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Assembling The Right Stuff: The Keys to Gathering and Supporting A Successful EHR Go-Live Support Team

Posted on August 16, 2017 I Written By

The following is a guest blog post by Jaime Jaimes, Instructional Writer at Conduent, Breakaway Learning Solutions). Check out all of the blog posts in the Breakaway Thinking series.

For just a moment, put yourself in the shoes of a provider who needs to work with a new EHR. You’ve known that the EHR go-live event was impending, and now it’s here. You took the training, slipped a little job aid booklet in your pocket, and think you’ve got everything under control. But once you’re on the floor, you hit a sudden roadblock. Rifling through your packet in hopes of finding an answer could waste valuable time. What you really need is a friendly face to calmly talk you through that first hurdle and get you back on track.

This scenario is the reason that some physicians are identifying at-the-elbow support as a vital part of successful EHR implementation. A confident support team can create a calm and stable environment for your staff as they learn the ins and outs of their new system. But structuring your support strategy is easier said than done. Fortunately, I was able to sit down and discuss some key go-live support elements with two of Breakaway’s client services managers: Adam Koch and Meredith Wheelock.  Between them, they’ve overseen countless go-live events for hospitals and ambulatory locations alike, and they have three key pointers for any team planning a new EHR implementation or update.

Start assembling your support team early

Creating a support team is a daunting prospect. In our experience, at least a 1:3 support-to-learner ratio is the ideal level of staff training needed for a go live, a number backed up by online research journal Perspectives in Health Management. Beginning your search for the right people early on gives you the time to vet potential team members, and ensure they have the necessary certifications and experience specific to your go live. While you can get a team together in a month, we recommend starting the process two months or more before the event so that you can identify the right people and make sure they are prepared.

This may seem like a lot of time to invest, but having this at-the-elbow support can actually save you time at go live. A support team member can resolve questions and frustrating issues quickly, which in turn allows your staff to return to their other duties. Plus, the fact that the question was resolved in-the-moment, and in the environment in which your staff will likely face the issue again, increases the probability of knowledge retention and improves their confidence in using the system.

Get everyone on the same page

Even though you’re assembling a team of experts familiar with your EHR, you still need to make sure they’re all following the same workflows. This ensures your support team won’t teach different workflows to different departments or locations. Learning your best practices also means there won’t be a conflict between pre-go-live training and at-the-elbow assistance. After all, your staff expects help when they approach a support team member. If they get advice that contradicts their training, they will walk away feeling even more confused and frustrated, hindering their adoption progress. As this EHR Intelligence article notes, “Critical to the project’s success is supporting physician EHR users the right way at the right time.” Taking the time to teach your support team best practices is the easiest way to make sure you’re supporting your team the right way.

Establish lines of communication

A go-live event is a big endeavor, and even the best support team will encounter a quirk in the system they haven’t seen before. It’s at these times where having a defined path to escalate problems and share the solutions you generate will keep your EHR’s implementation on track. For those first few weeks, a daily touchpoint meeting with your support teams and site super-users can prove invaluable, as it allows everyone to identify pain points, troubleshoot issues, and come away with one clearly identified solution. Having this coordinated effort and standard way of communicating is critical for organizations large and small, and helps guarantee that even when a larger problem arises, your team doesn’t grind to a halt as you try to figure out the solution.

Your at-the-elbow support team is just one part of the successful go-live puzzle, but it’s a piece that can mean the difference between a frustrated staff and one that’s confident that this new EHR is just another part of their day.

Conduent is a sponsor of the Breakaway Thinking series of blog posts. Breakaway Learning Solutions is a leader in EHR and Health IT training. Download their Free Whitepaper “Leadership Insights: Gaining Value from Technology Investments.”

Simulation-Based Education: The New Paradigm in Healthcare Technology – Breakaway Thinking

Posted on July 19, 2017 I Written By

The following is a guest blog post by Heather Haugen, PhD, Managing Director and CEO at The Breakaway Group (A Conduent Company). Check out all of the blog posts in the Breakaway Thinking series.
Heather Haugen
Imagine a warehouse filled with classroom training sessions running simultaneously, hotel lobbies packed with consultants checking in and out at the same time, overrun parking lots, buses shuttling employees off campus, and more. These are the harsh, yet common challenges healthcare organizations face with classroom training – a predicament explored in the second edition of Beyond Implementation: A Prescription for the Adoption of Healthcare Technology. As the book explores the real-life headaches of classroom training, it calls on healthcare leaders and organizations to embrace a new education paradigm.

Today the healthcare industry has made considerable advances in technology. Enterprise applications now offer more features and functionality than ever before. Analytics programs, telehealth platforms, mobile health applications – each represents one of the many innovations changing the face of our industry. Yet despite these advances, classroom training remains one feature that has yet to change, a feature deeply-engrained in the habits, mental models, and beliefs of the industry. Healthcare executives already face significant pressure from making multi-million-dollar investments in clinical information systems. Changing how users are educated disrupts another component of healthcare for which executives become solely responsible, and must address and manage.

Despite the strength of the status quo, Beyond Implementation calls for healthcare’s departure from the classroom training model, as research highlights its ineffectiveness for teaching learners how to use new technology – a reason why most industries have abandoned or redesigned the model. Instead of face-to-face instruction, the book recommends healthcare organizations take a simulation-based approach to education, which provides learners with hands-on experience completing their workflows in a simulated EHR. The value of simulation-based education was first proven in the commercial airline industry. Like healthcare today, the airline industry experienced significant disruption through technology as the industry transitioned from analog to flight control systems. Unable to educate pilots quickly enough, the industry developed flight simulators that provided hands-on training that was relevant, accessible, repeatable, and sustainable. The new education model produced impressive learning outcomes, which is why the book argues for a similar model to be applied to healthcare.

Unlike classroom training, simulation-based education is more personalized and targeted. Education is role-specific and teaches learners how to complete their daily tasks in a simulated EHR environment. Users learn to complete their daily tasks according to best practice workflows guided by real-life clinical scenarios that increase relevancy, retention, and engagement. One significant benefit is users accumulate experience in the application without risks to patient safety. They also access their education at a time most convenient to them, as education is accessible 24/7 anywhere there is an internet connection. The accessibility of simulation-based education eliminates the headaches and costs of renting out warehouses, hiring trainers and consultants, scheduling staff to attend three eight-hour training sessions, and more.  It’s no wonder why simulators are shown to improve confidence and knowledge in the system – which are key indicators of proficiency.

Considering the challenges and opportunities facing healthcare organizations, the need for a better education paradigm is apparent. Now more than ever, our industry is grappling with the challenges of swapping their legacy systems with new enterprise applications, which research has shown brings significantly greater challenges than the switch from paper to electronic. In addition to new strategies around leadership and other areas, organizations must provide education that helps users make the transition from old workflows, keyboard shortcuts, and habits more quickly and seamlessly. Our industry is also beginning to focus on improving outcomes through technology, a trend that requires organizations to create a workforce of proficient users efficiently and effectively.

In every aspect, healthcare stands to benefit by replacing its analog approach to education. Whether reducing costs or improving knowledge and confidence in the system, the argument for classroom training is obsolete. It’s time that our industry embrace a new model that reflects the level of innovation healthcare leaders and professionals are working so hard to adopt.

Conduent is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training. Download their Free Whitepaper “Leadership Insights: Gaining Value from Technology Investments.”

The New Leadership Agenda: 6 Effective Strategies for Driving the Adoption of Healthcare Technology – Breakaway Thinking

Posted on June 28, 2017 I Written By

The following is a guest blog post by Heather Haugen, PhD, Managing Director and CEO at The Breakaway Group (A Conduent Company). Check out all of the blog posts in the Breakaway Thinking series.
Heather Haugen
In executive conference rooms around the country, a common dialogue is emerging. In the wake of multi-million-dollar investments in electronic health record (EHR) systems, healthcare leaders are admitting that they underestimate the “care and feeding” of adopting these new applications. Whether this realization occurs from implementing a new system for the first time, or replacing an existing legacy application, the challenges are largely the same. Change fatigue, resource shortages, user resistance, workarounds, patient safety concerns – all reflect barriers healthcare leaders face adopting new healthcare technology.

But there is good news for healthcare leaders. This month marks the release of the new edition of Beyond Implementation: A Prescription for the Adoption of Healthcare Technology. The book offers healthcare leaders a playbook for approaching and leading the effort to adopt clinical information systems.

The book explores several important leadership strategies that have proven invaluable to healthcare executives around the country.

Strategy #1: Establish a New Leadership Agenda

Leadership is the most fundamental driver of EHR adoption. Because of its importance to the success of the initiative, leaders must relentlessly commit to making EHR adoption a daily priority for executive teams. This includes focusing on the factors that drive optimal use of clinical information systems long after the implementation.

Strategy #2: Stop Doing List

Time is a scarce and vital asset for every executive team, which faces a host of competing priorities and time-sensitive initiatives. The most successful leadership teams prioritize the right projects that add the most value to the organization. One strategy is to develop a Stop Doing List, a concept popularized by renowned author Jim Collins. The Stop Doing List is the process of choosing which initiatives to stop in order to focus on the most crucial activities. For healthcare leaders, this means eliminating or reprioritizing enough projects to make EHR adoption among the top three priorities for the organization. To develop a Stop Doing List, Beyond Implementation recommends prioritizing initiatives per these criteria:

  • Projects/meetings that do not directly affect quality of care or safety
  • Projects/meetings that are not related to compliance or legal risk
  • Projects that can be delayed with little overall impact
  • Meetings that can be eliminated or consolidated

Strategy #3: Engage Clinical Leadership

Providers carry a powerful voice in a healthcare setting. Leaders must actively engage providers and promote their buy-in through several strategies. One strategy includes developing a provider council. Including representation from across the organization, endorsement from top leadership, and a formal charter and vision for the body, this council should oversee and govern EHR use.  Another strategy is to engage members of the council to serve as champions of the effort by helping their departmental colleagues and serving as an extension of leadership.

Strategy #4: Create a Tone at the Top

Crucial to engaging users in the effort is establishing a tone that emphasizes EHR adoption. Leadership must promote awareness of the initiative by creating a value proposition and brand that connects the EHR system with the organizational vision and mission. Leadership must also establish a rhythm with their messaging and ensure it remains authentic when interacting with users. Leadership should make it a focus to answer key questions about the transition, such as how EHR adoption improves clinical and financial outcomes and how the change will affect users individually. Establishing the importance of the effort, as well as being open and transparent, helps users navigate and accept the transition more easily.

Strategy #5: Governance

Governance is also another key ingredient of effective leadership. Competing interests, differing opinions, and varying experiences all pose barriers to EHR adoption. Leadership must develop a well-defined governance process, which overcomes these barriers by creating policies and procedures that hold users accountable and define expectations and best practices around use of the system. The governance process should evolve over time to address the evolving needs of users as they adopt the application. After developing the governance process, leadership must measure its effectiveness to enforce accountability and make continuous improvements.

Strategy #6: Track Performance Metrics to Drive Continuous Improvements

To improve outcomes, leadership must track the clinical and financial results of EHR adoption. Leadership should identify, select, and empower the right individuals to lead this effort. These individuals should collect, analyze, and report performance metrics that are important to caregivers and will motivate engagement and improvement.

To see improved clinical and financial outcomes, healthcare leaders must ignite and sustain the movement toward the adoption of clinical information systems. It starts with establishing a new leadership agenda that places adoption at the forefront of organizational priorities and continues through strategies that facilitate engagement, communication, governance, and measurement. When leaders engage in these activities, adoption becomes a pervasive mindset across the organization for optimal results.

Conduent is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training. Download their Free Whitepaper “Leadership Insights: Gaining Value from Technology Investments.”

The Misguided EHR Replacement Decision

Posted on March 22, 2017 I Written By

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

This post is part of the Breakaway Thinking blog post series which is sponsored by Breakaway Learning Solutions, a Conduent Company.

Almost every healthcare organization I meet is talking about how to get better adoption of their EHR software. They’ve implemented their EHR as part of a massive go live. Many are even doing fine with programs like meaningful use and are working on MACRA. However, they all realize that adoption of their EHR software by end users could be better than it is today.

During these conversations, it’s easy to see how some organizations slip into the thinking that if they replaced their EHR with a new one that somehow that would spur more adoption and EHR use by their end users. When you hear users complaining about EHR software, it’s easy to blame the software itself. This is a dangerous line of thinking because that’s just not how it works. Switching EHR software does little to improve adoption of EHR by end users. EHR adoption problems that exist with one EHR are likely to exist in any new EHR.

That’s not to say there aren’t legitimate reasons for you to switch EHR. There are many good reasons to switch EHR software including when your organization is bought out and you want to align EHR software or when your product is being sunset. These can be good reasons to switch EHR and there are many more. However, it’s usually a mistake to switch EHR when you don’t have a good strategic reason to switch and lack of adoption is not a good strategic reason to switch.

When EHR adoption is lacking in your organization, instead of considering switching EHR, look at doubling down on your existing EHR. Core to successfully “doubling down” is leadership. Heather Haugen highlights this fundamental principle in her whitepaper “Leadership Insights: Gaining Value from Technology Investments when she says, “Organizations with leaders who are fully invested in the daily march toward adoption will reach the early stages of adoption quicker and enjoy a reinforced cycle of meaningful clinical and financial outcomes.”

The most successful organizations I’ve seen are led by people who understand that EHR adoption is not a one time event, but is an ongoing process of workflow improvement, training, and process modification. The value an EHR can provide is extracted as organizations incrementally improve their use of the EHR. It doesn’t happen by accident or by happenstance. It requires thoughtful and well executed leadership.

The idea of replacing your EHR to improve EHR adoption and use is often just an easy way out from addressing the real reasons why EHR use in your organization is not optimal. When this happens, you’re still generally faced with the same hard challenges after replacing your EHR. Don’t fall into this trap in your organization. If there’s not a strategic reason to replace your EHR software, then don’t. Take the energy you’d have spent replacing your EHR and make a deeper investment in optimizing your current EHR usage. That investment will pay off far more than an EHR switch.

Learn more about the Breakaway Thinking blog series sponsor, Breakaway Learning Solutions, and download their FREE whitepaper “Leadership Insights: Gaining Value from Technology Investments.”

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

Posted on October 26, 2016 I Written By

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

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

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

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

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

What can you do?

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

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

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

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

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

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

Is Your EHR Contributing to Physician Burnout?

Posted on September 28, 2016 I Written By

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

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

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

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

quadruple-aim-of-healthcare-physician-wellness

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

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

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

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

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

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

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

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

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

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

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

Are You Wasting your EHR Investment? – Breakaway Thinking

Posted on August 31, 2016 I Written By

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Is Your Organization Ready for EHR Adoption? – Breakaway Thinking

Posted on July 20, 2016 I Written By

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

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

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

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

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

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

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

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

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

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

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

Posted on June 16, 2016 I Written By

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

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

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

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

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

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

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

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

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

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

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

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

Posted on May 18, 2016 I Written By

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

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

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

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

Incorporate metrics early

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

Utilize system data found through metrics

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

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

Metric-driven optimization is an ongoing process

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

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

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

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