By Jerry M. Garcia, Lead Partner, Health & Life Sciences (Canada)
Global momentum is quickly building for the widespread adoption of electronic
health records (EHRs) and related information technology (IT) to improve health
care quality, safety and operating efficiencies. Support for this movement has
taken hold in many parts of the world.
Provinces across Canada are at different stages in their EHR strategies and
roll-outs plans. Recently, Ralph Klein has mentioned the growing importance
of EHRs in Alberta. Recent news reports and quotes from
Canada Health Infoway
have stated that “Canada's short-term goal is to have an electronic health
records system covering 50 percent of the population by 2009.”
Besides Canada, the United Kingdom, France, Italy and Singapore are well
advanced into country-wide initiatives to build national electronic health
record systems and other health care IT tools. More recently, the United States
has begun its national EHR vision with the president and congressional leaders
endorsing EHRs as a critical component of solutions aimed at dramatically
enhancing care while reducing costs.
Despite the enormous opportunities, the effective use of IT in health care has
been challenging for all involved. Some reports suggest that the success rate
for clinical IT projects in actually achieving their stated objectives may be
less than 50 percent.
For clinical IT to fulfill its potential of helping to transform health care,
an understanding of success factors is critical. To that end,
Accenture recently collaborated with the Vanderbilt Center for Better Health to identify the critical success factors for clinical IT adoption. The study suggests a number
of key strategies that appear to have a significant affects on the adoption of
new technologies by clinicians.
The Seven “Secrets” of Successful Clinical Change
Vanderbilt researchers interviewed nearly 50 executives and clinicians at 22
hospitals and health systems in five countries, including three organizations
from Canada, that are in the process of implementing clinical information systems
such as EHRs, Computerized Provider Order Entry (CPOE) and clinical decision support.
Perhaps the most important finding is that, regardless of the formal relationship
to the institution, physician engagement and support is a critical variable in
the overall success of an implementation.
Maybe not big news, we know. What is news from this research is how few people
really do this well. But the research showed very clearly that the organizations
who took this step into account had a far greater likelihood of success than those
who did not. Most actually went back to this idea, and the ones below, only when
an implementation failed and they had to re-group. We also know that doing this
right takes more time and effort, and therefore larger investment at the start,
but experience suggests that it’s more expensive to have an implementation fail
after a year, than it is to start slowly.
From this insight, and the experiences and perspectives of other successful
implementations, seven hard-won lessons for implementing clinical IT projects
emerged from this research:
- Alignment of Clinical and Administrative Leadership
First and foremost, clinical and executive leadership must agree on the goals and
expected results of clinical IT projects. In fact, our research found that executives
and clinicians are most likely to agree when a clinical IT initiative is presented as
part of an overall strategy.
- Effective, Early Engagement of Clinicians
Real and substantive involvement of the clinicians in early planning as well as
throughout the project is essential. Clinicians expect their input to weigh heavily
on the selection, design and deployment of the system. In choosing physician input, it
makes strategic sense to enlist medical leaders who have influence over broad groups
of their peers as champions for the project as well as IT-savvy physicians who may be
more willing to act as early adopters.
- Unique Relationship between Physician and the Institution
As the face of the medical institution to patients, physicians have an undeniably
unique role. For example, they often bear the major burden in adopting EHRs, CPOE and
other new IT systems. These systems often require physicians to make real changes to
their ingrained work behaviors and practices if they are to accomplish safety and
patient care objectives.
It’s been well documented that attempts to mandate physician use of IT tools can lead
to resentment, lack of trust and even behavior that undermines the IT initiative.
Instead, leading organizations have begun focusing on ways to help physicians understand
how the tools can improve their practice and patient outcomes. Many organizations
reported that sharing information about the improved information access, ability to
coordinate patient care and other benefits achieved by early adopters helped persuade
many “wait-and-see” doctors to use the new technology.
- Unwavering Commitment to Success
Leaders can champion a successful project by showing strong resolve and holding
project managers accountable for progress and implementation deadlines. Institutional
leaders that spent time at the outset identifying potential challenges and developing
strategies for dealing with them fared better than their peers. In particular, leaders
must emphasize that the clinical implementation project represents a strategic
imperative for the organization and that there is no turning back.
- Deploy To New Places When the Benefits Are Clear to Clinicians
Organizations have successfully used a variety of deployment approaches, from going
live simultaneously across an entire institution to moving across units over time.
Whatever the deployment strategy, however, many health systems did not implement the
new system until a critical mass of clinical leaders in that specific unit, practice,
service or facility agreed the technology would benefit the group. To win this
critical mass of support, many organizations facilitated collaborative sessions
between the administrative, IT leadership and the clinicians and only went ahead
with the project when there was agreement that implementation would be a win for all
parties.
- Individualized Approaches to Training and Support
While some organizations started with classroom training for clinicians, virtually
all 22 organizations in the study have migrated to individualized training and
support. With severe time constraints, physicians respond better to training that
adapts to their schedules. When several organizations began sending trainers to
physicians for one-on-one help, their willingness to adopt the system rose
dramatically. Moreover, using the actual system in real-life patient care settings
improved the actual, as well as the “perceived,” effectiveness of the training.
- Tight Feedback and Enhancement Cycles
The ability and commitment to gather and incorporate feedback from users after the
initial roll-out are vital for continued clinical use of the system. Organizations
that quickly enhanced technology based on the experiences of early adopters improved
the system, its benefits and its credibility. Paying attention to the feedback
clinicians provide on how to make the system produce even greater benefits for
patients, clinicians and the institution is a key strategy for driving adoption as
quickly as possible.
The innovation of technology offers the promise of better and more consistent
patient care with fewer problems and costs. Regardless of the country where new
technology is being implemented, the more of these critical success factors that
a hospital can incorporate into a large-scale technology implementation, the more
likely it will be to drive adoption and produce better outcomes for clinicians and
patients.
Jerry M. Garcia is the partner leading the Health and Life Sciences unit in
Canada, serving health care organizations, governments, and life science
clients (pharmaceuticals, research and bio-medical). He has a personal mission to
help improve health care in Canada.
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