Managing the Transition to EMR—Before and Beyond Going Live

by Sue Murphy, MS, RN

Enactment of the American Recovery and Reinvestment Act (ARRA), and specifically the Health Information Technology (HITECH) provisions, has opened a broad, vigorous discussion around healthcare reform and technology.  Among hospitals and physicians seeking to qualify for the post-purchase incentives, the challenge of proving "meaningful use" is understandably a key area of discussion.  However, another important discussion that needs to occur is around the challenges of change.  

To assure hospitals realize the intent of these technology changes – namely to improve healthcare delivery and patient outcomes – you need to appreciate the nature of change and what it requires.  The day of "go live" is just the beginning of transition.  It's a milestone.  The mission has yet to be accomplished.

Understanding Change
Change and transition. So what's the difference?  Don't think for a moment that this is an exercise in semantics.  Change is the event – the act of going from a paper or a hybrid record to an electronic record.  Transition involves the emotional or psychological response to physical change and it requires changing attitudes and habits.  How transition is managed can determine the speed or degree of success or failure.  Consider these examples.

Case I

Change:  Consider the case of the administrator of a hospital that serves a small geographic area that is densely populated.  The hospital is considered a Disproportionate Share Hospital.  Additionally, total non-reimbursed care is high.  The hospital has operated with a negative margin for six consecutive years.  The historical IT adoption rate has been very slow.  Change – the purchase and placement of physical equipment for all of the facilities and units – occurs slowly because the budget needed to purchase all of the required technology doesn't exist.

Transition: If and when the hospital spends the money to make the purchase, it will still need to budget additional dollars for:

• Designing new processes so the new technology works
• Training the staff to assure it's properly used and embraced
• Continued process improvement to optimize use and accommodate new protocols and core measures

Only by addressing all of these issues can the hospital expect to achieve a successful transition.

CASE II

Change:  A 2005 executive order by then Arizona Governor Janet Napolitano calling for all healthcare providers to install EMRs by 2010 resulted in high uptake in EMR technology, according to the June 24, 2009 issue of Healthcare IT News.   

Transition:  However, the same article reported that physician groups had begun "de-installing" that technology.  Though EMR had been widely adopted, physicians were canceling their EMR contracts as they encountered a wide spectrum of training, functionality and affordability issues.   Given Phoenix's physician shortage, waiting rooms were overcrowded.  Doctors and their staffs had little or no time for training so, for them, the technology was more of a disruption than an enhancement. Sadly, it seems now that the governor is gone, so is the incentive. 

Having the equipment didn't bring about a lasting change in behavior or value.  The change will only be sustainable when users can see that EMR makes a difference in terms of cost, quality and time.  An element of intuitiveness goes a long way toward gaining staff buy-in.  Make the workflow part of the work, not in addition to work. Streamline the workflow so it improves productivity. And, realize that healthcare workflows differ from other workflows.  Clinical workflows have a low degree of predictability and controllability, so special attention needs to be paid to the "what ifs."

CASE III

Change:  An article in the January 2008 issue of Healthcare Informatics reported that the Salt Lake City-based Intermountain Healthcare, implemented a homegrown system 40 years ago.  Dubbed "HELP," it was beyond the technology of its time. Hardware was purchased and installed, and software was loaded to initiate a change in how transactions were handled.

Transition:  Intermountain Healthcare is known for superior patient outcomes attributed in part to its EMR and early adoption.  That system is still in use today, although it is in the process of being replaced.  Among Intermountain's secrets to success:

• Intentional change management: Updating with new solutions as new issues arise
• Respect:  Organizational commitment to employee empowerment and participation in the change process
• Unity:  "One team" with a unified goal, implementing consistently across all geographic regions

Pundits have likened the controversy and angst over EMR to many modern-day experiences, such as the Y2K scare.  Dr. David Blumenthal, National Coordinator for Health Information Technology, was recently quoted as saying, "Electronic technology will soon be considered as fundamental to medicine as the stethoscope."  The intention here is apparent, and that is to stimulate Americans to think, to be optimistic, to problem-solve. 

For us in healthcare and IT, this is what we do.  This is an exciting time. It may be overwhelming now, but this, too, shall pass.  In the meantime, as healthcare organizations and providers identify their IT strategic plan and make decisions on what they plan to seek in terms of federal and state grants and incentives, IT vendors and consultants will stand ready to support them in managing the change and transition. 

After all, the goals of improving the quality, safety and efficiency of the American healthcare system are noble.  And one day we will all be ready to partake.

Want to Continue the Discussion?  Engage Sue on LinkedIn.

About the Author
Sue Murphy is a recognized expert in inpatient hospital operations, covering all areas of the hospital balanced scorecard. She has more than  30 years professional experience developing, delivering and directing effective Lean process improvements focused on enhancing efficiency, improving quality and reducing costs in the hospital industry. Learn more about Sue.