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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.

Resident EMR Training, FDA EMR Regulation, and MEDITECH Twitter

Posted on November 10, 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.

I bet 5 hours is generous for resident EHR training. It’s amazing how training a resident on an EHR is almost an afterthought. I partially understand it since the residents have so many things to learn, but EHR will become a standard part of that training. I live right next to a medical school and it’s amazing to hear the stories of these residents doing rotations at clinics with EHR. Most prefer it, but they don’t get much training.

Is the FDA regulating EHRs? Other than the guidance they put out recently for health applications, I haven’t seen them do much more as far as regulating EHR software. Although, after seeing this and reading a tweet from Farzad suggesting that the FDA should leave EHR “regulation” to the ONC framework, I wonder if something else is brewing. What have you seen or heard?

I didn’t think this tweet was that significant, but it was the first time I remember seeing MEDITECH participating in social media. In fact, I’m trying to remember where I’ve seen MEDITECH participating in any of the national conversations. For such a large EHR vendor, they sure have kept a low profile. I feel like I get around, and I have yet to meet a MEDITECH person. I can’t say that for many EHR vendors. Of course, I look at their social media account and see they have 1,243 tweets. So, they’ve been doing something, but I’d never seen it until today. Just for reference, I have about 28,000 tweets between just my top 2 Twitter accounts.

EMR Implementation Training and Computer Training

Posted on August 5, 2009 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.

When someone comes to my clinic to see our EMR implementation, they always ask “what lessons did you learn during your EMR implementation?” It’s inevitable, and obviously a good question. One of the answers I give the most is that I was surprised at how much of the initial training was on basic computers skills and not actual EMR software training.

On that note, I got an email from Michael Archuleta of ArcSys Inc. that described some of the challenges of training before an EMR implementation including training on some of the new technologies (see tablet, convertible, laptop and EMR discussion) that might be implemented with an EMR.

First, no two medical professionals are alike. They have been taught differently and see things through different lens.

Second, people have different computer skills. Some are very adept at tackling new technology, and others are easily intimidated.

Third, the flow of work or processes differs markedly from one group to another.

Regarding observation #1: People are best trained one-on-one. Each has their own terminology and it is best to talk the same “language” of medicine.

Regarding observation #2: The doctors and medical staff are best trained on desktop computers. They are, for the most part, familiar with the keyboard, mouse, and monitor. The hand-eye coordination is a known entity. In particular, knowing how to page up or down from the keyboard. Or, how to move the cursor back and forth across a line using the arrow keys. The monitors are large and they are accustomed to how things look. They are familiar with the location of icons on the desktop. They know how to start up applications and how to close down the pc. Thus, it becomes a really good idea to understand how the application works on hardware that you know. Once you are comfortable with the application, then you can advance to new hardware.

Now, contrast this with a tablet pc. The keyboard is smaller and this usually results in hunting for the location of familiar edit keys like page up, page down, arrows, end, and home. If you are trying to learn a new application and a new keyboard layout, your frustration will skyrocket.

The monitor is smaller. You are going to be spending more time squinting. It may be time to invest some time with the eye doctor and get some new corrective lenses. Again, if you are familiar with the application, you will not be visually hunting for tiny icons.

When using a laptop you will have to use either the touchpad, eraser head, or pen for your mouse. All three require an amazing amount of finger dexterity. If you can recall your initial learning curve with the mouse, multiply that by 10 and you will have an idea of what it will be like to re-learn your mousing skills with this new technology. My recommendation would be to get a regular mouse and plug it in the USB port. It is messy with an extra cord, but is one less thing to learn. Better yet, get a wireless mouse. But, then that is also one more piece of technology…

The desktop of the tablet pc will have different icons. It is a good idea to eliminate as many as reasonable. The hard part of any laptop is knowing how to configure it. A laptop is designed to work off of batteries and thus needs to conserve energy. It will go to “dim mode” when it senses the batteries are losing their charge. It will go to “blank mode” when it decides that you haven’t touched the keyboard in a long time. What you need to know is how to bring it back to life in these (and other) circumstances. Because of these types of quirks, if you are not familiar with the application, you will become extremely frustrated and discouraged.

Regarding observation #3: Baby steps. Implement only one automated procedure at a time. Don’t flood everyone with all the bells and whistles. Make certain that everyone understands a new automated procedure before launching the next one.

My Least Favorite EMR Vendor Sales Line

Posted on May 26, 2009 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.

A feature of every EMR vendor is a whole multitude of sales lines. If you’ve ever talked to a EMR sales person, you know what I’m talking about. This isn’t really unique to EMR sales. The same can be said of most software that’s trying to solve complex problems.

Well, there’s one EMR vendor sales line that gets on my nerves more than any other line. Let’s take a demo of an EMR vendor’s templates. Now here’s the line that I absolutely abhor:

“You can make it do whatever you want.”

Hearing this is like hearing fingernails on a chalkboard for me. Certainly, the intent of their comment is that the EMR template creation is really flexible (and it very well might be). However, the superlative “whatever” is just wrong. Every software system has limitations and I can guarantee you that if you really start using an EMR system you’re going to bump into those limitations.

I guess my problem is using superlatives like whatever, any, all, always, etc. is just misleading and leads to what I call EMR sales miscommunication. Anytime you hear one of those things during an EMR demo (or even during an EMR training) you better start asking lots of questions.

Of course, these superlatives do a lot better job selling EMR software. I guess that’s why I’ll never be an EMR salesperson. Maybe it’s also why people seem to like reading my EMR blog posts.