can certainly build it all at once and mandate that all the physicians do CPOE on the first day, but that wasn’t our reality. We targeted a significant percentage of physicians that we knew were ready to accept this kind of change and would be our champions.
Manage expectations, difficulties head-on and honestly: Count yourself fortunate if your projects have gone off without a hitch. For most of us, setbacks are inevitable. The challenge is handling in an intelligent, productive way.
“We set the expectation with the organization, and they were so bought into it — from the physicians to nursing to administration to the board, everyone was super engaged and knew it’s not going to be perfect when we went live but we’ll work through it as a team,” observes Tom Ogg, Vice President and CIO of Akron Children’s Hospital. “And it wasn’t perfect when we went live and we did work through it. There were a lot of issues, but it was just a matter of having the support.”
Sell the adoption to staff based on their needs, wants, personalities: Daniel Morrealle, Vice President and CIO at Kingsbrook Jewish Medical Center in New York, has developed a tongue-in-cheek mnemonic device based on CPOE — compulsion, persuasion, obsequiousness, and extortion — that has been useful for him when working with different sorts of clinicians.
Sometimes you must simple compel physicians that the adoption is necessary. “Compulsion is the low-hanging fruit. It’s the physicians who are just coming out of med school the past few years,” says Morrealle. “They get it, they know it, they know it’s better care, they know it’s the right thing to do, they use EHRs, and more so they want EHRs.”
Other times it’s about persuading those clinicians who may be resistant to change by investing more time in speaking with them about the benefits of the adoption. “Those are the particular doctors for whom the meaningful use incentives have been helpful in capturing — the ones who need just that little push,” adds Morrealle.
Still other times it’s about working tirelessly with a physician leader, acknowledging that this individual holds the key to getting his entire staff on board. “It’s about finding that physician leader who’s not geeky but a good clinician who can take that message and spread it among his or her peers,” notes Morrealle.
And lastly, there’s the give-and-take of working with holdouts whose participation can be gained through tradeoffs or tell them that it’s way or the high way. It may be harsh but in Morrealle’s experiences it’s true.