Healthcare Talent Transformation

I'm Your Huckleberry, Mr. President

Kerry Willis, MD, www.aihinc.com

Dear Mr. President,

I love old westerns, and I’m a fan of some of the newer versions as well. One of my favorites is Tombstone and the one scene in particular where a bad guy is looking for a fight, Doc Holliday with his reply provides the answer to his questions. He is letting him know that Doc is the perfect guy to solve his problem. Well Mr. President, here’s a quick note to let you know that “I’m your huckleberry,” and I can help solve some of the problems in healthcare.

From a physician’s standpoint things have gotten very complicated. Most of us entered medicine because we felt we could make a difference in the lives of our patients. Mostly today, I have made a difference in the number of trees killed in the US as I have struggled through the mountain of paperwork that is required by our system. Sadly, I have failed in my attempts to slay the beast of bureaucratic entanglements and have spent far too much of my day signing forms and paperwork that will be repeated again in the future. One of my least favorite things to do is complete diabetic supplies forms. I work really hard to get my patients to take their blood sugar and adjust their regimen as needed. I fail to see any utility to these forms and wonder why they are all different. I’m pretty sure I could design one form that could be used by every doctor and would be glad to provide an electronic version to make signing easy. The standardization of many of the forms the government requires would make my life easier, and if we were really smart, the prescription and the form would be the same thing and wouldn’t that make life grand. You would think studies showing that 25% of a physicians' time is spent doing paperwork would mean something to someone. We could solve a large portion of the healthcare manpower shortage problem by eliminating uncompensated paperwork. I suspect being required to compensate physicians for much of the paperwork required by the government and insurance companies would solve much of the need for these forms.

Similarly much of my time is spent monitoring the business affairs of medicine in my office to be sure we have money to pay bills and meet payroll and such. Recent statistics  that I have seen reflect that as much as $30 is spent to collect the average office visit charge that runs around $75. This includes billing filing and electronic support and transmission charges and posting the charge to the proper account. It’s silly to think that this kind of administrative waste is acceptable. We seriously need to consider different models for primary care that don’t include filing claims.  A system where waste was eliminated would not involve spending a third of the cost of care on getting paid.  But as I said Mr. President, I’m your Huckleberry and I do have a solution. For every government program, let’s allow an option for patients to receive a voucher for their primary care needs and contract for their care with their doctor directly without any government involvement between the two. The patient could be allowed to use the voucher in a medical home setting where quality monitoring is part of the baseline arrangement and becoming an MBA to manage your business isn’t your primary concern.

There are many lessons to be learned from our current mess of a system that we have currently. One is its very complicated and two it doesn’t have to be that way. I fill out credentialing requests every year for the same companies and same agencies that are required to collect the same information required by our government. Perhaps our government should become part of the solution rather than causing the problem. Credentialing is becoming a huge problem. Why not require each state to develop and maintain a credentialing service for each physician in the state who is licensed to practice in that state? I could fill the forms out one time and the folks wanting that information could be allowed to query the state database for the needed assurances that I wasn’t a figment of the imagination. This would result in a uniform quality of credentialing and in fewer burdens on the individual practices. 

I hope Mr. President, that my thoughts have been helpful to you. I have some more ideas on cost savings that would increase the quality of care in medicine as do most of my colleges who don’t see the need of things required by the government just to make it happy and serve to delay care. I fervently believe that the best solutions will come from the ground level...from people working in the field every day. Most of us believe that we are your best “Huckleberry” and only wish we had a way of communicating our thoughts to you.

All the best,

Kerry A Willis MD

Dr. Willis is a practicing family physician in Beaufort, NC, where he founded East Carteret Family Medicine. He currently serves as Chairman and CEO of the largest and oldest self-sustaining physician-led network in NC, The Beacon Company, and Chief Operating Officer of Atlantic Integrated Health (AIH). A true believer in the need for healthcare reform, Dr. Willis believes that the best solutions will be community-based and provider-directed and are aimed at improving the affordability and accessibility of medical care by reforming the healthcare delivery. The need to consider new models that are patient-centered and eliminate many of the moving parts that cause waste are the driving goal for Dr. Willis and his organization. 

The Evolving Provider - The Other Side

Jonena Relth,
TBD Consulting

When I sat down to write about this month's topic, "The Evolving Provider," I must admit that I felt some empathy for my physician friends because of all the changes that are happening around them.  Let's be honest:  CHANGE SUCKS, especially for us 'ol cronies!  Not only are they expected to diagnose and treat their patients, now they are expected to manage their practices in a whole new way with computers and Lean/Six Sigma processes.  Their chosen career to heal people is now embroiled in an environment which is pressured by government bureaucrats, IT gurus and business, OD and training consultants telling them how they should do their job.  And for all of this, physician incomes are decreasing and their medical malpractice insurance is skyrocketing.  It's not a surprise that so many talented men and women are hanging up their white coats and retiring or becoming consultants!

We all know the "fortunate" docs that have been able to continue practicing medicine and fulfilling their life's dream.  These are folks that, for one reason or another, can go with the flow, adapt to the changes and/or simply stay out of the fray.  They are comfortable with change and working in and around change.  They will continue to thrive in the changing medical arena.

But what concerns me are three groups of docs:

1. The single practitioners who have merged their practices into the big clinics so they could still afford to practice medicine...those who:
   
   • Couldn't afford to implement EHRs and the other government mandates without going broke, or
   • Didn't have the computer or technology skills to manage the system implementation, MU, ICD-10, etc.
   • Refused to work a 50-hour week practicing medicine and give another 30+ hours to manage all the changes necessary for their practice's EHR implementation
2. The talented specialists who have given up treating patients because of all the red tape and have chosen to be consultants.  Don't get me wrong, I'm a consultant and have no problem with consultants!
   
   • We need those people with years of experience treating patients and mentoring younger docs.
3. The dedicated family practitioners who couldn't make enough money to justify the sacrifices of long hours away from their families and the OBGYNs that stopped practicing because it was made more sense financially to quit medicine than to continue paying their malpractice insurance premiums.

I've had some good and not-so-good physicians treat me over my lifetime, but overall, I've been very lucky to get good care.  But as I look back and realize that the majority of my primary docs have moved on, some retired and some just into new professions, I'd like to say:

"Thank you for helping me or my children when we needed a kind word or medicine in the middle of the night or on a holiday.  Thank you for holding your laughter and smirk when I asked a stupid question you just heard from other patients for the umpteenth time! Thanks for showing up for work even when you didn't feel like it.  That was the day I needed you the most!"

Jonena

TBD Consulting has a proven track record for ensuring staff and physician adoption of EMR/EHR system implementations. Whether you need assistance to create a training department, help your existing training organization meet the needs of the ongoing changes, or simply need "extra hands" to meet your deadlines or ROI goals, please contact Jonena Relth. She and her qualified staff are here to assist you with your organizational development, coaching and training initiatives.

Corporate Office 602-263-1961. Email Jonena today!

So, Who is Easier to get On-board with EMR Training and Use?

Jonena Relth, TBD Consulting

Historically, we've found the younger docs more inclined to jump on the EMR bandwagon. It's been our experience that the younger docs are more computer literate and were exposed to computer-based training and research in school, making their transition to EMR easier.

However, we've also seen a trend of older docs as champions of EMR. When that happens, getting everyone trained is easier because their leadership presence adds credibility to the use of the tool. It's also more fun to sit back and watch this phenomena.

Years ago, we started out developing mostly instructor-led training (ILT) because that was the training culture in the hospital systems. We found it very difficult to get all the physicians through the training for various reasons: time, convenience, egos, etc.

More recently, we've found that by creating task-driven WBTs customized for the different user groups, our training is better "attended" and the users get up to speed on the EMRs much quicker. Each person is only required to take the modules that are applicable to their workflows, and they can take the training when it is convenient for them.

And honestly, the feedback on the training has been much better with the WBTs than ILTs, so why do so many organizations continue with training in the same instructor-led, death by PowerPoint?  It's time for learning officers to encourage 21st Century learning, and yep, that might also include social networking and mobile technologies, too!

Comments anyone?  What has been your experience?

Jonena

What Can Healthcare Learn from the Business World?

Posted by: Jonena Relth, TBD Consulting

I've watched this discussion on the Healthcare Executives Network group in LinkedIn with much interest. While there has been lively debate, the one piece of the puzzle I haven't heard mentioned is that of patients now demanding that their healthcare be more cost effective.  Medicine has the issue of unwarranted costs due to our legal system being what it is. Businesses have learned, with the help of thousands of in-house attorneys, that they need to closely watch their processes, products, services, safety, etc., or they get sued for unintended injuries.

Physicians have the added issue that every time they enter data into their EMR/EHR or they treat a patient, their every decision is now being scrutinized to see if "the doc did everything by the book"--whatever that means in a profession that needs physicians to think out of the box all day, every day.  Sure physicians make mistakes, but our legal system of "sue first and see what we can get" is way out of line.  Docs aren't all millionaires who are able to pay huge malpractice premiums.  If they were, we wouldn't have a shortage of high-risk specialties like OBGYN.

Patients want quality care, but they also are well aware of inefficient business practices within the profession that are contributing to the high costs. All areas of the healthcare compendium (providers, insurance, etc.) should be able to make a profit for their goods and services, but I think everyone would agree that there has been culpability on all ends.  It's been suggested many times that if we limit the amount docs can be sued for malpractice, we could at least eliminate MANY unwarranted tests from the coffers.  If docs can stop worrying about being sued, they will spend more time treating their patients and less time covering their legal... 

This is just one tiny tip of the medical cost iceberg, but if we start here, it would begin to fix some "broken" processes within healthcare, thus starting the "lean" journey of many businesses.

Jonena

How Should Physicians Best Prepare for the Future

Posted by: Dr. David Scher, DLS Healthcare Consulting

The next two to three years the healthcare system in this country will see the most drastic changes since managed care made its impact felt over ten years ago. The percentage of physicians that are now hospital employees is greater than those in private practice. 

http://well.blogs.nytimes.com/2011/04/14/what-big-medicine-means-for-doctors-and-patients/?scp=7&sq=medicine&st=cse

Older physicians in small private practices are finding it hard to sell their practices. The movement of physicians is due to multiple factors.  The increased overhead of practice, decreasing reimbursement for specialists, increased reimbursement to hospitals for some procedures, and frustration of regulatory requirements.

So what does the future look like?

Physicians will be seeing less patients and likely become administrators unless they are performing invasive or surgical procedures. Routine caregivers will be physician assistants and nurse practitioners.  Computer-assisted diagnosis will lead to practice guidelines from which the diagnostic and therapeutic course will proceed.  Hopefully, with enough human interaction and input, those exceptions to ‘the rule’ will be best treated.

The fee for service payment system will disappear.  This payment model rewards increased number of procedures and the treatment of disease rather than preventative measures and wellness initiatives. It will be replaced with a system of ACOs or accountable care organizations which will cover many thousands of lives each. It will be an association of providers and hospitals that will share in the financial savings or losses of treating the individual patient’s diagnosis. It will be all-inclusive of diagnostic tests, procedures, medications, post hospital care, and all provider services. This sounds good at first, but savings will likely not be seen for the first few years, according to experts. Physicians are hesitant and healthily skeptical about ACOs and present the biggest resistance to them at this time. ACOs may result in cheaper prices of purchased drugs and devices because of their large sizes.

There are many ways for physicians to prepare for these changes.  Physicians in private practice need to take a more active role in practice management.  This will keep their ear to the ground regarding changes in the local marketplace.  Make yourself aware of what your local hospitals are doing even if they don’t volunteer the information. Electronic records are an increasingly important aspect of practice now.  If you are thinking of becoming hospital-owned in the near future and do not have a system, do not invest in one now.  You will not get an ROI on it and may actually lead to problems with integrating it with the hospital’s system.  If you already have one, make sure you are participating in the government’s Meaningful Use incentive program. If you are negotiating with a hospital, there are issues with physician employee contracts that are important. Restrictive covenant, benefits, and scope of practice are the usual issues of any contract.  However, governance, incentive-based practice issues, any conflict of interest regarding other contract with the hospital (ex. A pulmonologist also hired as an intensivist) should be addressed. Hire a healthcare contract attorney. 

Dr. David Scher was a practicing cardiac electrophysiologist for 20 years with extensive experience as a clinical investigator, reimbursement committee member, and institutional review board chair.  He is currently director at DLS HEALTHCARE CONSULTING, LLC with a focus on medical device and mobile health companies. You can reach Dr. Scher at dlschermd@gmail.com or on Twitter at dlschermd.

Buyer Beware: Validate the Data You Use to Make e-Prescribing Decisions

Posted by: Jonena Relth, President and Leadership Evangelist, TBD Consulting

I'm feeling feisty these days. Guess it's because spring is in the air, or maybe it's because of the absolute dribble being published about healthcare IT these days!  Everyone is trying to stake their spot in the experts' arena on every aspect of EMR and the surrounding technology.  So...read at your own risk!

For those of you who know me, I'm a huge fan of social media and participatory medicine.  Knowledge is power.  I believe in the power we have at our fingertips with the Internet. But our healthcare profession is not policing the so called "experts" publishing studies that are totally out of the realm of scientific relevance.  With something as important as e-prescribing, how could such a small sampling be used to publish data? Case in point is an article posted this month by Modern Healthcare.

Study outlines docs' eRx barriers

By Joseph Conn

"Clunky data-management tools and the juice not being worth the squeeze in obtaining information were cited as the two main barriers to the use of electronic prescribing systems in a Center for Studying Health System Change study of 24 physician medical-group practices.

The research, funded by the Agency for Healthcare Research and Quality, found that physicians in most of the survey group's medical practices had access to patient formulary information, but just slightly more than half could access patient medication histories using their e-prescribing systems. The researchers found that many physicians "did not routinely review these sources of information when making prescribing decisions."

Respondents cited two key barriers to use of e-prescribing systems, according to the report: cumbersome tools to view and import data into patient records, and data "not always perceived as useful enough to warrant the additional time to access and review them, particularly during time-pressed patient visits."

According to Joy Grossman, principal investigator and senior health researcher at the Washington-based not-for-profit center and lead author of the report, "Physician Practices, E-Prescribing and Accessing Information to Improve Prescribing Decisions," the study relied on 114 interviews conducted in 2010. Survey subjects included representatives of 24 physician practices, 48 community pharmacies and three mail-order pharmacies actively transmitting and receiving prescriptions via an electronic prescribing network, Grossman said."...

And forgive me, but, DUH!  Take a look at their conclusions... I'm guessing that each and every one of my readers would know this without having to spend research dollars!

"Not surprisingly, physicians in practices with greater access to complete and accurate data and those with easier-to-use e-prescribing systems were more likely to use these features consistently, she and fellow researchers concluded."

Buyer Beware:

As meaningful use becomes a reality with e-prescribing, may we all be diligent in the data we trust to help us choose the right vendor with the right e-Rx technology.  Remember that the ONC requires as a condition of certification for meaningful use that EHR technology be capable of generating and transmitting electronic prescriptions. However, the certification does not require that EHR technology also be capable of performing electronic prior authorization.  This will be a huge issue when interoperability is considered.  To my knowledge, and I'm not an expert on this for sure, I don't believe there is a universal electronic format to facilitate distribution authorization forms.  According to the article:

"The standards development organization, the Scottsdale, Ariz.,-based National Council for Prescription Drug Programs, is working on an XML-based prior-authorization messaging standard and a real-time eligibility check messaging standard, Fridsma and Posnak wrote, but these are draft standards that have not yet been tested."

So, the lesson of the day is that we all need to be diligent in where we spend our money and whose reports we accept because they need to be relevant, accurate and add value to our healthcare system.

Without standards, I question how we choose the right technology that is going to allow practices to participate in the incentive programs under Medicare and Medicaid.  This is a complex healthcare IT issue. We need to get this right and it's going to take a lot more user analysis than what was collected from the small study above.

 

Read the entire article.

Read the report. 

Part 2: Measuring What Works

Posted by: Peggy Salvatore, www.healthsystemed.com

Question of the Day: Do You Really Need Fully Implemented and Integrated Electronic Patient Records? 

Answer: Only If You Want To Get Paid.

As we continue to chew on the issue of what healthcare payers should pay for, the payees are starting to get a little nervous about survival under these rigorous conditions. Some have become creative in their approach to getting paid.

Personalized medicine: Instead of waiting for outcomes, providers using some biologics will know in advance if something works. Using genetic testing – at $200 to $5,000 a pop – providers will know if the drug under consideration will work in the patient in front of them. At the cost of genetic testing, the math only works if the drug in question costs at least 10 or 20 times as much as the test. But it is starting to be done, as labs are coming up with assays that can determine which genetic markers indicate susceptibility to a treatment. At this time, about 5% of employers are paying for this kind of advanced knowledge.*

Performance Rebates: Some drug companies give a money-back guarantee. In essence, they are saying, “Our drug works, we promise. Either the blood pressure numbers go down or you get money back.” This practice is not widespread, but one or two big players are trying it in some high-cost, high-utilization therapeutic areas to move product. 

These are all steps along the road to paying for what works as the private sector tries to find gentler ways on this very rocky path. Because under health reform, payment is dependent on outcomes. Payers (ie, Medicare ACOs at first) will hold back a portion of provider payments in a “shared savings account” and will review measures with the “savings” to be “shared” as additional payments with the ACOs depending on their results.

How does this affect pharma, medical device companies, surgeons and anything or anyone else that gets measured in this process? Your product or service needs to have proven superior outcomes (trials and procedures that include lots of patients, lots of times) and have a value proposition that holds up under Comparative Effectiveness Research that tracks how well one drug, treatment, surgery fares against another in this cost/benefit scheme.

Not saying that this is necessarily a bad idea. In a perfect universe, it sounds like a reasonably fair way to apportion finite resources among the hundreds of millions of patients and their unlimited needs. But the 800 pound gorilla in the corner is collecting all this information in a uniform way that is usable, asking all the right questions in the right way and having a dispassionate third party crunching the numbers correctly. Then, depending on the results of the data analyses, buying the most cost-effective goods and services, and paying providers according to their patient outcomes.

If I’m selling drugs, I’ve got my fingers crossed that the data swings my way in those head-to-head comparisons. If I am a health network, I’m hoping I’ve had fewer readmissions than almost everyone else, so I’m on the better side of the bell curve when they distribute the “shared savings”.

To very roughly paraphrase one participant at that NYC confab on the future of  pharmaceutical payments last week, he just wasn’t sure we had the ability to collect the information we need, or to know exactly what to collect, or how to collect it – yet.

When you get down to it, it’s all about the data. Only if you want to get paid.

*Pharmacy Benefit Management Institute, 2010-2011 Prescription Drug Benefit Cost and Plan Design Report.

Related Posts:

Part 1: Measuring What Works

Health IT Beyond Blogging

Posted by: Peggy Salvatore

Our host here at Healthcare Talent Transformation, Jonena Relth, has given me a platform for the past year and a half to talk about my passion – healthcare. We have chosen to restrict my conversations to the future of electronic patient records and its effect on the healthcare industry. Personally and professionally, I am in a season of reflection and change. That means that this will be my last blog here – at least for the foreseeable future within my line of sight.

Before I reflect on how far electronic patient records have come since I started guest blogging for TBD Consulting in July 2009, let me thank Jonena for this platform and opportunity to flesh out some thoughts on this topic. For those of you who know her, you know what an outstanding lady that she is.  So, Jo, thank you. It’s an honor to be among the bloggers that inhabit this column.

Now, for the long view. As I look at the trajectory of health IT, the timing on this transition is perfect. My interest in the future of health information technology really dates back to 15 years in health policy, including several years doing research on the privacy of electronic patient records for the pharmaceutical industry after the passage of HIPAA and then research into the effects of a potential Y2K meltdown on the delivery of drugs to patients. Around that same time, I briefly worked for Intel to summarize the analysis of some workflow issues in the very early days of dissecting physician productivity as it is affected by technology.

In the context of HIPAA and Y2K, I had the great fortune of working for consultants to the top of the industry, looking at the critical importance of IT and how gathering accurate patient data would make healthcare better, cheaper, and more efficient. From my perch, most of the relevant discussions around these issues began in the mid-1990’s. It was just a matter of time until healthcare on the ground and at the bedside caught up to the academics and think tanks. We’re there.

Since President Bush appointed a health IT czar in 2006, the push has been on in earnest to move the discussions and plans out into the real world. And since the passage of the stimulus bill in April 2009, the momentum has been flash forward. Even since I began guest blogging in this space, much of what’s been pondered has come to pass. As a sign of the times, one of the most vocal and public critics of the health IT rollout plan for meaningful use, head of MGMA, Dr. William Jesse, is now on board and leading the push with our current health IT czar, Dr. David Blumenthal. And Blumenthal, perhaps as an indication  that we have reached a new plateau in the uptake of electronic health records, announced that he’ll be heading back to Harvard to do what high-level ex-government officials do – continue to impart the values and agenda of DC decision makers to the nascent elite in that rarified Massachusetts air.

Let’s look at where we’ve been recently. In just the last 12 months, we have achieved certification of software, standardization of processes and coding, cross-discipline education pulling together IT professionals, medical professionals, and training experts, and the establishment of best practices for all aspects of development and deployment. It’s happening in a big way, and what used to seem like insurmountable hurdles are now just issues to be addressed.

One of the keys to success is that the federal government has managed to de-link electronic patient record laws and payments from health reform, so when health reform hits snags, it won’t trip up progress on health IT. As I’ve preached from this pulpit before, real savings, efficiency and quality will be the result of the benefits of electronic patient records, done well and thoroughly, with patient safety and clinical excellence as its guiding lights. Health reform involves politics (ie access) and payments, unlike health IT which involves quality and cost.

We’ve come so far, so fast, because so many have gone before and the dirt roads were already pioneered. The healthcare infrastructure of the future – the electronic patient record superhighway – is being built quickly and with only a few minor modifications to adjust to the realities of the road. A truly modern and efficient system is underway. Health IT has everything to do with good patient care, and it will rise or fall by respecting the privacy and individuality of the patients whose care is at the core of the mission.

The future track is inevitable because the cloud is the modern platform for information and communication, and the integration of technology into the fabric of human life naturally translates into the integration of technology into the fabric of the way we provide patient care.  Recently, Jonena and I were talking about how health IT best integrates into provider settings, and agreed that electronic patient records will work best when they evolve out of the environment in which they occur – their greatest value will emerge organically when health IT vendors and users view information within the context of healthcare holistically. And that is why she is such a big fan of process mapping a project when she meets with a customer.

Technology in service to humanity; not humanity in service to technology. And all should be well.
Again, thank you, Jonena, for allowing me to be part of your blogging family and thank you, dear readers, for your time. Please continue to reach out to me at peggy.salvatore@gmail.com. I expect to continue to work and write on my great passion in new ways. And to return to this space occasionally, as Jonena’s schedule and mine permit.

Always a pleasure. Onward!

Dear Readers,

We will miss the wisdom and insights of Peggy Salvator's blogs.  She has been an integral part of our TBD blogging family and we hope her schedule will allow her to contribute her wit and knowledge on occasion.  Please join me in thanking Peggy by staying in touch and following her career. She's an awesome lady with a passion for healthcare IT that is going to take her far!   Jonena Relth

Training Can Smooth the Way for Your EMR Implementation and Adoption - Part 2

Posted by: Jonena L. Relth, TBD Consulting President and Leadership Evangelist and Esther Groves, TBD Consulting Senior Consultant

Continued primer on what healthcare organizations should do to ensure that the critical components of their training and development process is firmly rooted in reality and will propel the organization toward successful electronic medical record (EMR) implementation and adoption.

We started this conversation in an earlier blog.  For those just checking in, here's Part 1.

Here are some top-of-mind details for what is needed to ensure successful EMR Implementation communication, organization analysis, audience analysis, training capability analysis, training design/development and evaluation.

So far we've introduced the following topics that needed to be addressed to ensure EMR training iniative:

• Scenarios that descripe your healthcare organization
• An honest appraisal of the organization’s readiness (or not!) to embrace technology and change. 
• Executive support
• Training and communication timing
• Benefit: ROI

As we stated in Part 1, the stakes are high when a new EMR system is underway.  Patient care and safety hang in the balance.  Our EMR users need to do their jobs well and their jobs now demand competency using our EMR.  So now, let's look a the details on what is needed to ensure successful EMR Implementation communication, organization analysis, audience analysis and training capability analysis, training design/development and evaluation. Today, we'll start with a:

High-quality training plan that includes an overarching communication plan along with these key success components:

1. Organization analysis
2. Audience analysis
3. Training capability analysis
4. Training solutions
5. Training design and development
6. Roll-out
7. Evaluation

Today we'll address the first four bullets and will finish up later in the week with the last three bullets in Part 3.

1. Organization Analysis
One size DOES NOT fit all! It seems trite to say that every organization is different.  And yet, one-size-fits-all solutions may appear attractive at first, so this bears mentioning.

A qualified training professional will take a high-level look at the organization, talk to executives, managers, IT, subject matter experts and end-users to get a feel for the organization as a whole.

• Is this a tech-savvy organization?
• Is there general reluctance among the population to embrace technology?
• Is there strong exec/manager/supervisor support for system training and development?
• Is the organization receptive to change or is change viewed as scary and threatening?

The above factors will affect not only the content of the training but its overall success.

2. Audience Analysis
End-users come with their own unique attitudes, skills and knowledge.  A high-impact training and communication strategy will take into account all three.

The first step is to look at each individual role: 
What EMR tasks does a person perform in this role and what is the DIFT rating for each?  What is the level of Difficulty of the task?  How Important is it?  How Frequently is it performed?  How much Time does it take to complete?  Using the DIFT model will help to prioritize tasks from most to least critical and guide the training methodology to best teach the task.

Next, what are the expectations, limitations and constraints with regard to training for individuals in each role?

• What do they already know?
• What is their availability for training?
• How receptive are they to training?
• What is their comfort level with different types of training (web-based training, instructor-led classroom, and virtual, hands-on simulation)?
• What unique training needs do they have?
• What is their comfort level with technology?
• What is required to maintain their self-esteem?

This will inform the training plan, described later.

3. Training Capability Analysis
When it comes to training delivery, critical components need to be considered:

• Facilities – Are there classrooms?  What size? How convenient are they to the users?
• Equipment – Do the facilities have computers?  Projectors?  Support equipment for hands-on simulation practice?
• Trainers – Do trainers have the facilitation skills to address a variety of audiences with different skills, needs and receptivity to training?  Are trainers enthusiastic about the training and do they have the support they need?
• Learning Management System (LMS) – Is there one available?  How sophisticated is it?  Can it deliver web-based training modules and track participant completion?
• EMR Training Domain – Is it separate from the mainstream? Is there a test system to use for training?

4. Training Solutions
With the help of the data collected in the first three steps, the training design begins. The training component of the intervention includes the development of blended learning solutions that take into account people, process and technology:

• People: How work will be carried out by individuals in roles within a department.
• Process: How work should be done with a clear vision of the future state, integrating the changes and improvements to workflows (i.e., “Practice to a Standard”).
• Technology: Use of technologies and enabling people to use the solution effectively.

Please drop by in two days and we'll finish up this primer for making sure we design the right kind of training, roll it out properly to everyone who needs it and then the particulars for conducting an after-action review to find out:

• what went well,
• what could have gone better, and to
• make positive steps to improving the process for the next time.

Related post:
Training Can Smooth the Way for EMR Implementation and Adoption Part 1

Training Can Smooth the Way for EMR Implementation and Adoption Part 3

TBD partners with our clients to create organizational development solutions that drive bottom-line results.  We focus on improving performance management, employee engagement and process effectiveness.  Click here to request information or call our office to discuss your EMR learning needs today.   You'll be glad you did!  602-263-1961

Training Can Smooth the Way for Your EMR Implementation and Adoption - Part One

 

Posted by: Jonena L. Relth, TBD Consulting President and Leadership Evangelist and Esther Groves, TBD Consulting Senior Consultant

As we look at the new year anticipating MANY EMR implementations, I thought it would be good to do a bit of a primer on what healthcare organizations should do to ensure that the critical components of our training and development process are firmly rooted in reality and will propel our organization toward successful electronic medical record (EMR) implementation and adoption.

Does one of these scenarios describe your healthcare organization?

• Young teaching hospital with tech-savvy interns
• Mature practice with ready-to-retire physicians
• Computer literate and open to change
• Still in manual mode, resistant to new technology
• Combination of the above

Any successful EMR implementation must start with an honest appraisal of the organization’s readiness (or not!) to embrace technology and change.  Decision-makers must:

 

• Realistically assess end-users for their attitude, skill and knowledge (A.S.K.),
• Prepare the organization for change,
• Provide targeted training and
• Support the implementation through every milestone and celebrate success.

 

Not new news, but we often fall short here... First and foremost, to ensure employee engagement throughout the process, executive buy-in and support for all aspects of the training must be visible and present from the earliest planning stages to beyond roll-out. This is not just a “nice to have.”  Gallup studies based on thousands of employees from hundreds of organizations have shown there is a direct and positive correlation between employee engagement and profitability.1

Executive support comes in the form of:

• Adoption and oversight of a solid change management plan that includes training
• High-level communication of upcoming changes and WIIFMs (what’s in it for me) for the organization and each user group
• Ongoing communication and support for the process at each step
• Problem resolution at a high level as needed

Training and communication cannot be an afterthought written after plans are made and the system is built.  Failure to recognize this will result in frustration, finger-pointing, re-work, and squandered resources. On the other hand, successful training and communication can pave the way to improved patient care, reduced errors, and a healthy ROI for the entire implementation.
1. John Fleming, PhD & Jim Asplund, Human Sigma, 2007.

And of course, to make sure we get what we pay for (Positive Return On our training Investment): we need a high-quality training plan that  includes an overarching communication plan along with these key components:

1. Organization analysis
2. Audience analysis
3. Training capability analysis
4. Training design and development
5. Evaluation

Hopefully we've got your brain cells alerted to the fact that an effective EMR implementation requires more than just IT. Well thought-out training should be an intregal part of EMR implementation from the inception of the project.  Without it, is like installing one traffic light in Kathmandu, Nepal and expecting the drivers to slow down for the yellow lights and stop for the red lights without being told what a traffic light it, why it was installed, and what the lights are telling them what to do. (Actual example - I've been there...)

The stakes are high when a new EMR system is underway.  Patient care and safety hang in the balance.  Our EMR users need to do their jobs well and their jobs now demand competency using our EMR.

Details on what is needed to ensure successful EMR Implementation communication, organization analysis, audience analysis, training capability analysis, training design and development and evaluation will be explained in Part Two.

Related Posts:

Training Can Smooth the Way for EMR Implementation and Adoption Part 2

Training Can Smooth the Way for EMR Implementation and Adoption Part 3