John Schrenker, CIO, Lakeside Health System
Even if they haven’t seen the movie everyone knows the line from Field of Dreams, “if you build it they will come.” It’s a great movie, but the idea doesn’t apply to information systems, not in healthcare or any other industry. Technology by itself will not affect patient safety, quality of care, productivity, or profitability. Technology by itself rarely accomplishes anything, it’s what we do, or don’t do with it that will have an impact. That’s why Meaningful Use includes utilization requirements in addition to functionality requirements.
It would be easy to end here, point made, but unfortunately many organizations will still use the Field of Dreams approach. Why? In their efforts to implement an EMR and meet all of the deadlines they will rush through the process to implement the technology without making sure all stakeholders are fully engaged and without properly reviewing the process and policy changes needed to ensure success.
Not to minimize the technical challenges, but implementing an EMR is NOT an IT project. In many ways the technology is the easy part. Viewing it as an IT project (by either the IT or clinical staff) leads to the “if you build it they will come” approach. The hard part is making it work right and doing that requires active participation from those who will use it. You need champions who come from your clinical staff that can guide the process. They know the current workflow and what changes must be made to current process to be productive and safe. Your champions understand how the system needs to be configured, and they’ll challenge you regarding where you need to change your processes.
Success requires give and take by all parties. Clinicians need to change, processes need to change, hardware and infrastructure may need to change. Nothing can be off limits. If everything isn’t on the table, then you won’t have buy in and you’ll have a hard time finding champions. I hate the phrase “too big to fail,” but we all have a lot riding on successful EMR implementations. “If you build it they will come” won’t work, they need to be there to help lay the foundation.
jbormel says
John,
Nice post; I strongly agree with the message.
To build on your thought “implementing an EMR is NOT an IT project,” I think it’s useful to address whether it’s a “project.”
Project implies it being managed as a project, with a charter, and disciplines in place to deliver on-time and on-budget, with a commitment (aka submittal) schedule as well as a project schedule.
There’s a strong argument to made that the project structure, without reference to a larger program structure with it’s portfolio management is also doomed to produce casualties and waste. How many IT projects have been killed at the eighth month of their metaphorical nine month gestation, because of instrumental reactions to real (or projected) revenue shortfalls and global cost problems?
This submittal schedule concept makes the “all parties” reference you made a discipline, rather than a dream.
For more on this idea, see how the building construction industry has evolved, as described by Atul Gawande in The Checklist Manifesto. His section on the demise of the Master Builder makes it clear that other industries have recognized that dealing with the complexities of an EMR cannot be managed by authoritarian rule or even simple committee governance structures.