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Creating buy-in among hospital physicians when embarking on a new technology initiative can be difficult. Here are some tips.
Whether it’s electronic health records (EHRs), hospital information systems, or another healthcare technology, creating buy-in among physicians when embarking on a new technology initiative can be difficult. Many have a healthy skepticism about the capabilities of health IT systems.
Charles SettlesWhile physician resistance to new technology can crop up in any healthcare setting, it’s particularly prevalent in a hospital environment. One doesn't have to look far to find scathing evaluations of EHRs written by emergency physicians and hospitalist physicians, including this recent one, by Robert M. Wachter, MD, in TheNew York Times.
Adopting an electronic health records system at a hospital for the first time is a challenge, but it's also one that is becoming less common. According to HealthIT.gov, 85% of all eligible hospitals have demonstrated meaningful use (MU) of electronic health records and received EHR Incentive Program payments from the Centers for Medicare and Medicaid Services (CMS).
Despite the relative ubiquity of EHRs at U.S. hospitals, dissatisfaction with EHRs is causing many hospitals to switch vendors. Indeed, our own data at backs this up: traffic to our various categories shows notable interest in replacement software for hospitals or larger physician groups.
Despite the many issues that have arisen in conjunction with the adoption of electronic record-keeping, prescribing, ordering, and so on, most physicians, as Wachter put it, realize that, “We will never make fundamental improvements in our system without the thoughtful use of technology.” Most clinicians recognize the transformative potential of healthcare IT. Better data means better population health modeling, better predictive analytics and generally superior information for clinical research.
This is especially true if CMS and software vendors can solve issues with interoperability and health information exchange. Presumably, all of this leads to better health outcomes. Convincing individual physicians is usually effective, but one-on-one meetings with each staff member aren’t feasible.
Creating buy-in among a group is a more challenging endeavor. Coordinating internal and external teams of physicians, IT staff, trainers, and other stakeholders is an extremely challenging, but crucial endeavor. To complicate matters further, learners will grasp concepts and master the system at different rates, as they’ll likely have varying levels of experience with EHRs and/or software in general.
Here are some tips to ensure your physicians are actively engaged with your EHR and using it appropriately:
1. Acknowledge and own the challenge you all face, early on. Ask your physicians, nurses, and staff for their help. You’ll need tech-savvy, patient people from each potential user group. Involve these volunteers from the beginning as part of the team that evaluates systems and participates in the demos with each vendor. These people will be your super users or user champions. They will serve as the evangelists and eventual teaching assistants to the rest of your staff, working in conjunction with the vendor’s trainers.
2. Involve super users in the selection process. All too frequently, hospital administrators, finance, legal, and other stakeholders that aren’t the end users are the only ones involved in the early evaluation process. If the budget allows for it, put some of your super users on a plane and take them to a healthcare IT conference (or look for one nearby). They’ll be able to demo several systems at the conference and quickly establish a short list. Even better, once you’ve narrowed the candidates to just two or three systems, pilot each vendor’s system in as many departments or affiliated ambulatory facilities as possible.
3. Test the system. Piloting the systems that appear to be the best fit will allow you to not only test them in an actual care delivery setting, but also allow you to see how the vendors perform during implementation on a smaller scale. The pending rule for the third stage of MU is likely to cause innovation and consolidation among vendors as they’re pressed to fix issues with interoperability and health information exchange. A trial period will give you additional time to see how these changes start to play out, before committing to a contract that could last years and cost several hundred million dollars when all is said and done.
The time and/or money spent in the beginning could, depending on the size of your organization, save millions of dollars in the end. If time and/or budget constraints prevent the piloting of several systems, at the very least don’t make a decision until after the rule for the third stage of meaningful use is finalized.
4. Involve super users in the design process. Despite many vendors’ claims to the contrary, adopting EHR at your hospital will require changes to many of your users’ daily workflows. Involving your super users in the design process will reduce (but probably not eliminate) the initial decline in productivity. They can also help design processes and interfaces that best fit their positions’ user groups and minimize the system’s impact on clinical efficiency and patient flow.
Due diligence in the vendor evaluation process and involving end users early on will not only aid buy-in and increase confidence in the eventual end result, but also will decrease the time-to-fluency for many of your users. Seeing colleagues using the system makes it more approachable, and knowing that one of their own was involved in the selection and design process from the beginning inspires more confidence in the system’s architecture and functionality. Having a peer demonstrate a particular feature, rather than an outside implementation consultant, can also be more effective for certain users.
Though creating buy-in for a healthcare IT purchase among physicians at your organization involves many factors, it begins and ends with your super users. Select them carefully and treat them well-it is their evangelism or criticism that will spell the ultimate success or failure of your implementation.