Health Systems Implementation - Advice for getting it done right - the voice of experience
Monday, September 21, 2009
| Theodore Blizzard, MBA, MSHI and Anne Burgess, BSN, MSHI
About the Authors: Theodore Blizzard, MBA, MSHI is Vice President and Chief Information Officer for the Mass Medical Society and New England Journal of Medicine. Anne Burgess, BSN, MSHI is Clinical Database Program Manager, Cardiac Surgery, at Brigham and Women's Hospital.
Ted Blizzard is also a speaker and co-chair for the 2009 Connected Health Symposium - Oct 21-22.
Imminently, healthcare organizations will be facing important decisions regarding implementation of electronic medical records systems. These systems offer enormous benefits and demonstrate improved patient care and outcomes. Based on past experience, many systems will fail to meet clinician expectations. Some systems will be implemented only partially, while others will outright be rejected. How can clinical and technical professionals ensure the most favorable outcome during this challenging and exciting time?
We had the privilege of sitting down with some of the most experienced technology leaders in the country. They have literally decades of experience and understand what it takes to effectively implement healthcare systems. We asked a series of questions to identify important characteristics for successful implementation. In this brief article, we will provide a summary of some of their advice and ask you to participate in providing your own input.
1. Start with clearly articulated core objectives that are modest and achievable; build on that success.
2. Plan carefully and in short phases (three months or less); celebrate at major milestones.
3. Show completed work quickly and iterate design in real-time.
4. Develop common vocabulary (glossary) to facilitate usability and expedite development by utilizing those similar basic design elements.
5. Recruit, develop, and retain specialized personnel to minimize project risk. Cultivate leaders in your organization. Give people the opportunity to grow.
6. External changes such as legislation and/or pay-for-performance requirements may result in project failure if there is a lack of awareness, response, or incorporation. It is critical to have detailed functional and technical specifications for each project phase. This allows teams to minimize scope creep within each phase but maintain flexibility for later phases, maximize opportunity to integrate new domain requirements and lessons learned.
7. Vendor contracts should specify use cases for each workflow design and be held accountable for such. Many contracts have open-ended design specifications, which may turn into “Change Requests”. This could lead project demise due to budget constraints and/or clinician/project fatigue. Understanding which workflows need to be included in the final system product will also enable domain customization.
8. Interoperability between integrated systems should be defined in advance. Many systems fail because they cannot properly communicate with other mission-critical systems. Lack of interoperability is rarely sustainable, lacks efficiency, and can be costly.
9. Engaging a committed sponsor to provide continuity, minimize interference, and advocate success is described as critical. Senior leadership changes often cause disruptions at the project level. Different philosophies or management approaches can impose undo stress and should be mitigated against when possible.
10. Training for the entire staff in EMR workflow is an important success criterion. Many implementation specialists focus training on clinical staff but may overlook administrative staff. The detailed project plans should specify appropriate stages for linking these teams together in order to train and solidify all user experiences.
It is important not to lose sight of the ultimate goal when implementing these complex systems. In the end electronic medical records should benefit patient care. We hope these 10 summary items provide some tips for successful implementations and anticipate your suggestions as well.
We want to thank our colleagues who participated in our interviews including:
- Cole Dowaliby-Riley, MGPO, Corporate Manager, PHS IS, MGH
- Steven Flammini, Chief Technology Officer, Partners HealthCare
- Erica Hokenson-Salazar, Manager of Nursing Informatics/Advanced Clinicals, Caritas Norwood Hospital
- James Noga CIO, MGH
- Christine West, Practice Consultant, Massachusetts eHealth Collaborative