When the uninitiated think of electronic health record implementations, they focus on build and rollout. Most likely, the implementation is considered an "IT project," and the communication machine starts rolling just before staff members are affected. However, the initiated know that EHR implementations—successful ones, that is—are process, workflow, and operational in nature. They are considered operational improvement projects with a healthy dose of change management, and communication begins when the decision to move to an EHR is made.
With the American Recovery and Reinvestment Act's HITECH incentives, healthcare organizations are being urged to roll out EHRs and use them in a "meaningful" way. The following are three areas that often get the short shrift during an EHR implementation, but they are as critical to success as the functionality itself.
Communication. One of the first steps in an EHR implementation is to carefully create a communication plan that focuses on all classes of end users. The message should address the benefits of the new system's functionality, as well as, the changes that will occur post-implementation to people's everyday workflow. From implementation experience at academic medical centers, ambulatory facilities, and community hospitals, my colleagues and I have identified the need to better prepare end users for the effects on their daily processes.
The learning and change process begins with these early communications. In addition to the "training" concept inherent in it, early adoption questions can surface that may alter the build and the training program. In addition to end users, leadership and the project team require early and frequent knowledge. You can use e-demos and training materials based on actual scenarios to help assimilate everyone involved to the new environment.
"IT" project vs. "operational improvement" project. It is a common mistake to label these types of implementations as IT projects. Regardless of whether it's an EHR, PACs, laboratory, or other system, the purpose of the implementation is to improve operations. Even though the IT department provides technical direction and support, the owners are the users. Early communication and adoption of this concept results in a more engaged user base, and the implementation feels more like a cross-functional team effort. This heightened participation leads to input that makes the system configuration and optimization more relevant to users. It should also eventually improve patient satisfaction, as end users across the organization represent various aspects of the patient experience.
EHR training approach. All too often, the topic of training is an afterthought. Yet if people aren't adequately trained, an EHR implementation can fail. By failure, I mean that delays mount along with frustration, and inversely, patient satisfaction plummets. Although it's understood that training is required, early focus is on acquisition, build, configuration, technology, and implementation. Therefore, the training team is usually not identified until later in the process and thus not involved in the build and configuration processes. Early involvement with the project team allows trainers to:
- Have adequate time to create a good curriculum based on the build and configuration requirements.
- Develop an understanding of operations and workflows that should be integrated into training scenarios.
- Develop relationships with application and user teams to enhance communication and response time regarding issues, questions, and resolutions.
The following are some suggestions for how to approach the training aspects of an EHR implementation.
- Create a training plan that clearly communicates the vision, mission, and approach. The plan should identify the organization's approach to staffing, curriculum, and process based on an assessment of the technology, environments, and audiences involved. This document will be used to obtain support during early communication sessions and with the organization's leadership.
- Don't rely entirely on computer-based training. Given the number of staff who may not be very computer literate, it will not be the most effective way for them to learn.
- Combine computer-based training, instructor-led training, hands-on exercises, and practice time. This blended approach should meet most of the diverse end-user characteristics.
- For end users who need additional training, computer-based training is a good option.
Rob Drewniak is a consultant with Hayes Management Consulting in Newton Center, MA, and the former senior vice president of clinical resources at Glendale Memorial Hospital. He can be contacted at rdrewniak@hayesmanagement.com or visit www.hayesmanagement.com for more information.