There is an adage, Parkinson’s Law, which states that “work expands so as to fill the time available for its completion.” Although it seems we have been gifted with an extension for Meaningful Use Stage 2, the reality is that this is borrowed time and we need move forward as planned. Implementing electronic health records (EHRs) is no small task, and even organizations with the most well-planned strategies will face their challenges. But luckily, we can learn from one another’s successes and challenges because, at the end of the day, we are all in this together.
As the director of risk management and a physician champion for EHR implementation at Henry Mayo Newhall Memorial, a 250-bed hospital, I am seasoned when it comes to facing technology adoption challenges. Although my facility is currently attesting for Stage 2 of Meaningful Use, attaining this level was not without its hurdles.
Before staging a “big bang,” system-wide implementation, we ran a pilot in our Emergency Department, where I work. This served as a litmus test, allowing us to see, first-hand, what worked and what didn’t and enabled us to make modifications. We also chose to run a secondary pilot in our OB/GYN department, which is a unique group with distinct requirements. After assessing and modifying the process, we were ready to launch an EHR system-wide.
When I tell people this, I generally hear the following response: isn’t an organization-wide implementation too much for physicians to handle? My short answer is: no. Think of it as ripping off a Band-Aid. Is it painful? Yes. But does prolonging the removal process make it any less painful? No. A staged implementation process forces physicians to acclimate to a new workflow that will only be disrupted by the next adoption phase – and before you know it, it’s been a year-and-a-half and your frustrated clinical teams are still working through the wrinkles. The downstream effect is that as physicians can become frustrated, they may discuss their challenges amongst themselves, subsequently causing pre-implementation physicians to develop antibodies to the EHR before they even begin learning about the system. This noise often leads to adoption resistance.
As with any implementation, without a doubt, there will be a couple months of discomfort. Change is, after all, never easy. So in order to assist with physician adoption, I recommend setting up early wins. For example, to encourage 100% physician dictation into EHRs, we promoted “Top Dragon,” a program that celebrated those clinicians who were documenting electronically. Winners received a lapel pin and their names appeared on monitors throughout the hospital. Physicians are generally competitive by nature, so this friendly competition helped to encourage adoption.
Another tactic we employed was the creation of a grassroots physician advisory committee. A recent study shows that physicians want to be involved in technology decisions that affect them. By inviting influencers, physician champions, skeptics and critics, we assembled a robust group who carefully discussed and decided what technologies worked best and how best to implement them. This provided traction to our implementation, as all voices had been heard and all parties had agreed. As a result, we achieved successes that would have been near impossible had the committee not been formed.
Although EHR implementation is challenging for clinicians and administrators alike, the key to success is physician involvement. These technology changes are directly impacting doctors, and they need to be included. After all, physicians know best what will and won’t work for them, so involving them early in the process will make EHR adoption easier for everyone.