Healthcare IT Strategy

Users—Odd Man Out

Healthcare IT Strategy

paulroemer@healthcareitstrategy.com

Why will this EHR implementation be different?

Einstein defined insanity as doing the same thing over and over and expecting different results.

How high is the risk of failure of this EHR?

Plenty if the project is underway and you do not already have a very detailed workflow analysis.

What are the odds of failure?•Fifty percent of all IT projects costing more than $15 million dollars fail.

•Failure is defined as one or more of:

•Over budget

•Late

•Not accepted by users

•60-70% of hospital EHR projects fail (NEJM)

•EHRs do not fix poor processes, they automate them—that is why productivity drops

What make an EHR successful?

UsabilitySuccess is not meeting Meaningful Use, Meaningful Use is a byproduct.

If EHR is done right, your hospital will define what meaningful use means to them.

When you build a new hospital wing…Who decides how many beds it will have, what the clinical staff needs, and what care will be offered?

The architect? The builder? Of course not.

Why then is EHR any different?

Whose project is it currently?It is an “IT” project

Demand to see the project plan:

•Who wrote the plan:

•IT

•IT & the vendor

•Assess the major tasks. The vast majority of tasks will be:

•Build

•Rollout

For this EHR to work…

Here are some good rules of thumb.

•The number of USER tasks should be greater than or equal to the tasks of the Vendor + IT

•USER tasks should start before the build

•IT will not simply hand it over the management of the project, especially if they are paying for most or all of the effort.

What are the USER tasks?

The user tasks define what IT and the vendors should build. The major user tasks are:

•Oversight

•Communication

•Processes

•Process definition

•Process unification—one way to do each thing

•Process improvement

•Change Management

•Training

Why are you installing EHR?The project is underway for the users, not IT.

EHR’s goal is to improve many aspects of operations.

•Productivity

•Care

•Safety

•Increased revenues & access

•Reduced errors & cost

IT does not need an EHR—users do.

What is the work flow issue?The biggest mistake made on EHR projects is to implement EHR to match current work flows.

The workflows of every department that touches a medical record should be assessed.

Implementing EHR has nothing to do with getting rid of paper. Less paper is a byproduct, not a goal.

The atom is split…

USERS

IT

Vendor

Internal forces naturally repel individual stakeholders.

For EHR to work, the stakeholders must fuse.

USERS

Vendor

IT

What is the Users’ Role?

•Rigorously document the use context of the EHR

•Who will use it

•How often

•Why

•How

•How will each user interact? There are hundreds of interactions.

Before users design anything…Determine what could go wrong or went wrong last time

•Navigation—I can’t figure out how to get it to do what I need it to do

•Workflow—it takes too long to do this

•Communication—it takes me away from my patients

•Wasteful and repetitive

•Incompetent—it does not mimic how I work

In short, it was not usable. User involvement is your “usability insurance”.

What should users be doing?Identify all target user groups that currently perform the tasks or processes the EHR will automate.

Define the current workflows the users employ to accomplish the tasks or processes

Determine what the users do before and after they perform the processes—the interfaces, inputs, & outputs

Let the users “play” with the EHR to understand what must be modified

What must users overcome?•Inadequate support for cross-functional processes

•Mismatch of EHR functionality and user requirements

•Limited ability to change processes due to inflexibility of EHR

•Lack of visibility of processes

•Inability to support clinical and patient interaction

•Lack of understanding of specialized functionality

•Inability to integrate with other user-specific systems

Processes versus workflows•Business Process - A set of one or more linked procedures or activities which collectively realize a business objective or policy goal.

If the process does not support a business objective, kill it. Do NOT automate it.

•Workflow - The automation of a business process, in whole or part, during which documents, information or tasks are passed from one participant to another for action, according to a set of procedural rules.

What must users control?

Users Retain Control of:

• Assignment of Responsibility• Groups, Roles, Skills• Deadlines• Alerts, Reminders, Escalations• Order of Tasks• Addition of Manual Tasks• User Interfaces

What must IT control?

IT Retains Control of:

• Computational Logic• Data Representations• Scalability / Performance• Interoperability• Master Data Management

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Who?

When?

Users Retain Control of:

Users Retain Control of• Assignment of

Responsibility• Groups, Roles, Skills• Deadlines• Alerts, Reminders,

Escalations• Order of Tasks• Addition of Manual Tasks• User Interface

Depends strongly on who is in each organization.

Changes on daily basis

Organizational Culture

Optimize for each team

Respond to market or legislation

Related to Training, Experience

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IT Retains Control of:

IT Retains Control of:

• Computational Logic• Data Representations• Scalability / Performance• Interoperability• Master Data

Management

Requires expensive technical capabilities

Very low or no dependence upon the organizational culture

Knowledge of infrastructure