Practices aren’t always successful with electronic medical record (EMR) implementation. Some have even abandoned attempts to implement an EMR system, reverting back to the old way of doing things—a waste of valuable time and money.
The reason projects fail is often not about the software but about practices not wanting to change, says Susan Ordway, senior director of HIT services and manager of the Quality Information Technology program at Masspro. Project failure may be caused by:
A resistance to change (e.g., no operational design)
A lack of preparation (e.g., budget, communication plan, appropriate resources)
Selecting the wrong partner
To get a failed project back on track, first determine the reason for the project’s collapse. Before recommitting to your implementation, make sure your practice is equipped with the right tools. Start by creating an assessment form that includes questions about what you want to accomplish this time, Ordway says.
During the assessment phase, Ordway suggests groups draft a project that includes their renewed strategic vision, goals, and objectives. Also, take a closer look at your practice from an operational standpoint.
“Do you have regular meetings, and is there a definite leader responsible for these tasks?” Ordway says. “What are the practice’s initiatives, and does your practice have enough time to focus on saving the EMR project based on these initiatives? Do you have any standard documented policies and procedures in place?”
EMR projects often fail due to a lack of leadership. If you didn’t previously have a champion for your implementation, get one. If your former leader isn’t up to the task, make it a priority to find the right person to motivate and lead your team. “This person needs to be someone who can lead through change and be a part of the project beyond the go-live phase,” she says.
But an implementation is far from a one-person job. Make sure you have a dedicated implementation team that includes both clinical and executive leadership, Ordway says. “It’s not just the business manager; there needs to be physicians discussing this too. You also need people that are not so much [technically] educated, but folks who want to spend extra time on this project and are open-minded to other people’s input,” she says.
Finally, make sure your group is culturally ready for change. “There are practices that say we’ve been doing the same things for 20 years and there is no need to go paperless,” Ordway says. Your leader needs to help the group do away with this attitude before you proceed.
Shannon Sousa is the editor of The Doctor's Office. She may be reached at Ssousa@hcpro.com. This story was adapted from one that first appeared in the March edition of The Doctor’s Office, a publication by HealthLeaders Media.
It's not uncommon when I'm interviewing a physician—and the topic could be just about anything related to healthcare—for the conversation at some point to turn to the state of the reimbursement system and the need for some type of healthcare reform. Increasingly these days, that means we're talking about universal healthcare.
Some think it is a necessary next step, particularly physicians whose reimbursement suffers because they treat a lot of underinsured and uninsured patients. Others take a look at the bureaucracy of Medicare and the current healthcare system and consider a movement to universal coverage the equivalent to throwing gasoline on a fire. But with the election in full swing and healthcare one of the key issues of the campaign, universal healthcare is on many physicians’ minds.
Which is why I found a survey released last week regarding physicians’ attitudes about universal healthcare particularly interesting. The verdict? Fifty-nine percent of the more than 2,200 physicians surveyed say they support legislation to establish national health insurance. This represents a 10 point increase from a similar survey conducted in 2002.
A second question was asked about whether physicians support achieving universal coverage through more incremental reform, which is essentially what the major presidential candidates are proposing, and support actually dropped to 55%. Aaron Carroll, MD, MS, a pediatrician who was lead researcher on the study at the Indiana University School of Medicine, thinks this reflects physicians’ impatience with previous reform efforts that didn’t go far enough in addressing the problems of the uninsured and rising healthcare costs.
“Everything seems to be going downhill, and all the incremental reforms over the last five, 10, 15, 20, 30 years are not doing a good job,” he says. “If anything, most people feel that everything is getting worse, and I think physicians are recognizing that we need to have much more radical reform.”
But some physicians still have reservations. Another survey came across my desk this week from the physician recruiting firm Jackson & Coker. It found that 47% of physicians think patient care would probably be worse under a universal healthcare system, and 60% think patient wait times would increase dramatically.
Many questions still linger as universal healthcare looms on the horizon. Is healthcare a right or a commodity? Will our healthcare system become less efficient? How will we pay for universal coverage? How can we offer universal coverage without limiting patient choice? Will physician reimbursement suffer? Senior editor Les Masterson poses some additional questions in this week’s Health Plan Insider.
Though these questions range from the philosophical to the practical, physicians’ answers may be more predictable than we think. Female physicians and younger physicians tend to be more supportive of universal healthcare, Carroll says. And the specialty breakdown may be most revealing. Only three groups in Carroll’s survey had less than 50% support for universal coverage—radiology, anesthesiology, and surgical subspecialties—all of which earn well over $300,000 annually.
In fact, self interest may be the strongest correlate to support for national insurance. The specialties that most strongly supported it—psychiatry, emergency medicine, pediatrics, and primary care—all make less than $200,000 (MGMA median levels) and often have patient panels with a lot of uninsured or Medicaid patients.
But it’s important to remember that these are only patterns. I know primary care physicians who strongly oppose universal coverage and surgical subspecialists who favor it. This is a very contentious issue, and as is the case in the general public, physician opinions about universal healthcare are far from universal.
Several weeks ago in this space I asked the question, “Will We Ever See Zero?” The “we” referred to healthcare organizations and the “zero” the rate of patients acquiring infections during their hospital stays. At the time, I was skeptical that we would ever see zero, but shortly after, I was introduced to individuals at three different organizations who do believe zero is possible. Why do they believe this? Because they’ve done it. Their organizations have achieved a rate of zero catheter-related blood stream infections and held it for several months at a time. Over the next three weeks, I’ll introduce you to these organizations and show you how they became “zero heroes.”
At Beth Israel Medical Center in New York City, CEO David Shulkin says many factors led the 1,106-bed system to become “zero heroes.”
“Like every other effort in a hospital, it’s multi-factorial and multi-dimensional. There’s not just one thing you can point to,” Shulkin says. “Several specific things have led to our success.” He names six actions that helped the hospital succeed.
1. Have the right leaders
Shulkin gives a lot of credit to the organization’s director of infection control, Brian Koll. Koll has taken charge and inspired the organization’s staff to really work to prevent infections. “He understands the value of communication, education, and he’s passionate about what he does,” Shulkin says.
2. Train your staff’s ‘natural leaders’
In conjunction with the Service Employees International Union Chapter 1199, Beth Israel trained members of the hospital staff to become infection coaches. These staff members were educated in what it takes to reduce infections—specifically handwashing and the importance of wearing gowns and gloves when inserting central lines. “The union supported us in a joint effort. Now we have a small army of employees who are knowledgeable about controlling infection,” Shulkin says.
3. Show them what they’re missing
Even when you wash your hands, there still could be germs that you’re missing. That’s why Beth Israel uses a product called Glow, a gel that shows germs still left on hands.
“We had our infection control staff go around with the Glow and show people how they really need to wash their hands,” Shulkin says. “Having the visual component of this was very, very important.”
4. Stop when you see red
If an employee—at any level—sees something happening at the hospital that puts a patient at risk, he or she has the responsibility to speak up and stop the process. This “red rule” was put in place by Shulkin almost three years ago when he assumed the CEO position. “We all carry around red rule cards and if we see anyone who is about to put in a central line without doing everything in the bundle (wearing gowns and gloves and washing hands), we’re supposed to stop it. And we take this seriously,” he says. In addition, the infection control staff can issue “tickets” to anyone that deviates from best practices. “They can take out a ticket pad and write someone up and tell them what they’re doing wrong,” he says.
5. Empower the employee
The red rules are just one way that Beth Israel uses to put infection control power in the hands of its employees, Shulkin says. “We want them to feel that they own and are accountable for these results,” he says, “and that every employee has the ability to eliminate infection.”
6. Give feedback
Each unit at Beth Israel has frequent poster presentations of data to allow employees to measure the progress that their infection control methods are making. The presentations not only help instill ownership of the data among employees, but Shulkin says they’ve also inspired a bit of competition among units.
Perhaps the most important message that Shulkin offers his fellow hospital leaders is to be patient and consistent with your message while your organization goes through the quality process. “Change is a long-term strategy. Nothing happens quickly,” he says.
Metairie, LA-based East Jefferson General Hospital has established a partnership with the University of Texas' M.D. Anderson Cancer Center in Houston. East Jefferson officials called the move a boon for cancer care in southeast Louisiana, and that the pact extends the range of M.D. Anderson's expertise to the New Orleans area. Under the three-year agreement, East Jeffeson will pay M.D. Anderson $500,000 annually, with an option to extend the relationship.
A $2.5 million donation by Carnival Cruise Lines and the Miami Heat has paid for an expansion and renovation of the Miami-based Pediatric Intensive Care Unit at Holtz Children's Hospital at Jackson Memorial. The unit will now be called the Carnival Cares for Kids Center. A pediatric medical unit that is also being renovated will be named the Miami Heat Home Court for Kids.
Under a major reform of Cuba's vaunted free healthcare system, President Raul Castro's government will close more than half of Cuba's family doctor offices and boost staffing at the rest. The overhaul of one of the pillars of the health system came in response to public complaints, according to sources.
The Florida House has decided to push forward with a plan to expand a change in the way Medicaid works. Under the plan, Medicaid would work more like private healthcare and put patients into care networks like health maintenance organizations. Supporters said that would boost preventive care and limit cost increases, but some advocates for the poor say it would leave some people unable to find the care they need.
It takes patients at Philadelphia health centers an average of more than five months to get an appointment to see a doctor, according to a report released by the city controller. It took 15 days to get an appointment in New York City and only seven days in Baltimore, according to the report. There are eight public healthcare centers throughout Philadelphia, and data shows most of the 85,000 patients who visited them last year were impoverished African American and Hispanic adults. About half of their 320,000 visits were uninsured.
Citing a recent state report, New Jersey Health Commissioner Heather Howard told lawmakers the state may need to let some hospitals close in an effort to strengthen others. Of the state's 78 hospitals, four hospitals closed in the last 18 months. Four others announced plans to close, five filed for bankruptcy protection, and about half the others are losing money. Twenty years ago, New Jersey had 112 hospitals.
More than 30,000 people, or about 19 patients in 1,000, contracted infections in 2006 while undergoing treatment at hospitals in Pennsylvania, according to a state report. The report, from the Pennsylvania Health Care Cost Containment Council, found that patients who got infections remained in the hospital an average of 19 days, compared with fewer than five days for those who did not do so. Patients with infections wracked up hospital charges averaging nearly $176,000, compared with less than $34,000 for other patients.
