The first common mistake healthcare organizations make when implementing new EMR/EHR software is a half-hearted effort buying into principles.
For example, many hospitals have a ‘patient-first’ fundamental principle incorporated into their operations. This is not the inherent problem; ‘patient-first’ is an excellent guiding principle. But if it’s going to work, it needs to be a full commitment. Where organizations struggle is in buying into these principles 75 percent of the time, getting away from them when budgetary issues arise or when a doctor is prideful and may be upset.
When the going gets tough, that commitment can wane. This is where leadership needs to step in and assure the staff if their jobs change or are replaced, they’ll find them another spot. But above all, they need to stand firm. Once doctors and nurses see there’s wiggle room, the floodgates open and everything falls apart. If a doctor screams and cries and leadership gives in, it becomes nearly impossible for leadership to stand its ground later when someone else does the same thing.
To get this kind of buy-in, it’s important to understand the motivations of the party pushing back. Many times it happens because of a misperception of what people are being asked to do. Leaders need to take into account their needs, plus the limitations of the software. And you need to communicate with physicians in a productive manner — in other words, make sure you’re initiating back-and-forth conversations, not just one-way communication. Also, it’s critical to encourage face-to-face talks as often as possible, even refusing to respond to emails in some cases. As I’ve told my staff, sometimes we have to meet to figure out the problem. If it takes more than three exchanges, we cannot get to the essence of our issue resolved over email.
The second common mistake is not understanding the questions you’re being asked and the decisions that need to be made at the start of a project.
For example, imagine you’re planning to take a road trip to San Francisco. But the decisions you’re making at the beginning of the trip set you on course to visit San Diego instead. Early-stage decisions can be costly, because by the time organizations figure out where they’ve gone wrong, they’ve already wasted valuable resources going in the wrong direction for weeks or even months at a time.
One decision that can hurt is using project plans that come directly from the software vendor. In some cases, these plans are copied directly from another organization, and may not fit into your team’s workflow. This requires a lot of clean-up, so it’s a big problem. Leaders burn a ton of money trying to clean-up the basic tools and get the decisions that an organization needs to make inline to implement the software. It’s funding that could have been put to better use in other areas.
The risk hospitals and health systems take when relying too heavily on vendors during the implementation planning process is that companies often employ bright, young people who don’t have the depth of experience in healthcare. They know what they’ve been told, but sometimes they can’t think critically to process the information that you need to process in advanced healthcare environments.
Having a few strategically placed consultants on the project can make all the difference. With their experience, consultants can help guide the project leadership team, analysts, and project management team. And while this will cost more in the short-term, being able to leverage expertise and prevent missteps can provide benefits in the long term.
In fact, I can’t tell you how many times a seasoned professional has found something that a new person would have missed because they have experience in healthcare. It takes a long time to understand the depth and breadth of the project. I learn something every day, and I’ve been implementing software since 2005.
We all still have a lot to learn — and a long way to go, but by avoiding some of the common pitfalls, we can get there in a better, more efficient way.
Sheryl Bushman, MD, is a CMIO with Optimum Healthcare IT, currently serving an interim term as Physician Executive at Integris in Oklahoma City, Okla. She has helped lead implementations in 15 hospitals and hundreds of ambulatory clinics, most recently as CMIO at NYU Langone Medical Center.