If you’ve ever tried to navigate the streets in Boston, you’re familiar with the issues created by taking what works for you now and making it permanent without proper planning and evaluation.
Boston’s streets were laid out in 1630, and “intuitive” is not a word that would be associated with trying to navigate them. While the rumor that Boston’s streets used to be cowpaths has been put out to pasture (pun intended), there are some great lessons that can be applied to digital health.
Atul Gawande’s most recent article in the New Yorker, Why Doctors Hate Their Computers, depicts his journey with Partners Healthcare as they migrated to a new EMR, the fallout 3 years later, and the trending issues that medical software is causing for those in the healthcare profession: burnout, a burden on work-life balance, decreased job satisfaction and decreased job efficiency.
“A 2016 study found that physicians spent about two hours doing computer work for every hour spent face to face with a patient—whatever the brand of medical software. In the examination room, physicians devoted half of their patient time facing the screen to do electronic tasks. And these tasks were spilling over after hours. The University of Wisconsin found that the average workday for its family physicians had grown to eleven and a half hours. The result has been epidemic levels of burnout among clinicians. Forty per cent screen positive for depression, and seven per cent report suicidal thinking—almost double the rate of the general working population.
“Something’s gone terribly wrong. Doctors are among the most technology-avid people in society; computerization has simplified tasks in many industries. Yet somehow we’ve reached a point where people in the medical profession actively, viscerally, volubly hate their computers.”
Many of par8o’s clients chose to implement a referral management solution because their current EMR didn’t meet care coordination needs, and/or there was a need to coordinate care across healthcare systems that use different EMR instances.
Implementing a health IT system, like par8o, to work in conjunction with the EMR provides organizations an opportunity to evaluate what’s working in current workflows (perhaps a “cowpath”) and make improvements, before reinforcing staff and provider activities (with a little bit more “pavement”) - avoiding the dreaded “I hate this system” mutter from a doctor who would rather be interfacing with patients.
Our experience in the pre-implementation phases - which can last anywhere from 6-12 months - has helped us compile an internal playbook we use to ensure our clients have the smoothest transition possible on Go-Live day.
Here are five key areas we consider when planning an implementation with clients, and we feel are paramount to a successful health IT software implementation across any organization.
5. Will This Implementation Add Clicks to Provider Workflows?
As Gawande points out in his anecdote about the “Revenge of the Ancillaries”, the source of EMR burn out for providers can in many cases be attributed to administrators making decisions without consulting providers about potential workflow impact.
“Ordering a mammogram used to be one click,” she said. “Now I spend three extra clicks to put in a diagnosis. When I do a Pap smear, I have eleven clicks. It’s ‘Oh, who did it?’ Why not, by default, think that I did it?” She was almost shouting now. “I’m the one putting the order in. Why is it asking me what date, if the patient is in the office today? When do you think this actually happened? It is incredible!” The Revenge of the Ancillaries, I thought. “
It’s easy to ask a provider to make one extra click or fill out one more field. In aggregate, those “one extras” add up. It should go without saying: When implementing a new system, make it as easy as possible for providers who should be focused on caring for patients.
4. Consider the True Impact: Interview Stakeholders from All Stages of Related Processes
Referrals touch just about every part of a healthcare organization, and if you don’t bring all parties to the table to determine if needs will be met by a new solution, you risk lack of engagement and the overall success of the implementation.
Make sure your implementation workgroups have clinical, administrative and IT representation at a minimum, and that your steering committees consider groups such as population health and revenue cycle.
3. Value Referral Coordinator Input As Much Provider Input
Healthcare organizations keep moving forward due to the countless administrative staff who keep an organization functioning on the day-to-day. When possible, a medical software should also simplify the lives of administrative staff by “bubbling up” or highlighting the work that requires attention.
In our product, that means having a meaningful newsfeed on the homepage of patients and referrals that require attention, and having the referrals intelligently routed between offices and staff.
2. Prepare for Trust Issues As Related to Change
So often when we’re implementing new clients, we’re required to challenge current referral workflows that are wrought with workarounds in the EMR or manual steps. Staff who are focused on referrals have often gone to great lengths to make the tools in their toolkit work for them.
Those tools and workarounds have inevitably already cost the organization resources - in time, money, or both. People can have a pride in ownership about learning and adopting the band-aid approach, and informing them they will need to abandon it in order to make room for an overall improvement requires some public relations skills. Staff have sometimes then lost trust in proposed changes - if the previous solution was supposed to work, how can they trust that the proposed solution will, and not be replaced again in X months or years?
1. Discover the ideal workflow from staff & providers and plan for the future
As the saying goes, you don’t know what you don’t know. As hard as it may be, try to encourage staff to think about their “dream state” for a referral workflow, and then apply those ideas to the technologies you are evaluating. Can you reduce clicks? Is there room for process automation? Can your selected vendor meet those goals - if not now, then in the future? What integrations will you need to reach an ideal state?
From there, don’t let perfection be the opponent of progress, and work to come up with a logically-phased implementation.