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New INFRAM Model Creates Healthcare Infrastructure Benchmarks

Posted on November 14, 2018 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.

During the frenzy that was healthcare organizations rushing to implement EHRs and chase government money, it was amazing to see so many other projects get left behind. One of the biggest areas that got left behind was investments in IT infrastructure. All the budget was going to the EHR and so the infrastructure budgets often got cut. There were some exceptions where upgrades to infrastructure were needed to make the EHR work, but most organizations I know chose to limp along with their current infrastructure and used that money to pay for the EHR.

Given this background, I was quite intrigued by the recent announcement of HIMSS Analytic’s INFRAM (Infrastructure Adoption Model). This new model focuses on a healthcare organization’s infrastructure and whether it’s stable, manageable, and extensible. I like this idea since it’s part of the practical innovation we talk about in our IT Dev Ops category at the EXPO.health Conference. What we’ve found is that many healthcare organizations are looking for infrastructure innovations and the benefits are great.

The INFRAM model has 5 main focus areas:

  • Mobility
  • Security
  • Collaboration
  • Transport
  • Data Center

No doubt these are all areas of concern for any healthcare CIO. Although, I wonder if having all 5 of these in the same model is really the best choice. A healthcare organization might be at a level 6 for secruity, but only at a level 3 for mobility. Maybe that’s just fine for that organization. I guess at the core of this question is whether all of the capabilities of stage 7 are capabilities that are universally needed by all healthcare organizations.

I’m not sure the answer to this, but I think a case can be made that some organizations shouldn’t spend their limited resources to reach stage 7 of the INFRAM benchmark (or even stage 5 for some organizations). If a healthcare organization makes that a priority, it will probably force some purchases that aren’t really needed by the organization. That’s not a great model. If the above 5 focus areas had their own adoption models, then it would avoid some of these issues.

Much like the EMRAM model, the INFRAM model has 7 stages as follows:

STAGE 7
Adaptive And Flexible Network Control With Software Defined Networking; Home-Based Tele-Monitoring; Internet/TV On Demand

STAGE 6
Software Defined Network Automated Validation Of Experience; On-Premise Enterprise/Hybrid Cloud Application And Infrastructure Automation

STAGE 5
Video On Mobile Devices; Location-Based Messaging; Firewall With Advanced Malware Protection; Real-Time Scanning Of Hyperlinks In Email Messages

STAGE 4
Multiparty Video Capabilities; Wireless Coverage Throughout Most Premises; Active/Active High Availability; Remote Access VPN

STAGE 3
Advanced Intrusion Prevention System; Rack/Tower/Blade Server-Based Compute Architecture; End-To-End QoS; Defined Public And Private Cloud Strategy

STAGE 2
Intrusion Detection/Prevention; Informal Security Policy; Disparate Systems Centrally Managed By Multiple Network Management Systems

STAGE 1
Static Network Configurations; Fixed Switch Platform; Active/Standby Failover; LWAP-Only Single Wireless Controller; Ad-Hoc Local Storage Networking; No Data Center Automation

STAGE0
No VPN, Intrusion Detection/Prevention, Security Policy, Data Center Or Compute Architecture

As this new model was announced, I had a chance to talk with Marlon Harvey, Industry Solutions Group Healthcare Architect at Cisco, about the INFRAM model. It was interesting to hear the genesis of the model starting first as an infrastructure maturity model at Cisco and then evolving into the INFRAM model described above. Marlon shared that there had been about 21-24 assessments and 35 organizations involved in developing this maturity model. So, the model is still new, but has had some real world testing by organizations.

I do have some concern about the deep involvement from vendor companies in this model. On the one hand, they have a ton of expertise and experience in what’s out there and what’s possible. On the other hand, they’re definitely interested in pushing out more infrastructure sales. No doubt, HIMSS Analytics is in a challenging position to balance all of this.

That said, a healthcare CIO doesn’t have to be beholden to any model. They can use the model where it applies and leave it behind where it doesn’t. Sure, I love having models like INFRAM and EMRAM to create a goal and a framework for a healthcare organization. There’s real value in having goals and associated recognition as a way to bring a healthcare IT organization together. Plus, benchmarks like these are also beneficial to a CIO trying to convince their board to spend more money on needed infrastructure. So, there’s no doubt some value in good benchmarking and recognition for high achievement. I’ll be interested to see as more CIOs dive into the details if they find that INFRAM is focused on the things they really need to move their organization forward from an infrastructure perspective.

Healthcare Security Humor – Fun Friday

Posted on August 3, 2018 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.

After Mike Semel’s recent post on embarrassment, career suicide, or jail, it may seem a bit ironic to offer some healthcare security humor. That’s exactly why we think it’s good to share some healthcare security humor. We love irony and we often have to remember that what we do is extremely serious, but we shouldn’t take ourselves too seriously. Plus, humor can often get a point across in a way that is extremely memorable. That’s how I felt when I saw the healthcare security cartoon below:

This cartoon reminds me of the hospital CIO who told me “I’m most concerned with the 21,000 security vulnerabilities that existed in my organization. I’m talking about the 21,000 employees.” This is a real problem and one that many people don’t take serious enough in healthcare. It’s not something you can just put as a line item on a budget. It takes shaping the culture of your organization and that’s hard, but essential.

The State of the Healthcare CIO

Posted on November 2, 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.

As I’ve talked to hundreds of healthcare CIOs this week at the CHIME Fall Forum, a number of themes keep coming up. No doubt there’s always a lot of excitement in the air at a conference like this. In many ways, it’s great that there’s a good, optimistic energy at a conference. A conference wouldn’t be very good without that energy, but under the covers, there’s often more to the story. Here are some broad insights into the state of the healthcare CIO that goes beyond the natural excitement and energy of a conference.

No More Systems – Most of the CIOs who I’ve talked to feel like they have all the IT systems they need. In fact, most are trying to find ways to get rid of IT systems. They’re not looking to add any more IT systems to their mix. There’s a strong desire to simplify their current setup and to maximize the benefits their current IT systems. They don’t want to add new ones.

Do Want Solutions – While healthcare CIOs don’t want to add new systems, they do want to find solutions that will be complementary to their existing systems. There is a massive desire to optimize what they’re doing and show value from their current IT systems. Solutions that are proven and work on top of their existing infrastructure are welcomed by these CIOs.

Security Is Still a Concern – I have a feeling that this topic may never die. Security is still a huge concern for CIOs and something that will continue to be important for a long time to come. Most now have some kind of security strategy in place, but I haven’t met anyone that’s totally comfortable with their security strategy. It seems that this is what keeps CIOs up at night more than any other issue.

Analytics Is a Challenge – Most of the healthcare CIOs know that analytics is going to be an important part of their future. They can see the potential value that analytics can provide, but most don’t know where to find these analytics. Most organizations don’t have a clear analytics strategy or direction. We’re still just seeing anecdotal results for very specific solutions. There’s no clear direction that every healthcare CIO is following for analytics.

CIOs are Stressed – It was very appropriate that yesterday’s keynote presentation was on turning stress into a positive. Most of the healthcare CIOs I met are quite stressed. They have a lot on their plates and most don’t know how they’re going to manage it all. Plus, they’re still overwhelmed by all the changing regulations and reimbursement changes. The fact that there doesn’t seem to be any end in sight adds to that stress.

Turnover is Still High – It seems that there’s still a lot of turnover that’s happening with CIOs. This is a challenge when it comes to continuity at organizations. However, those CIOs that have been able to stay at an organization for a longer period of time are starting to see new opportunities to be more strategic. They’ve fought all the initial fires and cleaned up the processes and now they can start working on more strategic initiatives.

Holding On vs Embracing Change – I see two different views evolving by CIOs. Many are holding on tightly to the old Chief Infrastructure Officer versus embracing the new Chief Innovation Officer mindset. CHIME is certainly espousing the view of the CIO becoming a Chief Innovation Officer and it’s the view that I think is best as well. However, there are plenty of CIOs that just want to provide the technology to their organization. It will be interesting to see what happens to both of these approaches to the CIO position.

Those are some high-level thoughts from talking with CIOs at the CHIME Fall Forum. What are you seeing? Are you seeing or hearing anything different from what I described above? We’d love to hear your thoughts in the comments.

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.”

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.

Top 10 Healthcare CIO Budget Priorities

Posted on September 22, 2015 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.

For those on the email list that can’t see the image that Charles Webster, MD shared, here are the list of top technology priorities:
1. BI/Analytics
2. CRM
3. Digitalization/Digital Marketing
4. Legacy Modernization
5. Industry-Specific Applications
6. Enterprise Applications
7. Infrastructure and Data Center
8. Application Development
9. Architecture
10. BPM
11. Cloud
12. Collaboration

Sure makes the life of a CIO look pretty easy, doesn’t it? (That was my sarcasm font in case you don’t have that font installed on your computer)

As I chew on this list, I’m processing Will Weider, CIO at Ministry Health Care’s response to me asking him what would he consider the 3 key focus areas for healthcare CIO’s:

Applying Technology to Healthcare Workforce Management

Posted on June 10, 2015 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.

I mentioned before that at HIMSS this year I made a shift in focus from EHR technology to a look at what’s next after EHR. In most cases, the technology has some connection or tie to the EHR, but I was really interested to see where else a healthcare organization can apply technology beyond the EHR software.

I found one such case when I met with Ron Rheinheimer from Avantas. For those not familiar with Avantas, they’re a healthcare scheduling and labor management solution. In most cases, their workforce solution is something the nurses choose and often the CNO. I imagine that’s why it’s not talked about nearly as much as things like the EHR. It takes a pretty progressive CIO at a hospital to be able to see through all the noise of other regulations and work with the CNO on a workforce management solution. Or it takes a pretty vocal CNO who can make the case for the solution.

Ron Rheinheimer from Avantas made a pretty good case for why workforce management should have a much higher priority for hospital CIOs. He noted that about 60% of a hospital’s budget is labor expenses and 50% of the labor budget is for nursing. It’s no wonder that nurses take it hard when a hospital goes through layoffs thanks to an EHR implementation. However, given those numbers, optimizing your workforce could save your organization a lot of money.

I think this is particularly true as hospital systems get larger and larger. We’ve all seen the trend around hospital system consolidation and as these organizations get larger their staffing requirements get much more complex. Most of them start moving towards a centralized nurse staffing model. They start working on a floating pool of nurses in the hospital. While humans are amazing, once things get complex, it’s a great place for technology to assist humans.

Ron Rheinheimer also told me about the new incentive models that many hospitals are employing to be able to incentivize nurses to take the hard to fill shifts. Night shift differential has long been apart of every workforce, but with technology you can use analytics to really understand which shifts are the hardest to fill and reward your nurses appropriately for taking those hard to fill shifts. My guess is that we’re still on the leading edge of what will be possible with technology and managing the schedule in a hospital. Real time dynamic pricing for shifts is something that only technology could really do well.

As you can tell, I’m new to this area of healthcare technology. However, I find it fascinating and I believe it’s an area where technology can really improve the current workflow. I look forward to learning more.