It is general knowledge among seasoned EHR implementers that EHR technology is not the primary concern when promoting EHR adoption (while there are many areas of potential improvements, the tech is generally “good enough” in most cases). There are, however, many challenges surrounding the deployments EHRs and one of the biggest is that not enough training or pre work done to prepare staff and resources. A great way to ensure EHR success is by creating a “Culture of Adoption,” which is something I discussed at length with my friend John Lynn after he attended a recent “think tank” style event hosted at TEDMED by the Breakaway Group (a Xerox Company). I invited John, a prolific blogger and fellow EHR implementation expert, to talk about what the creation of such a culture means and how it can be done. Here’s what John had to say:
At the Healthcare Forum, Bill Rieger, CIO of Flagler Hospital, spoke on how they created a culture of adoption as their hospital transitioned from one EMR software to another. Flagler Hospital is a 355 bed community hospital that had been using an EMR since 1993 and after a two year search process had chosen to move to a new EMR system.
As they prepared for the move to a new EMR, they found an interesting challenge when evaluating the benefits of the transition. In the case of CPOE, med reconciliation, and physician documentation they would be making a paper process electronic. When it came to radiology, lab, registration, scheduling, HIM, pharmacy, nursing documentation, eMAR, and billing they were moving from one electronic process to another electronic process. They found that the move from paper to electronic was easier to communicate the benefits. However, the move from electronic to electronic was much more difficult to communicate the benefits.
This difference in transition is important since we are likely to see more organization making the electronic to electronic transition in the future. Part of this electronic to electronic move will be driven by EMR dissatisfaction, but hospital consolidation will also be a large driver of hospitals changing from one electronic system to another. Switching electronic processes has unique challenges. People become ingrained in their electronic habits. For example, they may get use to hitting a specific keystroke as part of their routine. Changing this muscle memory can often be much harder to deal with than the challenges faced when moving from paper to electronic.
In order to facilitate this transition, Flagler Hospital created a solid vision for the project. Bill Rieger’s goal for the project was to move “beyond using our EMR to leveraging our EMR.” Together with the CMIO (Chief Medical Information Officer) they created the following guiding principles for the project: “Such a system would improve quality, reduce the cost of healthcare, foster loyalty, and enhance our service to the community.” Then, Bill stood back while the CMIO was out in front of the physicians to explain why the hospital needed to make the EMR transition.
After building a clear vision they worked to get buy in from their organization. This included creating a “Patient Centered Care Team” which included a nurse leader, Subject Matter Experts & Super Users, PIT Crew, and the CMIO. They also held a Project Naming Contest, a Project Kickoff Event, and created a Project Portal. As Bill Rieger explained, “There’s power in ceremony. People don’t forget. They talk about them and relive them.”
One of the most powerful things they did was film a YouTube video to kick off the EMR project. You can see it embedded below.
Bill Rieger commented that the best part of the video was the filming of it. During the filming, the implementation team got all sorts of questions about the EMR project. Bill Rieger commented, “We didn’t expect that engagement.” They decided to replicate this experience by filming another video near the end of the project.
They also tracked the team members’ response to the project on Twitter, even making a tweet cloud that they framed and put up in their office. Everyone also had “Finish Strong” bracelets that they wore until the completion of the project. At the end of the project they held a Project Reboot Event as another ceremonial reminder of what they had accomplished.
Another important part of the adoption culture they created for the EMR implementation was one of accountability. They did this first with adoption metric tracking. Then, they tied that to adoption results and goals centered on Quality, Efficiency, and Cost. Each of these goals corresponds directly with the guiding principles for the project.
As Bill Rieger noted, “We don’t want to just go live. We want to adopt and use.” The adoption culture they created was focused on adoption as opposed to implementation so that they could get to their goals faster. This included: training from an adoption perspective, activation from an adoption perspective, and workflow design from an adoption perspective.
Bill Reiger finished his comments on culture saying, “Culture is not just for Google or Apple. You are creating a culture whether you like it or not. You can lead your culture towards adoption or not. There will be a culture either way.” Organizations often underestimate the effort required to lead EHR adoption. Creating a culture of adoption which shifts from IT ownership to clinician ownership of EHR adoption is a good place to start.
You can see Bill Rieger’s full presentation at the Healthcare Forum (embedded below):
The Breakaway Group, A Xerox Company, sponsored this coverage of the Healthcare Forum in order to share the messages from the forum with a wider audience. You can view all of the Healthcare Forum videos on The Healthcare Forum website.