March 13, 2017
Evolutionary electronic medical record projects—adapt or die (Part II)
By: Ulla Kuukka

EMRs should be seen as holistic, organisational transformation of health and social care providers, which touches all hearts and minds in the organisation.

Last time I highlighted the importance of a clear vision when implementing evolutionary EMRs, and stressed the engagement with all groups at all levels of the organisation. Three practical steps you can take to achieve this are: measuring impact on all players, getting buy-in from all organisational levels and paying special attention to leadership engagement.

Measure impact on all players

Equally important: Assess the impact of new ways of working on social workers, unit clerks, neurosurgeons and hospice nurses, and devise mitigating strategies to aid adjustment to the new. During EMR implementation, one large hospital organisation held workflow review sessions, where each hospital was shown workflows that would require most operational changes to their departments and wards. This was done months before the actual go-live, so hospitals had time to adjust to the new ways of working and also make necessary changes to, for example, the location of printers and educate staff on how to engage patients while using new EMR solutions.

Analytics can be used to track where an organisation is on its change journey but also predict where it is going to and what activities change leaders should focus on.

Buy-in from all organisational levels

Encouraging adoption of EMR requires involvement from many throughout the organisation, not just leadership. Creating change networks at many levels and encompassing various roles has proved to be beneficial. Different Subject Matter Experts (SMEs), unofficial change agents and, most importantly, mid-level leaders need to be involved1. People will follow those that they trust and appreciate. Having nurses talk to nurses, social care workers to social care workers and surgeons to surgeons has proven to be an efficient way to get different employee groups on board.

Making sure the organisation is ready for the EMR also requires making sure people understand what will change in their current roles, workflows and tools. Assessing the concrete gaps between current state and future state provides a tangible understanding of how organisations will need to prepare for the new (i.e., using barcode scanners when administering medications, need of new printers or bigger screens in wards, agreeing on centralised scheduling or referrals process or collaborating with labour unions on possible role changes). It will require change in care givers’ attitudes and organisational culture to, for instance, accept that patients want, and with modern EMRs are able to, schedule appointments at times that best suit them.

Well-tailored, role-based training and communications that support different stakeholders differently in every phase of a program are critical to the success of an EMR program. As an example, using social media, webinar and video telestrations as communication tools and virtual learning possibilities and short videos to supplement traditional class-room training has proven effective.

Special attention to leadership engagement

Getting and maintaining leadership engagement should be considered an activity on its own. Providing tools and support to leadership ensures that they have means to support their subordinates. If people trust their supervisors and leaders, they are likely to trust the changes their leads are promoting. Without trust, intimacy and sense of belonging change will not happen. Modern EMRs enable data driven management like never before. Getting leadership comfortable with KPIs and metrics will help them lead operations more effectively and transparently.

Changing health and social care with the help of EMRs should be seen as holistic, organisational transformation that touches the hearts and minds of everyone. Change enablement should be at the core—it’s too expensive and risky to underestimate it.


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