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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 Education Game: Engaging HIT Learners for Successful Adoption – Breakaway Thinking

Posted on October 14, 2015 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
Your hospital is transitioning to a new EHR, and you are responsible for organizing training. To accommodate your staff’s busy schedules, you arrange several interdepartmental classroom sessions. However, after providers complete training, they tell you that they still do not feel ready to use the new application. They complain that much of the instruction was not relevant to their role, and their time would’ve been better spent caring for their patients.

It’s a common dilemma in healthcare – how can you make EHR education effective and engaging? E-learning is one alternative to traditional classroom training. However, for e-learning to be successful, it must do more than simply transfer classroom materials to an online format; it must utilize the technology in new and innovative ways to make learning more engaging. One of the most effective e-learning techniques is simulation. Clinicians frequently use simulations to practice new techniques on “patients” without putting real people at risk. The same principle can be applied to EHR applications; simulations mirror the live application, allowing providers to enter orders and document patient data just as they would with live patients. This interactive, hands-on learning method has been shown to improve clinicians’ proficiency while simultaneously reducing the amount of time spent in training.

To increase learner engagement, many simulations employ the concept of gamification. Gamification is the incorporation of game principles into traditional learning and e-learning methods. Not to be confused with game-based learning (the use of actual games to teach concepts), gamification identifies the elements of games that make them so compelling – including rewards, goals, and progress tracking – and integrates them into simulations to grab learners’ attention and keep them engaged.

Reward is one of the most common elements of games. Extrinsic rewards such as leaderboards, badges, trophies, and prizes can trigger a learner’s sense of competition and provide motivation to complete their learning. These elements can easily be incorporated into simulations for a game-like experience, encouraging friendly competition among providers or between departments. However, critics of gamification complain that competition and badges aren’t enough to improve learning outcomes. Studies have shown that intrinsic motivation is more effective for learning than extrinsic rewards alone. Intrinsic rewards are the positive feelings associated with playing a game. After all, you don’t just play for the prize; you play for fun. In addition to providing entertainment, games can improve self-confidence as users overcome mental and physical challenges. Learners who enjoy their education are more likely to return to it, reinforcing their knowledge of application workflows and best practices.

For healthcare professionals, one of the biggest intrinsic motivators is the patient’s wellbeing. Simulations satisfy providers’ natural care instincts by incorporating another common game element – the story. Stories transform abstract concepts into concrete goals that directly relate to the learner’s job. For instance, instead of lecturing a clinician about every allergy function in the application, a gamified course might present the following scenario:

While recovering from orthopedic surgery, patient Ashley Jones has a mild allergic reaction to her morphine. You need to add morphine to her allergies and communicate this to the rest of Ashley’s care team.

Adding a human element allows learners to connect with the subject matter on a more personal level. The course is no longer just a module they have to complete – it is a realistic scenario that they might encounter every day. According to an eLearning Industry article, “successful learning is a combination of three elements: 70% from real-life and on-the-job experiences, tasks, and problem solving; 20% from feedback and from observing and working with peers and role models; [and] 10% from formal training.” Story-centric simulations allow us to transform the 10 percent into the 70 percent, making learning more effective by mimicking real-life situations and problem solving. By focusing on tasks and goals, simulations also reduce the amount of time clinicians spend learning about extraneous features and workflows that do not relate to their job roles.

Simulation also makes it easier to measure learners’ proficiency. Classrooms often rely on paper tests to evaluate the success of training. While these types of tests are useful for assessing a learner’s understanding of workflow and policies, they do not evaluate whether the learner can actually use the application. Organizations may not notice issues until weeks after go live, when clinicians start using workarounds to complete tasks they didn’t fully understand in class. On the other hand, simulations can track clinicians’ progress throughout the course of learning, enabling organizations to identify common issues and trends before go live. Progress tracking also serves as a motivational tool for learners. New tasks, badges, and leaderboard rankings provide instant positive feedback; the more successful the learner feels, the more motivated they will be to complete their training. Negative feedback can be motivating as well. When learners feel a goal is clear and attainable, they are more likely to repeat the task until they get it right.

The healthcare industry is constantly innovating, and its education methods should follow suit. Research from companies like The Breakaway Group has shown that simulation and gamification have the power to revolutionize healthcare education, increase proficiency in EHR applications and other technology, and save time. Better education means that providers can adopt technology quickly and get back to what they do best – caring for patients.

It’s time to move on from traditional training methods and embrace technology to improve learning. Consider your own EHR training. How could you incorporate simulation and gamification principles to improve adoption?

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

EHR Swapping: A New Approach for Effective EHR Transitions – Breakaway Thinking

Posted on September 16, 2015 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
The trend to swap electronic health records has been gaining momentum in recent years. A 2014 KLAS report surveyed 277 large US hospitals, half of which indicated plans to replace their current EHR system by 2016. That number marks a significant wide-scale investment, since the cost of an EHR implementation may range from millions of dollars for a standalone hospital to hundreds of millions for a regional health system, according to a Becker’s Healthcare article. Organizations are increasingly swapping systems to gain needed functionality, achieve interoperability, leverage analytics and more. As the EHR market continues to consolidate, this development begs the question: are organizations ever fully adopting their EHR systems and overcoming problems uncovered during the initial go-live?

A new survey may provide insights. The American Academy of Family Physicians (AAFP) surveyed 305 physicians to uncover the challenges and outcomes associated with EHR-to-EHR transitions. While 59 percent agreed their new EHR provided useful functionality, only 39 percent reported being satisfied after transitioning. In fact, 49 percent disagreed that their new system improved productivity, and 41 percent considered their new EHR overly complex to use. These numbers suggest that changing applications does not always improve outcomes related to the EHR, especially since a majority of respondents had been using the application for a year or more.

The challenges being reported around EHR transitions are similar to those we have observed for years when the EHR isn’t fully adopted. Research published in Beyond Implementation: A Prescription for Lasting EMR Adoption identified how often organizations overestimate their adoption of an EHR system, a factor that can have significant consequences as organizations transition between applications. These organizations are likely to overlook problems impeding adoption and underestimate the resources and focus needed for the new system. Disengaged leaders, poor education, inadequate end-user support—all are inevitable if unresolved in the original system. The result is a continuation of an organization’s current headaches—from poor usability, to decreased productivity, to end-user dissatisfaction.

There are other potential pitfalls in transitioning EHR systems. For instance, leaders tend to underestimate the need for strong communication, physician alignment, and governance for upcoming changes. While they may have focused on these areas during their initial implementation, they may perceive them as unnecessary for the new system, a decision that puts adoption at risk over the long-term. Organizations should expect the EHR-to-EHR transition to bring the same, if not more significant, challenges as their original implementation.

Organizations may also struggle to anticipate end-user resistance to the new system, which is greater than the switch from paper. While end users may be dissatisfied with the current system, they are often not willing to face the challenge of learning a new system, requiring them to relearn the workflows and keyboard shortcuts they worked so hard to learn. Additionally, end users might question the value of an electronic-to-electronic switch. This is especially true when the transition is due to a merger or acquisition, as shown by the AAFP survey.

Organizations must rely on the tried-and-true methods to achieve EHR adoption, whether moving off paper or an existing electronic system. Beginning with leadership engagement, organizations must communicate, ensure physician alignment, and create governance to ensure accountability and ownership of the new system. End users should receive consistent and effective education. Education is most effective when it is scenario-based, repeatable, readily-accessible, and provides hands-on experience completing workflows in the EHR system. To understand the education and support needs of end users, organizations must track and measure performance. And lastly, they must sustain adoption efforts over time to ensure they remain relevant despite application upgrades and workflow improvements.

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

Engaging Clinician Leadership to Adopt Healthcare Technology – Breakaway Thinking

Posted on April 15, 2015 I Written By

The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer / Research Analyst at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Carrie Yasemin Paykoc

In many healthcare organizations, IT leaders are given the ultimate responsibility of implementing and adopting electronic health records (EHRs) and other health information technology (HIT) because the build and installation fall within their responsibility. While their technical skills and experience are necessary to select, install and maintain the HIT system, clinician leadership should ultimately own the use of the system.

Ownership of the system requires commitment to establish best practice workflows and system parameters that clinicians follow and evolve over time. The risk is that the technology won’t be used to its fullest potential and could even pose potential harm when used incorrectly or without knowledge of how information is entered, accessed, and used by other providers. In a recent alert from the Joint Commission, 23 percent of all reported HIT-related events were due to poor design and data associated with clinical content. Ensuring nurses, physicians, pharmacists, and other clinical staff are involved in decisions about how the system will be used will help alleviate these issues and ensure proper system use.

Over the years, The Breakaway Group’s research has shown that clinician leadership must be highly engaged to effectively adopt new EHRs and HIT systems. In fact, it is the most important predictor of successful EHR adoption. While clinician leader engagement may appear straightforward, competing priorities make it difficult to maintain the degree of engagement required after a new EHR system goes live.

For example, clinician leadership may see fewer patients or put certain responsibilities on hold until the system is implemented. In reality, responsibilities associated with the HIT system must shift and evolve among all stakeholders throughout the adoption journey. After go-live, clinician leadership involvement shifts from decisions around clinical applications and best practice workflows to decisions around upgrades, optimization of the system, and identifying workarounds. Both pre- and post-go-live responsibilities take time and need to align with the overall responsibilities for each role within the healthcare organization.

Involvement of clinician leadership early on in the adoption journey helps create a culture that embraces change and instills a sense of ownership to all levels in the organization. This cultural shift is not easy and requires the right mix of calculated planning and visionary leadership that must resonate with clinicians. A recent article published by The New York Times, describes the paradox of clinicians resisting new EHRs and creating “technology that physicians suddenly can’t live without.” On one hand this technology is causing resistance among clinicians to the point of reverting to paper, while on the other, this technology is helping mitigate countless medical errors and waste. Clinician leadership must engage to address both sentiments and create a culture conducive to change. With the rate of technological advances, a cultural status quo will not suffice.

Naturally clinicians are data scientists and lifelong learners. Show them data and provide them a comfortable learning environment to get up to speed quickly. Then they can help review the data and identify areas for improvement. For example, clinicians can query orders associated with quality outcomes such as electronic orders for flu vaccinations and determine if the rate ordered aligns with internal quality metrics. If the rate is below the agreed upon threshold, clinician leaders can focus efforts on systematically improving the rate ordered.

The longer clinician leadership involvement is delayed, the more likely resistance will fester and organizational culture will be at risk. Adopting technology, especially technology associated with government requirements, is painful and simply takes time. The difference is whether clinician leadership is involved early in the decision making process. If you do not want your clinician reverting to paper charts and/or throwing laptops and mobile devices out of sheer frustration, give clinicians the time and resources to fully engage in the adoption journey.

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

Paper or Electronic – Does Physician Age Matter?

Posted on February 13, 2015 I Written By

The following is a guest blog post by Jennifer Della’Zanna, medical writer and online instructor for Education2Go.
Jen - HIM Trainer
During the Annual Meeting of the Office of National Coordinator for Health Information Technology (#ONC2015), one of the presenters commented that the new generation of doctors have never seen a paper chart, and they have fundamentally different views about what an electronic health record can do compared to clinicians who worked with paper charts for most of their careers. I was inclined to agree and thought it would be fun to find out what those differences are. Luckily, I have access to doctors of all ages, so I decided to conduct a very non-scientific investigation.

My first victims—er—test subjects happened to be my daughter’s pediatrician and a resident on his rotation. Who could ask for a more perfect situation to test this theory? She was a young resident, and he has been a physician since before I was born. I was surprised, therefore, to hear the same complaints about what was wrong with the electronic health record from both and no real answers for what they expected from an EHR. Neither were afraid of technology in and of itself, so I considered that factor controlled. Their complaints? The cut/paste feature allows too many errors through (and they had many real-life examples), alert fatigue, and the narrative portions are too long to scroll through. They get hung up on the mistakes and then decide they can find out more, and more quickly, if they just ask the patient for the information again.

Alright, he actually said he hated it, and she didn’t say that, but that was about the only difference. Ideas for what they’d want instead or how the technology should work? Not so much—from either one.

A trauma surgeon friend at Geisinger Medical Center in Pennsylvania recalled her experiences when they first installed an EHR in her hospital. She hated it. You have never seen such hate as when she recalls her first interactions with the system. She is a vocal sort and, eventually, the hospital said to her that they had an opportunity to customize the system to their hospital and asked if she would serve on the consulting committee. She protested that she knew nothing about computers. They told her they didn’t want somebody who knew about computers. They wanted somebody who had definite opinions about how the system could improve clinical workflow.

My friend said yes. Today, she says she can’t imagine practicing medicine without the EHR. She says it makes her a better doctor. For the record, my friend started out in a paper environment, switched to the EHR, but is not really tech savvy at all.

I checked in again with her recently and asked if she saw any real difference between how older docs and her residents use the system. She said that the older docs use it to get information, and the younger docs do things with it. “That’s the reason for the resident minion,” she says. The older docs get their information from the system and tell the minion to do all the things that have to do with CPOE. She says, “I’d never be able to spell ophthalmology correctly in the system in order to get a consultation!”

She agrees that there is some alert fatigue among physicians, but she thinks it definitely keeps patients safer. She also says it’s often a love/hate relationship for most staff members, but that nobody would willingly practice without it again.

So, is adoption of and satisfaction with an EHR a function of age or technical ability or is it something else?

Perhaps it’s specialty. A pediatrician or a family practice doctor sees many different types of problems, usually has a long history with patients, and may have an electronic record much like the old paper records. I’m sure you’ve seen those thick files, bulging with years’ worth of reports and letters and hand-written charts. It seems that the electronic record, in those cases, may be no better than an electronic form of a paper chart. A trauma surgeon, on the other hand, sees a patient for a short period of time, has less information that requires review, probably makes full use of clinical decision tools but hears very few alerts to make decisions about. The patient is seen, operated on, and discharged to another practice (where they have to slog through the narrative details of the patient’s hospital stay).

More likely, EHR satisfaction is simply a matter of not realizing the advantages we have in front of us because of the difficulties we still focus on. Back when the only option was a paper chart, there were plenty of complaints about those, too. At least we no longer have to deal with doctors’ handwriting (and my friend made the case for me about why doctors have such bad handwriting—they can’t spell—but that’s another story).

Are there problems with EHRs that could still stand some fixing up? Of course there are. But, if you had an honest discussion with yourself about whether you’d prefer going back to paper charts, what would your answer be?

Maybe it’s time to crowdsource solutions instead of complaining about the products as they stand today. What do you expect from your EHR, and how can you be part of the solution? By the way, there is one critical element about people who’ve worked with paper charts and those who haven’t—their expectations and ideas about EHRs are equally important!

What’s been your experience with EHR use and the impact of a physician’s age?

About Jennifer Della’Zanna
Jennifer Della’Zanna, MFA, CHDS, CPC, CGSC, CEHRS has worked in the health care industry for 20 years as a medical transcriptionist, receptionist, medical assistant, practice administrator, biller and coding specialist. She has written and edited courses and study guides on medical coding and the use of technology in health care, and she is an associate editor for Plexus magazine. She teaches medical coding, transcription and electronic health record courses and regularly writes feature articles about health issues for online and print publications. Jennifer is active in preparing for the industry transition to ICD-10 as a trainer for the American Academy of Professional Coders (AAPC). You can find Jennifer on Facebook and Twitter.

The Future of Electronic Health Records in the US: Lessons Learned from the UK – Breakaway Thinking

Posted on December 17, 2014 I Written By

The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer / Research Analyst at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Carrie Yasemin Paykoc
With 2014 coming to a close, there is a natural tendency to reflect on the accomplishments of the year. We gauge our annual successes through comparison with expected outcomes, industry standards, and satisfaction with the work done. To continue momentum and improve outcomes in the coming years we look for fresh ideas. For example, healthcare organizations can compare their efforts with similar types of organizations both locally and abroad. In the United States, looking beyond our existing borders toward the international community can provide valuable insight. Many other nations such as the UK, are further down the path of providing national healthcare and adopting electronic health records. In fact, the National Health Service (NHS) of UK has started plans to allow access of  Electronic Health Records (EHR) on Smartphones through approved health apps. Although healthcare industry standards appear to be in constant flux, these valuable international lessons can help local healthcare leaders develop strategies for 2015 and beyond.

By the year 2024, the Office of the National Coordinator (ONC) aims to improve population health through the interoperable exchange of health information, and the utilization of research and evidence-based medicine. These bold and inspiring goals are outlined in their 10 Year Vision to Achieve Interoperable Health IT Infrastructure, also known as ONC’s interoperability road map. This document provides initial guidance on how the US will lay the foundation for EHR adoption and interoperable Healthcare Information Technology (HIT) systems. ONC has also issued the Federal Health IT Strategic Plan 2015-2020. This strategy aims to improve national interoperability, patient engagement, and expansion of IT into long-term care and mental health. Achieving these audacious goals seems quite challenging but a necessary step in improving population health.

EHR Adoption in UK
The US is not alone in their EHR adoption and interoperability goals. Many nations in our international community are years ahead of the US in terms of EHR implementation and utilization. Just across the Atlantic Ocean, the United Kingdom has already begun addressing opportunities and challenges with EHR adoption and interoperability. In their latest proposal the NHS has outlined their future vision for personalized health care in 2020. This proposal discusses the UK’s strategy for integrating HIT systems into a national system in a meaningful way. This language is quite similar to Meaningful Use and ONC’s interoperability roadmap in the United States. With such HIT parallels much could be learned from the UK as the US progresses toward interoperability.

The UK began their national EHR journey in the 1990s with incentivizing the implementation of EHR systems. Although approximately 96 percent of all general provider practices use EHRs in the UK, only a small percentage of practices have adopted their systems. Clinicians in the UK are slow to share records electronically with patients or with their nation’s central database, the Spine.

Collaborative Approach
In the NHS’s Five Year Forward View they attempt to address these issues and provide guidance on how health organization can achieve EHR adoption with constrained resources. One of the strongest themes in the address is the need for a collaborative approach. The EHRs in the UK were procured centrally as part of their initial national IT strategy. Despite the variety of HIT systems, this top-down approach caused some resentment among the local regions and clinics. So although these HIT systems are implemented, clinicians have been slow to adopt the systems to their full potential. (Sarah P Slight, et al. (2014). A qualitative study to identify the cost categories associated with electronic health record implementation in the UK. JAMIA, 21:e226-e231) To overcome this resistance, the NHS must follow their recommendations and work collaboratively with clinical leadership at the local level to empower technology adoption and ownership. Overcoming resistance to change takes time, especially on such a large national scale.

Standard Education Approach
Before the UK can achieve adoption and interoperability, standardization must occur. Variation in system use and associated quality outcomes can cause further issues. EHR selection was largely controlled by the government, whereas local regions and clinics took varied approaches to implementing and educating their staff. “Letting a thousand flowers bloom” is often the analogy used when referring to the UK’s initial EHR strategy. Each hospital and clinic had the autonomy of deciding on their own training strategy which consisted of one-on-one training, classroom training, mass training, or a combination of training methods. They struggled to back-fill positions to allow clinicians time to learn the new system. This process was also expensive. At one hospital £750 000 (over $1.1 million US) was spent to back-fill clinical staff at one hospital to allow for attendance to training sessions. This expensive and varied approach to training makes it difficult to ensure proficient system use, end-user knowledge and confidence, and consistent data entry. In the US we also must address issues of consistency in our training to increase end-user proficiency levels. Otherwise the data being entered and shared is of little value.

One way to ensure consistent training and education is to develop a role-based education plan that provides only the details that clinicians need to know to perform their workflow. This strategy is more cost-effective and quickly builds end-user knowledge and confidence. In turn, as end-user knowledge and confidence builds, end users are more likely to adopt new technologies. Additionally, as staff and systems change, plans must address how to re-engage and educate clinicians on the latest workflows and templates to ensure standardized data entry. If the goal is to connect and share health information (interoperability), clinicians must follow best-practice workflows in order to capture consistent data.  One way to bridge this gap is through standardized role-based education.

Whether in the US or UK, adopting HIT systems require a comprehensive IT strategy that includes engaged leadership, qualitative and quantitative metrics, education and training, and a commitment to sustain the overall effort.  Although the structure of health care systems in the US and UK are different, many lessons can be learned and shared about implementing and adopting HIT systems. The US can further research benefits and challenges associated with the Spine, UK’s central database as the country moves toward interoperability. Whereas the UK can learn from education and change management approaches utilized in US healthcare organizations with higher levels of EHR adoption. Regardless of the continent, improving population health by harnessing available technologies is the ultimate goal of health IT.  As 2015 and beyond approaches, collaborate with your stakeholders both locally and abroad to obtain fresh ideas and ensure your healthcare organization moves toward EHR adoption.

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

EHR Adoption: Step One to Successful Population Health Management – Breakaway Thinking

Posted on June 18, 2014 I Written By

The following is a guest blog post by Todd Stansfield from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Todd Stansfield

The Managed Care movement dramatically transformed healthcare in the 1990s. For the first time, our industry discovered increased margins by conserving the services we provided. Now, Population Health Management (PHM) is on the brink of transforming healthcare yet again—and perhaps in a more dramatic fashion. The transformation is already underway, with industry-wide consolidations between hospital networks, physician practices, and even insurance companies; government reforms targeting cost and quality controls; and new breeds of health organizations, professionals, and technologies.

Today’s PHM movement presents the same cost benefit as healthcare’s traditional models with a greater focus on health outcomes. The philosophy behind PHM is that healthcare providers and organizations will save money and improve care by identifying and stratifying patients with high, medium, and low risk for developing chronic conditions. Once patients are assigned a level of risk, care plans are then developed and deployed to treat them appropriately. For high-risk patients, strategic interventions are provided that reduce hospital admissions, readmissions, and complications. For low-risk patients, preventative care is offered to maintain health and avoid costly conditions. The PHM model requires broad-scale data collection, analysis, and transmission between healthcare entities—the latter not yet possible with the lack of integration between electronic health record (EHR) systems. PHM also calls for redesigning processes, discovering gaps in care, and extending patient-provider interactions beyond clinical events to encourage healthy life behaviors.

In order to reach the level of data collection needed for successful PHM, healthcare organizations must first adopt their EHR. Doing so makes it possible to intercept data, analyze it, and transform it into useful clinical information delivered to the point of care. Without EHR adoption, the most foundational elements of PHM cannot be supported: We cannot efficiently discover gaps in our current care, identify and stratify at-risk patients treated by an organization, or improve our processes to lessen the new financial risks of value-based care. EHRs are so central to PHM that overlapping incentives for both initiatives were proposed in November 2011 by the Centers for Medicare & Medicaid Services (CMS). The technology is also a necessary tool for Accountable Care Organizations (ACOs), which are a form of PHM. The Agency for Healthcare Research and Quality (AHRQ) published an interview with Dr. Stephen Shortell, a Distinguished Professor of Health Policy and Management at the University of California, who outlined aspects of EHR adoption as being essential to the success of ACOs.[“The State of Accountable Care Organizations.”The Agency for Healthcare Research and Quality.]

Our research at The Breakaway Group (TBG) points to four crucial components needed to adopt an EHR for PHM. Strong leadership must inspire continual engagement from users to embrace the EHR as a tool for positive change. Targeted and effective education—creating system proficiency in role-based tasks—must also be established before and after the EHR go-live event. Performance must be gauged, measured, and analyzed to enhance EHR use and establish governance measures. And with the evolutionary nature of the EHR, all optimization efforts must be sustained and refreshed to meet new challenges, such as application upgrades and process changes.

Although the PHM movement is relatively new, there are numerous examples of the model’s success. ACOs enrolled in CMS’s Shared Savings and Pioneer ACO programs have generated $380 million in savings.[“Medicare’s delivery system reform initiatives achieve significant savings and quality improvements – off to a strong start.” US Department of Health and Human Services.] One Pioneer ACO, Partners HealthCare, has established patient-centered medical homes that employ Care Managers specializing in customizing patient care plans.[“Patient-centered Medical Home: Role of the Care Manager.” Partners HealthCare.] While Partners HealthCare is not employing true PHM in the sense of sharing information with other healthcare entities, it is large enough in size to perform broad-scale data collection that can help better manage health populations. This example demonstrates the potential effect of PHM on our industry when data becomes transferrable.

EHR adoption is an essential feat we are capable of achieving now. Doing so is the first step toward learning more about the populations we serve, how we’re not serving them, and how we can adjust our processes to succeed in a value-based model. Yet to manage populations effectively, more is required from us, including being willing to work together in our pursuit of a better, brighter healthcare system. If we can overcome these hurdles now, then we will arrive ready for when our industry is capable of embracing true care coordination.

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

Learning by Doing: A Model that Works in EHR Training – Breakaway Thinking

Posted on March 19, 2014 I Written By

The following is a guest blog post by Todd Stansfield from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Todd Stansfield
I didn’t learn to change the oil in my car until I changed it. My father instructed me a dozen times, and I watched him a dozen more, but it wouldn’t resonate until I got my hands dirty. I can count an endless number of other tasks that never stuck with me after reading about them in a textbook or hearing about them in a classroom. Some things I need to learn by doing; and I’m not alone.

Why is changing oil different from learning about the Roman Empire? Even years after taking history in college, I still know the story of Romulus and Remus. I can tell that story with the help of a knowledgeable friend, someone to nudge me along as I weave through a non-linear narrative. But when you’re changing oil, you can’t begin at the end, jump to the start, and then fill in the middle details. It’s a linear task with a clear beginning and end, and the workflow impacts the outcome. Changing the oil in a car isn’t life-or-death, but placing an order in an electronic health record (EHR) does impact the lives of patients.

For decades, healthcare has relied on Instructor-Led Training, or ILT, as its answer to education. More hours in the classroom equals a more informed and prepared workforce. It’s the same model supported by our nation’s education system. This would be fine, except that the learning outcomes are vastly different. Where a history class, for instance, aims to teach learners to know something, a hospital class aims to teach learners to know how to do something. Clinicians enrolled in a three-day training session must emerge with the ability to place a medication order using the EHR—a single task that may require upwards of 30 clicks on the computer.

Because actions in an EHR impact the lives of patients, an education model with hands-on, simulator-based training is better suited for teaching health professionals the proper use of an EHR. Perhaps this need is best described by Charles Fred, Group President of Xerox’s Healthcare Provider Solutions division. Mr. Fred is the founder and former CEO of The Breakaway Group, a company providing simulation based training to prominent healthcare organizations across the United States and internationally.

“Consider the value of teaching caregivers to use EHRs through role-based simulators,” he wrote in an article for the American Society of Training and Development. “Simulation provides an opportunity to practice in a real-life environment without real-life risks and consequences. Caregivers learn inside their actual EHR application, which is critical for learning workflow and gaining new knowledge about the system. They only learn tasks that are applicable to their role.” (Source: Fred, Charles. “Driving the Transition to Electronic Health Records.” Training + Development. American Society for Training & Development. Alexandria: 2012, Print.)

Simulation-based education solves many of ILT’s limitations. For starters, the simulations are based online and allow the learner, rather than the trainer, to perform the task. Providers and clinicians can learn to place an order by performing the task directly in a simulated EHR. They may do so at their leisure, from their computer at home, at work, or even at a local coffee shop if they prefer. As long as there’s an Internet connection, they may train until they’re proficient. Simulation-based training also saves money spent on the herculean effort to jam too many professionals into too few classrooms. Another benefit is that it’s more accessible. The simulations exist as long as they are needed and can be upgraded to reflect changes in workflows. Where ILT provides a training event, simulation-based education provides a sustainable solution for ensuring the EHR provides clinical value to the organization. Simulation-based education shortens the learning curve for healthcare providers and allows staff members to train more quickly so they can focus on their core responsibility – their patients.

A combination of simulation-based education followed by ILT can be used to achieve better results. The chief benefit of classroom training is that it provides a venue for social interaction and the exchange of ideas, but this is best leveraged when participants have confidence and knowledge in using an EHR. Simulation-based education makes this possible. After completing role-specific simulations, participants arrive to the classroom already proficient in using the EHR. They are engaged before class even begins. What could have been banter about the next break is now a meaningful conversation about best practices and ways to improve processes. Social interaction can now be leveraged to improve education. What’s more, because participants already have a foundation of knowledge and ability in the system, the training can now focus on teaching participants to complete more complex tasks and workflows. It can also devote more time to independent practice (the most conducive form of learning).

While healthcare’s focus on training hasn’t changed, the industry itself has experienced a whirlwind of evolution. Why then, amidst all the evolution, must providers and clinicians rely on an outdated education model?

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

Healthcare Super Bowl – Winning with EHR Adoption – Breakaway Thinking

Posted on January 15, 2014 I Written By

The following is a guest blog post by Jennifer Bergeron, Learning and Development Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.

The most important – and most vulnerable – connection between strategy and execution is the actual performance of people.

~ Charles Fred, Breakaway

It’s the end of football season and the Super Bowl, the game that determines the best team in the country, wait – in the world – will be played February 2 in East Rutherford, New Jersey. The more I learn about the game, the more impressive the depth of leadership, preparation, strength, training, and split-second adaption the sport involves.

Clinicians need to be just as prepared for their own Super Bowl where they score touchdowns by improving patient care, meeting government regulations, and increasing efficiency related to their use of the best technologies. Electronic health record usage is a large part of the government’s Meaningful Use initiative. As of July 2013, 82% of hospitals successfully achieved Stage 1 Meaningful Use and continue to work to adopt EHR technology. How can providers and hospitals support their teams toward EHR success?

Engaged Leadership

First, let’s take a cue from Vince Lombardi, legendary coach of the Green Bay Packers who said that “individual commitment to a group effort – that is what makes a team work, a company work, a society work, a civilization work.”

A group is brought together by the leaders whether it’s the coach, a foreman, or an executive team. In the healthcare setting, the right tone for any change is set at the top of the organization. When adopting a major change like an EHR, leadership has the responsibility of making a game plan, getting the best people involved, and finding the right EHR education solution to help them succeed.


Which brings us to training and education. Rod Marinelli, currently of the Tampa Bay Buccaneers says, “I love coaching young players and it starts with the staff that understands how to teach.” When taking on the challenge of introducing a new EHR, a hospital needs a good plan with the right trainers. A good program doesn’t try to teach every intricacy of a play in detail in order to prepare for every scenario on the field.

The same concept applies to a hospital adopting a new EHR. Dr. Heather Haugen, Managing Director at The Breakaway Group, A Xerox Company, has done significant research on EHR adoption. In Beyond Implementation: A Prescription for Lasting EMR Adoption,Dr. Haugen states that “we know from nearly nine decades of research about adult learning that humans do not learn without a natural progression from discovery through experience. The average human brain is a very poor storage device for information and data, unless that information is recalled and reinforced immediately by experiential activities.” Rather than memorization of facts and workflows, a more efficient way to learn an EHR is through simulations of those workflows. Teach the process and decision-making and the learner creates their own pathways to making the right moves.


How do we know that the leadership coaching and the simulation training are working? By measuring the results. In football, the final score is what matters. As 20-season wide receiver Jerry Rice says, each person must take the necessary steps to reach the goal. In his words, “today I will do what others won’t, so tomorrow I can accomplish what others can’t.” Making big changes to process is difficult in execution and in motivation. But by employing the right leadership team as the “coach” along with the proper training and education, when EHR adoption is measured, the right results are possible.

Keeping Pace with Change – Sustainment

After implementing a new EHR application, it would be a mistake to assume that everything would stay the same day-to-day. Adopting an EHR rather than simply implementing an EHR indicates that an organization uses and depends on the system to make them better and more efficient. (Implementation implies only usage of the system, which leaves room for inefficiency and work-arounds.)

Once adoption is reached, it’s a continual process to stay at that level. With staff turnover, changes to software applications, and process updates, coaching, training, and keeping score fall into a plan of sustainment or the ability to keep pace with change. In the football world, Heisman Trophy winner Roger Staubach calls it dedication: “confidence doesn’t come out of nowhere. It’s a result of something…hours and days and weeks and years of constant work and dedication.” It takes continual effort to continually strive for improvement.

The Final Score

To reach the goals of excellent patient care, timeliness, efficiency, and to meet government regulations, each of these four elements must a priority, which is the definition of The Breakaway Method: Engaged Leadership, Education, Metrics, and Keeping Pace with Change. All of the pieces must be in play in order to make the most of any organization. Just as in football, the coaching staff, training program, measurements of results, and changes that meet each week’s challenges are critical.

Football does teach us that the road to success is long, to maintain success is hard, but winning is the name of the game.

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

Healthcare Innovation in a Brave New World – Breakaway Thinking

Posted on December 18, 2013 I Written By

John Lynn is the Founder of the 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 and 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 Carrie Yasemin Paykoc, Senior Instructional Designer at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Carrie Yasemin Paykoc
Healthcare providers are faced with a two-pronged challenge of satisfying government regulations and being profitable within a competitive and dynamic marketplace. Organizations that prosper take advantage of what’s going on in Washington and offer innovative products and services to their patient population. At the forefront of healthcare innovation is utilizing data from Electronic Health Records (EHRs) to provide better and more affordable care while preventing medical errors.

The November edition of United Airlines’ Hemisphere magazine highlighted several leading American hospitals that demonstrate innovative approaches to healthcare. The article addresses legislative pressures that hospitals face and the need for transparency as patients seek the best treatments and services across larger geographical boundaries. Many of the top performing hospitals utilize consultants outside of healthcare to obtain fresh perspectives and remain competitive. At Cincinnati Children’s Hospital, Dr. John Perentesis, co-director of the Cancer and Blood Disease Institute, shares collaboration with “…consultants in the airline and nuclear power industries reduce errors in human factors. In many ways, the hospital is similar to a United Airlines cockpit.”  Other hospitals pursue innovation by implementing the most advanced procedures and techniques to provide advanced patient-centric healthcare.

The comparison of healthcare with the airline industry or any other service industry is not too far-fetched. In fact, the founder of The Breakaway Group, Charles Fred, brought his experience in the aerospace industry to help healthcare organizations and providers transition from paper records to electronic systems. The Breakaway Group utilizes targeted role-based simulations to help clinicians rapidly learn new healthcare software systems. Simulation learning was a commonly used method when the aviation industry transitioned from analog to digital systems. This is only one example of the many innovations that occur when incorporating an outside perspective. Whoever thought we would use 3-D printers for facial transplant reconstruction?[1] Pretty amazing.

Furthermore, as healthcare organizations start to look inward and analyze their EHR data, it may be helpful to continue to look outward to other industries. In his article, The Data Drive Society, author and M.I.T. professor Alex Pentland[2] discusses the digital breadcrumbs left behind by individuals going about their daily lives, the free flow of information and ideas outside of our immediate social networks, and the power and responsibility behind analyzing this data.  Essentially, every time we make a transaction, update our Facebook status, or send a text message, we leave a digital breadcrumb. Over time, these breadcrumbs create a dynamic social map. This map could be used to design improved systems for the government and even for healthcare to operate in a more efficient and effective manner. However, with access to data lies responsibility. Pentland argues that although we could access every single digital breadcrumb available about a population, we might need to ask for permission. Individuals should have the right to control their own data and opt out of sharing their information.

So as healthcare begins to remove barriers to accessing and analyzing data from EHRs, we may need to circle back to our legislative body to ensure individual data rights are protected. Although open access to patient data appears to be the ultimate solution, in actuality, it is only the beginning and requires deeper thought. We must balance the desire to analyze and innovate with respect for individual data rights; otherwise classical novels such as George Orwell’s 1984 or Aldous Huxley’s Brave New World may foreshadow the future inevitability of our society.

But all is not so dire. Go forth and collaborate with outside experts and historians to develop and design solutions for healthcare in the 21st century and beyond.  Be bold. Be innovative. Just don’t forget the ethical stuff.

[2] The author, Alex “Sandy” directs the M.I.T. Human Dynamics Laboratory and co-leads the World Economic Forum’s big data and personal data initiatives.

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