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What to Expect When You are Expecting: The Challenges of Technology Adoption Across A Dispersed Organization – Breakaway Thinking

Posted on October 26, 2016 I Written By

The following is a guest blog post by Mark Muddiman, Engagement Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Mark Muddiman
Imagine you have just installed your new clinical information system. Everyone has been waiting for months and excitement has peeked; the big day is right around the corner. Go live is coming and all the organizational sites are prepared for the new workflows and application. The application goes live and suddenly everyone needs help, support is inundated, and it becomes apparent that the expectations were not aligned to the reality of preparedness.

All too often this is a common scenario for organizations that are dispersed over large geographic areas. Adopting healthcare technology is difficult in a singular location, but certain challenges are uniquely amplified when an organization is dispersed. What challenges can you expect related to adoption and learning, and what can you do to ensure you are prepared?

Expect a greater emphasis on change management
As HIMSS reports, individual sites may fight the loss of autonomy as everyone is brought to a standard application or workflow. Each location has developed their own way of using the legacy application, and they must now learn new procedures and processes in addition to a new application. Multiple locations present multiple groups to manage at a distance, without the ability of physical project team members to be present at all locations throughout the adoption process.

Expect deviations from best practice and follow-up learning
Medical Economics recommends that learning continues beyond the initial go live. Staff will deviate from the best practice workflows as they forget less common tasks, and learn to navigate and use the application in different ways. Deviation from workflows introduces inefficiencies, dependency for support, and impedes the ability of staff to rotate between locations because the experience differs. Anticipate a need to provide follow up learning that reinforces best practices and helps avoid poor use of the application.

Expect each location will need onsite support
During go live, staff will often forget where to start and need a source to turn to when they forget a step in the new application and workflow they are using. However, it is very expensive and likely impractical to have a project team available at each location. Instead, providing assistance through super users and clinical champions along with easily referenced education materials will provide accessible onsite support for most issues.

What can you do?

Bring local leadership into decision making
Regional and local leaders can clarify the unique needs and constraints of their site when selecting applications and designing workflows. Whether equipment varies at each site or there are different service offerings, there are multiple benefits of involving local leadership. It allows leadership to determine the appropriate level of standardization that still respects the unique needs of each site, consequently removing the necessity to deviate from the standard workflow. Involving local and regional leaders engages them, provides a sense of ownership and cooperation in the project, and will help reduce resistance to change. It is imperative leadership is aligned at all levels, engaged in the adoption process, and supportive of the approach if adoption is to succeed.

Implement and ensure metrics are utilized
Metrics serve as key indicators to progress, knowledge retention, and proficiency, but in dispersed locations metrics also serve as indicators that would otherwise be filled with in-person observation. Metrics show whether a location is developing poor workflow practices or struggling with the change; subsequently metrics indicate whether a site needs additional support or learning. New metrics may be employed, such as surveys to gain feedback from multiple sites that could otherwise be obtained from a meeting or observation.

Follow up with each location often
Some sites will likely be more vocal in their need of support than others. It’s important to follow up with all sites and provide remedial education if metrics indicate a need to do so. Staff may need refresher training if inefficiencies arise, but there may be a root cause such as an educational or workflow gap that was previously unknown. Because adoption is a long-term commitment, it is important to provide continuous availability of learning while sustaining content to support changes to the application and learning needs.

Employ communication from leadership effectively
Effective communication goes a long way in reducing resistance to change. It also provides a channel for feedback and continuous collaboration. Communication should come from executive leaders to show their support of the adoption initiative, but also from local leaders. Staff can’t stop operations in a healthcare setting to join conference calls, and emails aren’t always read, but local leaders are able to directly communicate with staff. A comprehensive set of communications ensures an aligned message at all leadership levels and improves the ability of messages to reach staff.

While these suggestions may help, there is a proven methodology to comprehensively address challenges. At the Breakaway Group, we work with leadership to support engagement and change management at all levels while providing comprehensive sets of communication. Our experienced teams can provide workflow recommendations and develop education directly from the application that is sustained through the life of the partnership. Real-time data and metrics provide indicators of how each location is performing and undergoing change. Regardless of the organizational structure or of what to expect, we employ a methodology to help any organization achieve successful technology adoption and value realization.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

Is Your EHR Contributing to Physician Burnout?

Posted on September 28, 2016 I Written By

The following is a guest blog post by Sara Plampin, Senior Instructional Writer from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Sara Plampin - The Breakaway Group
It’s finally come, the day you’ve been working toward for years – Go Live. Thousands (or even millions) of dollars, hundreds of hours planning and calculating and going back to the drawing board, and it’s about to pay off. You sit back and take a breath, proudly watching as your organization takes its first steps into the future.

And then the complaints start to trickle in. The Electronic Health Record (EHR) feels clunky, it doesn’t match current workflows, documentation takes too long, and the physicians refuse to use it.

Frustrations over EHR functionality and increased documentation time are a leading cause of burnout among medical workers. Physician practices, in particular, are showing a decrease in EHR use over time. Physicians say hefty documentation requirements take away valuable face-to-face time with patients, making them feel more like scribes than doctors.

The issue has led to physician groups reviving the ‘Quadruple Aim’ movement, in which physician wellness is more emphasized.

quadruple-aim-of-healthcare-physician-wellness

While many are quick to attribute this dissatisfaction to the EHR itself, it is more likely the result of a poor implementation plan that focused more on technological requirements and less on long-term adoption needs. There are three ways to ensure the needs of physicians and clinical staff are met and you have a successful EHR adoption.

Involve Clinical Staff from the Get-Go
One of the biggest mistakes you can make is failing to include clinical staff in the initial decision-making process. Before choosing an EHR vendor, assemble a team of representatives from all areas of your organization – not just physicians and nurses. Ancillary departments such as therapy, radiology, and pharmacy are often overlooked when it comes to EHR design and training. Each representative will be aware of the specific needs and workflows for their department; they can compile requests from their colleagues and help research different vendor options to determine which EHR is the ideal match for your organization.

Once the EHR is selected, clinical staff members become an integral part of the design team. Although vendor representatives can help identify best practice workflows, ultimately your employees are the experts on how the EHR will be used in their department. HIMSS physicians cited five factors that contribute to EHR usability issues: navigation, data entry, structured documentation, interoperability, and clinical decision support. Involving clinicians in the design and testing phases allows them to identify solutions to some of these common issues, making the EHR more intuitive for future users.

Including members from all areas of the organization not only ensures better EHR selection and design – it also improves morale. When staff feel like their voices are heard, the project becomes a joint initiative rather than a regulation from upper management. Representatives from the design team act as a go-between, communicating their peers’ requests to executives, while in turn reinforcing the importance of the transition and garnering excitement for go live and beyond.

Realistic, Time-Effective Training
Once the EHR design is solid, the next step is to make sure all staff are properly trained and comfortable using the application. While this may seem obvious, training is another area where many organizations fall short. It is not just the amount of training that matters, but also the type and timing of training. Full-day classroom training sessions can be ineffective for adult learners. Additionally, planning training days around complicated shift schedules is difficult, as is finding replacement staff. This is particularly an issue at small physician practices, where physicians may have to sacrifice patient time in order to complete training.

A more modern, time-effective approach to training is online simulation. Learning is chunked into modules based on small tasks users may complete throughout their day. Thus, learning can be spread over days or weeks, whenever the physician has a free moment. Simulations allow learners to practice using the EHR, giving them the chance to fail without repercussions and develop muscle memory for daily tasks. By go live, using the EHR should feel like second nature.

A lot of the frustrations users feel about navigation and documentation requirements result from their unfamiliarity with the application. When they receive the right training, they will feel confident using the EHR, thus reducing documentation time and increasing face-to-face time with patients.

Constant Feedback/Reevaluation
As with all large-scale projects, even the best laid plans are bound to hit a snag or two. If you’ve established a solid communication channel with all department representatives, you will be prepared to handle any complaints that come your way after go live. It is important that all staff have a clear path to communicate problems and suggestions, and that they are comfortable doing so. The best way to avoid dissatisfaction among your employees is to hear their complaints and proactively fix these issues.

If you’ve already implemented an EHR and are now dealing with the types of complaints outlined above, this is the place for you to start. Create testing and measurement procedures to determine how users are currently using the EHR, where they are getting stuck and where their actions deviate from prescribed workflows. Then, work with each department to determine where EHR functionality can be tweaked, workflows redesigned or a combination of both. Effective adoption requires a constant cycle of communication, design, training, evaluation, and redesign.

If you want to make sure your employees are happy with the EHR and physicians avoid burnout, go live is just the beginning.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

Are You Wasting your EHR Investment? – Breakaway Thinking

Posted on August 31, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Heather Haugen, PhD, Managing Director and CEO at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Heather Haugen
Healthcare leaders and clinicians continue to be disappointed with the value Electronic Health Record (EHR) technology provides in their organizations today. The challenges are real, and it will take some time and effort to improve. The technology will continue to evolve at the pace we set as leaders, vendors and healthcare professionals.

When Free Is Expensive
Several years ago, a reputable IT vendor offered us free use of their software, which provided monitoring of equipment that would be valuable to us. Initially, we were excited; the functionality perfectly aligned with our needs, and the application was robust enough to grow with us. We had a need and the software fulfilled the need. We couldn’t wait to have access to the dashboard of data promised by the vendor.

Months after the implementation, we were still waiting. The “free” price tag was alluring, but we quickly recognized the actual maintenance costs and labor required to make the application truly valuable to our organization were far from free. This story drives home a concept that we all understand, but often overlook. Underestimating the “care and feeding” required to maintain a valuable investment puts the entire project at risk. We all need to remember the importance of sustainability even when we are initially excited about a new investment.

EHR systems are expensive and require tremendous resource investment, but the effort is ongoing and we need to plan accordingly.

The Key to Long Term Behavior Change
The difficulty of moving from implementing an EHR to maintaining high levels of adoption over the life of the application is strikingly similar to weight loss and weight management efforts. The percentage of overweight adults in the U.S. is staggering and continues to rise. Today, over 66 percent of adults in the United States are overweight and 59 percent of Americans are actively trying to lose weight. But the problem isn’t weight loss – it’s weight maintenance. Many of us have successfully lost weight, but can’t keep the weight off. As a matter of fact, we regain all the weight (and often more) within 3-5 years.

This isn’t a complex concept: dieting doesn’t incent long-term lifestyle change, thus we re-gain weight after we settle back into old habits. To be successful in the long-term, we need to practice weight management behaviors actively – for years, not months.

We’ve taken the dieting approach to implementing new software solutions in healthcare for too long. We prepare for a go-live event, but fall back into our comfortable old habits afterwards – resulting in work-arounds, regression to ineffective workflows, insufficient training for new users, poor communication and errors. The process of adoption requires a radically different discipline, and the real work begins at go-live.

Instead of checking the project off your to-do list after a successful implementation, you need to create a plan to sustain the changes. A sustainment plan addresses two critical areas:

  • It establishes how your organization will support the ongoing needs of the end users for the life of the application. This includes communication, education and maintenance of materials and resources.
  • It establishes how and when your organization will collect metrics to assess end user adoption and performance.

Lack of planning and execution in these two areas will lead to a slow and steady decline in end user adoption over time.

Effective sustainment plans require resources – time and money. Keep in mind that adoption is never static; it is either improving or degrading in the organization. A series of upgrades can quickly lead to decreased proficiency among end users, completely eroding the value of the application over time. Leadership must plan for the investment and fund it to achieve improved performance.

Most organizations only achieve modest adoption after a go-live event, and it takes relentless focus to achieve the levels of adoption needed to improve quality of care, patient safety and financial outcomes. Sustainment plans are most successful when they are part of the initial budgeting and planning stages for EHR.

Metrics Make the Difference
Metrics are the differentiating factor between a highly effective sustainment plan and one that is just mediocre. End user knowledge and confidence metrics serve as a barometer for their level of proficiency, providing the earliest indication of adoption. Ultimately, performance metrics are powerful indicators of whether end users are improving, maintaining or regressing in their adoption of the system. If we get an early warning that proficiency is slipping, we can react quickly to address the problem. These metrics ensure the organization is progressing toward high levels of adoption, overcoming barriers and gaining the efficiencies promised by EHR adoption. Metrics act just as the scale does in long-term weight management; they are the first indicator that we are falling back into old behaviors that are not consistent with sustainable adoption.

Metrics also keep us on track when performance does not meet expectations. Two potential scenarios in which the go-live event is successful but performance metrics fail to reach expectations help illustrate this idea. For instance, performance metrics could not be achieved because the system is not being utilized effectively. This may be due to inadequate training and therefore lower proficiency, or a problem with the actual performance by end users in the system. Measuring end user proficiency allows us to identify “pockets” of low proficiency among certain users or departments and make sure they receive the education needed. Once users are proficient, we can refocus our attention on the performance metrics.

A second scenario is less common but more difficult to diagnose. Users could be proficient, but specific performance metrics are still not meeting expectations. In this case, we need to analyze the specific metric. Are we asking the right question? Are we collecting the right data? Are we examining a very small change in a rare occurrence? There may also be a delay in achieving certain metrics, especially if the measurements are examining small changes. A normal delay can wreak havoc if we start throwing quick fixes at the problem. In this situation, staying the course and having confidence in the metrics will bring desired results.

Like sustained weight loss, EHR adoption is hard work.  Commit to a sustainment plan and a measurement strategy to ensure your EHR continues to provide the long-term value that was promised at go-live.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

Is Your Organization Ready for EHR Adoption? – Breakaway Thinking

Posted on July 20, 2016 I Written By

The following is a guest blog post by Heather Haugen, PhD, Managing Director and CEO at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Heather Haugen
What is the most significant barrier to Electronic Health Record (EHR) adoption for clinicians?  This question was the foundation of our research published in Beyond Implementation: A Prescription for Lasting EMR Adoption in 2010. The answer wasn’t surprising then and won’t surprise you now, but let’s consider how your leaders are doing in the face of enormous change in healthcare (think telemedicine, high pharmaceutical costs, rising medical costs, medical ID theft). It’s more important than ever to focus on technology adoption in today’s healthcare climate.

The one factor that formed a pattern across every organization struggling with EHR adoption was a lack of engagement by those leading the effort, and this still holds true today. For many reasons, this is a hard pill to swallow. First, it places responsibility back on the earliest champions: those who decided to fund and move the entire organization into an EHR implementation or upgrade. Second, it requires already overworked executive and clinical leaders to make adoption a daily priority. Effective leadership is an antecedent to adoption.

There is no greater barrier to the adoption of a complex IT application in an ever-changing healthcare environment than believing we can simply pile this effort on top of the other priorities and expect success. Organizations with disengaged, part-time, and/or overworked leaders at the helm of an EHR effort will struggle and may never achieve full adoption. In contrast, organizations with leaders who are fully invested in the daily march toward adoption will not only reach the early stages of adoption, but will enjoy a reinforced cycle of meaningful clinical and financial outcomes. Leadership must take five steps to succeed in moving their organization toward EHR adoption.

Develop a “stop doing” list: Establishing a new leadership agenda requires freeing up time for those leading and working on the effort. Without reprioritizing daily tasks, EHR adoption receives inadequate time and attention. Leaders currently in charge of EHR adoption need to understand what they are going to stop doing and focus on maintaining the courage to follow through on their decision.

Create a positive tone at the top of the organization: One of the most challenging aspects of leading an EHR adoption is transforming the project into a compelling and meaningful effort for everyone. When people, especially clinicians, believe in a cause, they will go to extraordinary lengths to ensure a successful outcome. Creating a common message with purpose and constancy is not easy, and sustaining the message is even more difficult. But when leaders create the right tone for the EHR adoption message, it will be powerful and help maintain momentum to create change.

Connect to clinical leadership: The key to provider adoption of EHRs is engagement. A governance system will engage clinicians through responsibilities and accountabilities and create clinician champions – the most highly-respected and well-networked clinicians. A high level of provider engagement can ameliorate or even overcome the common barriers to adoption, including resistance to abandoning the previous charting method, the investment of time required to learn the new system and the initial drop in productivity until users attain proficiency.

Empower decision-makers and reinforce their spheres of influence: Implementing or upgrading an EHR requires thoughtful consideration of the policies and procedures that will govern the use of the system.  There are many stakeholders with a myriad of opinions and often competing interests that can dramatically slow adoption of the EHR. Adhering to a well-defined governance process ensures that the right people are involved at the right time with the right information. The lack of governance allows the wrong people to endlessly debate decisions, ignore standards and often conclude by making the wrong decisions. Leaders must establish strong governance processes that define expectations around adoption of the EHR, involve the right stakeholders to make decisions, establish policies and best practices and ultimately evaluate performance against expectations. Governance must also be flexible enough to evolve over time.

Relentlessly pursue meaningful clinical and financial metrics: The payoff for adopting an EHR comes in the form of clinical and financial outcomes. If results are neither tracked nor realized, the effort is truly a waste of time and money. Our expectations need to be realistic, but it really is the leaders who are accountable for the relentless pursuit of positive outcomes. Leaders must incent the right people to collect, analyze, and report on the data. Similar to engaging clinicians, this requires some finesse. The good news is that clinicians are generally interested in these metrics and may find the numbers compelling enough to change processes enough to impact the outcomes. Identify several key metrics that are easy to collect, work to improve them and then measure again.

Now is the time to create a new leadership agenda to drive EHR adoption and ultimately improve patient care – which is the goal we all share!

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

The 4 Learning Metrics Linked to Successful EHR Adoption – Breakaway Thinking

Posted on June 16, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Shawn Mazur, Instructional Writer at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Shawn Mazur - The Breakaway Group
There seems to be a trend in the education processes of a go-live for large EHR implementations: they’re scary. For large hospitals, the task of providing learning to hundreds, if not thousands, of employees for a go-live is daunting, and no matter how much time and resources you pour into designing the perfect curriculum and planning out a detailed schedule, you may quickly end up feeling like your learning effort is falling short. Learning metrics can play a vital role in making the task of creating and managing learning for a big go-live a little less scary.

Despite high levels of EHR implementations since the HITECH Act, many organizations still have significant go-live events in their future. A majority of learners are at least somewhat familiar with EHR systems, so education needs to be focused on making learners comfortable with a new, or advanced, EHR rather than teaching all there is to know about the systems. Since 2014, the number of buyers replacing existing EHR software has increased 59%, according to a 2015 EHR BuyerView report. It was also reported that challenges facing an organization were not overcome by the implementation of a new EHR. A lack of education for any go-live event will discount the value behind a new EHR.

Having the perfect plan for EHR education from the beginning is not the only key to successfully preparing your employees for go-live. Additionally, you should implement a plan to monitor the training process, completing learning metrics as you go, and then be flexible in how you carry out the remainder of your learning. So, you decide to be flexible in the information you provide to learners, but when do you know it’s time for a change in direction? Going beyond the summary of what your users should learn if they complete all of their learning, the following four metrics tell you how learners are reacting to the content.

1. Completion Summary
A simple but effective metric that lets you know how much progress your users have made in their learning objectives. This metric is especially important with e-learning and with self-paced learning. Collecting this data will also help you identify problems with different learning roles throughout your organization. Flagler Hospital, a regional hospital, kept completion summary metrics throughout their large switch from Meditech to Allscripts. They reported that their completion metrics began to show users were completing their learning much faster than expected. This data allowed Flagler to actualize their education plan to make remarkable reductions in training schedule, time, and cost from their original plan. Had Flagler’s completion summary shown less than satisfactory numbers, it would have also provided an opportunity for changes to be made. Low completion rates may mean that one role’s users are getting stuck at a certain point of their learning or struggling to even begin. In these cases, use completion metrics to push learning requirements along in time for go-live.

2. Assessment Summary
If your organization isn’t planning on testing users on the education they’ve received, it may be time to consider doing so. Using a step-by-step simulated assessment is the easiest way to put a solid number on how prepared your users are for navigating workflows in the live system. After implementing tests, compile metrics on them at a high level, including how many learners took their test, how many times each user attempted a test, and of course, the percentage of assigned learners who successfully passed their test. Flagler hospital also used assessment metrics alongside their completion summary. As a result, they saw that that their completion summary aligned with their assessment summary. Along with the fast pace at which they were completing learning, Flagler’s learners had average testing scores of 94 percent. The high test scores solidified their decision to make changes to the original learning schedule.

3. Assessment Audits
After implementing step-by-step testing of your user’s knowledge, dig deeper into your testing scores to pinpoint exactly where users are falling short. You will often find that a deficiency in learning curriculum leads to users missing the same steps during their test. For example, let’s say you break down your scores by step and see that over 60 percent of users clicked the incorrect button for documenting current vitals. This is an advantage over less effective traditional testing methods, like multiple choice formats. From this metric, it is clear that you should delegate additional learning resources on best practices for entering vitals before your go-live approaches.

When you test users without using the metrics to facilitate better learning, your learners will feel frustrated with their lack of proficiency. In his book, Why High Tech Products Drive us Crazy, Alan Cooper defines two types of learners. He says, “Learners either feel frustrated and stupid for failing, or giddy with power at overcoming the extreme difficulty. These powerful emotions force people into being either an ‘apologist’ or a ‘survivor.’ They either adopt cognitive friction as a lifestyle, or they go underground and accept it as a necessary evil.” Auditing your tests by step gives you the opportunity to return to your curriculum to elaborate on topics with low testing proficiency. Pinning down topics that require additional learning will eliminate the frustration and feeling of defeat among learners failing their assessments.

4. Knowledge and Confidence Level
Confident learners are a good thing, but not always the best come go-live. It is important that your learners not only have confidence, but also the knowledge to back it up. When knowledge and confidence are not aligned, the user is in a bad place for not only lacking proficiency in the system, but for their education going forward. Users who are pushed to use the live system before they feel confident enough will be far from proficient in the system, and will feel a resentment against the organization moving forward. Equally so, users confident to get in the system but lacking the knowledge to be proficient will also fail, and be quick to blame it on poor learning. In his book, Cooper also says, “Users only care about achieving their goals.” When learners can’t achieve their goals for the learning, they are quick to find a way to reach their goal, defining their own workflows and workarounds instead of sticking to best practices outlined by your organization. Collecting data from your learners, usually through a survey-like format, on how confident they are to start working in the live system and how knowledgeable they feel about the information taught, will help you gauge how ready users are for go-live. When aligning this with your other learning metrics, you will quickly see how ready your users are to proficiently use the live system.

It is often the case that the education plans you spent countless amounts of time and resources on leaves learners feeling distant with the EHR. Think about how you can use metrics to track your learning and be flexible to make changes using those metrics to benefit your learners in the long run.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

Can Using Simple Metrics Help Drive Long-Term EHR Adoption? – Breakaway Thinking

Posted on May 18, 2016 I Written By

The following is a guest blog post by Lauren Brown, Adoption Specialist at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Lauren Brown - Healthcare IT Expert
Gaining clinical, financial, and operational value from Electronic Health Record (EHR) applications has become a top priority for most health organizations across the country. Gone are the days of simply focusing on implementation that, in many cases, led to dissatisfaction and low adoption rates by staff. Previously, dissatisfied customers began looking to switch applications in hopes of gaining better results. However, studies show that switching EHRs does not solve the dissatisfaction problem. In fact, only a reported 43% of physicians are glad they made the switch to a new application, and 49% reported lower productivity as a result of the switch.

Recently, there has been a shift towards optimizing these new technologies and focusing on how to get the most out of their chosen application. It is essential for organizations to establish an optimization plan in order to achieve long-term, measurable results. Utilizing a metric-driven optimization approach gives healthcare organizations the opportunity to maximize their EHR investment and uncover opportunities for adjustments that substantially bolster technology integration.

Metric-driven optimization analyzes performance data and uses this information to drive continuous performance improvement throughout the organization. The U.S. Department of Health and Human Services suggests focusing metrics on how the system performs, how it will affect the organization, and how users experience the system. The ultimate goal is to execute well-designed strategies to help organizations identify and reduce workflow inconsistency, maximize application performance, and improve patient care.

So what are the keys to a metric-driven optimization approach?

Incorporate metrics early

Initial training serves well in focusing on application basics. But adoption occurs at a varying pace, so it’s important to continually monitor training and create a plan for late adopters. During training, staff will likely remember only a small portion of the information they are taught; if optimization occurs too late in the process, users do not learn best-practice workflow. This can result in workaround habits that become difficult to change. The use of metrics early in the process will help to monitor EHR adoption and focus on areas of opportunity. Metrics allow you to identify individuals who are struggling with their education and intervene.

Utilize system data found through metrics

Often, healthcare organizations try to mimic processes and workflows from past applications or paper records. This method can get you through the initial implementation, but it is not sustainable for long-term adoption. Before implementation begins, it’s important to analyze and document best practice procedures. In order to get the most out of the system once it’s in place, you’ll want to examine staff performance and analyze key workflows. The insights you gain will help ensure that productivity and stability continue to increase over time.

Capturing the right data allows you to identify inconsistencies and application issues that would have otherwise gone unnoticed. Developing and reporting metrics shows the value of optimization efforts and helps support staff moving forward. Existing workflow issues, if not addressed, will become more visible with technology. Utilize the technology to eliminate redundant, time-consuming processes. Look at your EHR as the leverage you need to create change to promote consistency and transformation across the organization.

Metric-driven optimization is an ongoing process

The need for optimization is an ongoing effort – not a one-time event. Incorporating metrics into the long-term roadmap as a continuous project will allow you to respond to changes in a timely fashion. Comprehensive metrics regarding how end users will be able to reach proficiency in the EHR application is an important element in ensuring adoption success. The more metrics are shared the more value an organization can gain from optimization efforts. Changes, including system upgrades and new employees, can continue to challenge optimization efforts that were previously made. They often require both functional and cultural changes in processes that impact many different groups across an organization. Data regarding these changes are key to ensuring those who will be impacted are aware and have the ability to adopt for the life of the application.

By taking a metric-driven optimization approach, healthcare organizations improve their use of technology and achieve long-term adoption. Instead of simply installing an EHR, the application is leveraged to enhance performance and push organizations to exceed expectations with patient care.

How has the use of metrics improved your organization’s technology adoption?

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

The Senate is Promoting Healthcare Innovation – How Organizations Can Keep Pace – Breakaway Thinking

Posted on April 20, 2016 I Written By

The following is a guest blog post by Mark Muddiman, Engagement Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Mark Muddiman
On March 9, 2016 the Senate Committee on Health Education Labor and Pensions (HELP) approved S.1101, better known as the Medical Electronic Data Technology Enhancement for Consumers’ Health (MEDTECH) Act. As HIMSS reports, the bill aims to limit the regulatory oversight of “low-risk” medical device software, while simultaneously making a clear distinction of the FDA’s reach of authority.

But how do you define “low-risk” when it comes to a person’s health?

The answer might surprise you. These items are deemed low-risk by the MEDTECH act and will no longer require oversight:

  • administrative, operational, or financial records software used in healthcare settings
  • software for maintaining or encouraging a healthy lifestyle unrelated to medical treatment
  • electronic patient records, excluding software for interpreting or analyzing medical image data
  • software for clinical laboratory testing, excluding software for interpreting or analyzing test data
  • software that provides medical recommendations and the basis for those recommendations to healthcare professionals, excluding software for acquiring, processing, or analyzing medical images or signals

Regulations serve a purpose in ensuring that the devices used do not put patients at risk, and some fear that the loosening of these restrictions could be problematic. But the number of policies vendors were previously required to abide by was staggering. There is little value in subjecting vendors or healthcare leaders to such stringent policies with software and devices that are unlikely to lead to increased risk or an adverse event. Unnecessary regulation ultimately restricts patient access to the most current technology and impedes more successful clinical outcomes.

As HIMSS further clarified, the MEDTECH act still allows the FDA to oversee medical software if it considers the product “reasonably likely to cause serious adverse consequences.” The congressional summary goes on to note that the FDA may assess a software function for safety and effectiveness if the medical device has multiple functions. For example, mobile applications do not need supervision if integrated by a vendor unless they become linked to something of medium or high risk such as medication administration. In short, vendors get the freedom they need to explore new avenues, but the FDA doesn’t cede total control and retains an option that can be interpreted broadly enough to intervene when needed. In this sense, the MEDTECH act finds a middle ground using a risk-based approach to focus oversight where it’s needed most.

Key players in the industry have supported the bill; Health IT Now and the American Medical Informatics Association (AMIA) both praised the passage of the act, while major vendors including Athenahealth, IBM, and McKesson strongly supported the push to pass the bill. Undoubtedly, the passing of the MEDTECH act was great news for vendors.

The benefits to patients and vendors are clear, but what about healthcare providers and administrators?

CIOs and CMIOs already have their hands full in keeping pace with a seemingly endless set of transformations in health IT. Now the senate is aiming to quicken innovation and promote shorter times for technology to reach the market, inevitably resulting in a faster rate at which organizations must adopt that technology. Some providers likely viewed the passage of the act with an exasperated palm to the face. The frustration is real; the move to ICD-10 occurred less than seven months ago, not to mention many organizations have implemented EHRs but are focusing on optimization to improve their ROI.

Simply put, there is no end in sight to new technologies arriving in healthcare, and there will not be a slowdown anytime soon. Healthcare organizations must proactively plan a long-term adoption strategy that accounts for continual enhancements in technology, with a focused ability to quickly bring staff to a high level of proficiency. Those that achieve such agility will be able to leverage the best technology to offer the highest standards of care.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

Has MU Been Useful? A Review of MU and Merit-Based Incentives – Breakaway Thinking

Posted on March 16, 2016 I Written By

The following is a guest blog post by Lori Balstad, Learning and Development Specialist at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Lori Balstad
Is it really the end of Meaningful Use? According to Andy Slavitt, Acting Administrator for the Centers for Medicare and Medicaid Services (CMS), it’s time for a change in incentive programs and 2016 may be the year for it. Alternative Payment Models and Merit-based Incentive Payments (MIPS) as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) may be replacing the complicated layers of requirements in Stage 1, 2, and 3 of Meaningful Use.

While CMS works on rolling out a new set of regulations, you may be wondering if this will ease the lingering pain of the past years. Will the program be easier to understand, navigate, and comply with?

First, let’s do a quick review:

CMS’s Meaningful Use Incentive program was rolled out in 2011 to incentivize eligible professionals and hospitals to adopt electronic health records (EHRs).

The goal was three-fold:

  • Improve quality, safety, efficiency, and reduce health disparities
  • Increase patient engagement and satisfaction
  • Improve care coordination, and population and public health

Stage 1 dealt with data capture and sharing, Stage 2 focused on advance clinical processes, and Stage 3 was to bring us to improving healthcare outcomes.

Achieving these goals is not an easy or quick process, but there have been many noteworthy accomplishments. As of 2015, 95 percent of all eligible and critical access hospitals have demonstrated meaningful use of certified health IT through participation in the CMS EHR Incentive Programs. Ninety-eight percent of all hospitals have demonstrated meaningful use and/or adopted, implemented or upgraded any EHR. As of January 2016, more than 484,000 health care providers received payment for participating in the Medicare and Medicaid EHR Incentive Programs, according to the CMS.

There have also been bumps along the way. Clinical quality reporting is controversial due to unrefined standards and a lack of a comprehensive strategy around the measures. Providers struggle to balance healthcare reform efforts with patient engagement and education under Stage 2. Eligibility determination issues in the CMS website threatened some physicians and other eligible professionals with Medicare payment penalties in 2015. Physicians are at the point where the regulations are so difficult that they feel like they are unable to focus on patient care.

So what’s next?

CMS has been working closely with physicians and healthcare organizations to address their needs and concerns, and plans to share the new regulations this spring under MACRA. They will work towards keeping the original ideologies while establishing new critical principles. The most important improvement will be moving away from incentivizing providers for the mere use of the technology towards the actual outcomes achieved with their patients. Other goals include allowing for flexibility to customize health IT to ensure physicians are supported instead of distracted.

Meaningful Use is not going away, just the way it’s measured and incentivized. Moving toward quality outcomes instead of measuring technology adoption levels will hopefully move us closer to the original goals of Meaningful Use. It all comes back to what physicians and healthcare organizations do on a daily basis – strive to provide the best possible care for patients.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

The New Healthcare Consumer – Engaging Patients through Technology – Breakaway Thinking

Posted on February 17, 2016 I Written By

The following is a guest blog post by Sara Plampin, Instructional Writer from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Sara Plampin - The Breakaway Group
When you get sick, where is the first place you turn for help? In today’s technology-driven world, most people look up their symptoms online before they even consider contacting their doctor. In fact, Pew Research has shown that almost 75 percent of patients use the internet as their first resource for questions about their health. And why not? Online, there’s no need to schedule appointments or spend time in the waiting room – the answers are available instantly.

As the healthcare industry becomes increasingly consumer-driven, technology is one of the critical factors patients consider when choosing a provider. You can use many different tools to increase patient engagement, including patient portals, mobile apps, wearable devices, and social media. Because healthcare consumers are actively involved in all of these areas, a savvy organization will use several different means to engage new and existing patients.

Patient portals and mobile apps
One of the most important things to consider when adopting new engagement technology is your patients’ needs and expectations. Simply setting up a mobile app or patient portal is not enough if it does not provide the information or functionality that the patient is seeking. A recent survey suggests most hospital mobile apps fail because they do not address patients’ top three desires: electronic prescription refills, appointment scheduling, and access to their medical record. Successful apps appeal to consumers because they give patients and their families more control over their health. For instance, if patients have access to their medical record through a patient portal or EHR app, they can make sure the information is up to date and inform the provider of any mistakes. Families of elderly patients can use apps to check up on their relative’s health and communicate with their caregivers. These technologies will become a deciding factor for patients seeking a new provider.

Health and fitness trackers
Health and fitness trackers are another great tool to increase patient engagement. While providers recognize the benefits of increased physical activity, they tend to have mixed feelings about the amount and quality of data these devices collect. However, wearables can be a valuable engagement tool simply for their ability to get patients actively thinking about their health. Calorie trackers and step counters are useful tools for patient education, helping patients learn to improve their health by making small changes in their daily routines. There are also trackers to help patients manage chronic conditions such as heart disease or diabetes. These apps can help ease the burden of health management by providing reminders and suggestions to patients, while allowing providers to keep track of their patients’ health remotely.

Social media
Consumers increasingly expect their favorite brands to have an online presence where they can share their feedback, ask questions, and learn more about the company. Healthcare should embrace social media as a tool to connect with and educate their community. Providers can use it to remind patients of the importance of sticking to their medication schedule or publish videos explaining common procedures and treatments. If patients see an organization as a relatable and trustworthy source of information, they are more likely to approach them with health questions and concerns. Social media gives your organization the opportunity to communicate directly with patients and help them discover the appropriate channels for their feedback.

EHRs
Unfortunately, sometimes EHRs and other technology can actually become a barrier to patient engagement. A study conducted by JAMA Internal Medicine showed that patients are less satisfied with their care when providers use computers during the patient visit. Providers and clinicians must find a way to harmonize patient care and computer documentation. One of the best ways to do this, as suggested by Dr. Melissa Lucarelli at Medical Economics, is to “address the elephant in the room” by showing the patient the EHR. Instead of a wall dividing provider and patient, the computer can become a link between them, facilitating valuable conversations and empowering the patient to take charge of their health. Most of all, patients will feel more trusting of their provider, who made them a partner in their care.

No matter what methods your organization chooses to increase patient engagement, HIMSS recommends that all changes go through the analysis-implementation-optimization model. It’s not enough to simply set up a patient portal; you need to analyze your organization’s and patients’ needs, implement the application accordingly, review how it is being used, and make improvements. Make sure both staff and patients receive the proper education they need to get value out of the new system. As with all technology, new patient engagement tools require time, effort, and careful planning to achieve adoption.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

Workflow Redesign Is Crucial to Adopting a New Health IT System – Breakaway Thinking

Posted on January 20, 2016 I Written By

The following is a guest blog post by Todd Stansfield, Instructional Writer from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Todd Stansfield
Workflow analysis and redesign have long been touted as essential to health IT adoption. Most organizations recognize the importance of modifying current workflows to capitalize on efficiencies created by a new application and identify areas where the system must be customized to support existing workflows. Despite this recognition, there remains room for improvement. In fact, last month the Office of the National Coordinator (ONC) identified the impact of new IT systems on clinical workflows as one of the biggest barriers to interoperability (ouch).

A successful redesign includes both an analysis of current workflows and desired future workflows.

Key stakeholders – direct and indirect – should take part in analyzing existing workflows. An objective third party should also be present to ask the right questions and facilitate the discussion. This team can collaborate to model important workflows, ideally in visual form to stimulate thorough analysis. To ensure an efficient and productive meeting, you should model workflows that are the most common, result in productivity losses, have both upstream and downstream consequences and involve multiple parties. The National Learning Consortium recommends focusing only on what occurs 80 percent of the time.

Once you document current workflows, you can set your sights on the future. Workflow redesign meetings are the next step; you need them to build a roadmap of activities leading up to a go-live event and beyond – from building the application to engaging and educating end users. Individuals from the original workflow analysis sessions should be included, and they should be joined by representatives from your health IT vendor (who can define the system’s capabilities) and members of your leadership team (who can answer questions and provide support).

After the initial go-live, you need to periodically perform workflow analysis and continue adjusting the roadmap to address changes to the application and processes.

Why should you spend all the time and effort to analyze and redesign workflows? Three reasons:

  1. It makes your organization proactive in your upcoming implementation and road to adoption. You’ll anticipate and avoid problems that will otherwise become bigger headaches.
  2. It’s the perfect opportunity to request customizations to adapt your application to desired workflows.
  3. It gives your staff a chance to mentally and emotionally prepare for a change to their daily habits, increasing buy-in and decreasing resistance to the switch.

Thorough and disciplined workflow redesign is an important step to adopting a new health IT application, but of course it’s not the only one. You’ll still need leadership to engage end users in the project, education that teaches learners how to use the new application to perform their workflow, performance metrics to evaluate adoption, and continual reinforcement of adoption initiatives as the application and workflows change over time.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.