About a year ago, we were helping an academic medical center on the East Coast with clinical documentation improvement, department-by-department. Our experience with the neonatal intensive care unit (NICU) sheds light on what it takes to have a successful health IT go-live event.
"Emotionally-sensitive" can be used to describe any inpatient department, but the NICU probably tops the list of high stress and emotionally draining environments. And it takes very special clinicians to serve the infants in the NICU and their families. The last thing a clinician in the NICU needs is one more thing to worry about.
So as we stepped into the NICU, we introduced ourselves and explained how one of our team members was a NICU nurse who still practiced in that department (the IT support work was part-time for her). The energy in the room shifted, and there was a palpable sense of relief from all of the clinicians.
At this point, most physicians have likely lived through an EHR or other health IT go-live event. For some, the experience was probably just okay. The physicians documented what they felt was important and they got through their day. However, over the past few years, we've spoken to hundreds of physicians who've had negative experiences and maintained negative impressions of the IT systems long after go-live.
As hospitals, health systems, and medical groups get ready to go-live, there's one way IT leaders can help alleviate physician anxiety and almost guarantee a smoother go-live experience for all involved: Have clinician consultants on hand to give immediate, one-on-one support.
Use our Clinical Go-Live Support Planning Tool
Physicians and nurses address clinical issues at go-live
Anyone with an appreciation for the complexity of health care will agree that clinicians' concerns around an EHR go-live are real and should be taken seriously. So it's important to get clinicians involved in pre-planning and implementation. However, in situations where physicians and nurses don't have the right level of involvement in the planning of the system or are inadequately trained, that lack of preparation will be highly visible during go-live. And that's when any health system or hospital will receive strong pushback from their physicians.
In 2012, our team was called in to support an EHR go-live at an especially busy urgent care center in Florida. This center had tried going-live once before, but it didn't go over so well with the physicians. At the time, the EHR vendor didn't have content specific to urgent care, and the technical resources supporting the go-live advised providers to just use Family Practice content.
For physicians, having content that isn't specific to their specialty is like cooking with an incomplete recipe. The full list of ingredients might be included, but the amounts for each ingredient and the cooking instructions aren't. For these urgent care providers, using family practice content would have been like cooking with a recipe full of optional ingredients; family practitioners cover much more in a visit than urgent care providers.
We helped by having our clinical team tailor content specific to urgent care. But most importantly, when the urgent care providers saw we had a full clinical staff that included a former ER nurse, they immediately relaxed. One even said, "Thank goodness, someone who knows what we do!"
'At-the-elbow' support brings even more value for a better ROI
Having people who understand both clinical care and the technical environment reduces physician apprehension about an IT go-live, which in and of itself is valuable. Having those resources actually in the practice or facility, working side-by-side with the physicians during go-live brings even more value— and increases the speed and breadth of adoption, which sets up the organization to more quickly realize the return on their technology investment.
One of our clients has a large employed medical group, and we are working to optimize its ambulatory EHR. At the beginning of the engagement, we used the reporting tools available in the EHR to evaluate which physicians were spending the most time documenting. Using that information, we were able to prioritize where to send our team of physicians and nurses to observe how they used the system.
Because our clinical team understood the physicians' workflows, they could give in-the-moment suggestions on minor changes to make better use of the EHR—and the physicians welcomed it! Traditional go-live support answers the question "How do I do this?" A clinically-oriented approach answers the question "What's the best way to do this?" and facilitates an enhanced level of physician adoption. After just one round of this, the average time spent in the EHR by these physicians was reduced by about five minutes per patient. That's giving them more than an hour back in their day.
Although we did this work well after the client's go-live, providing this type of clinical support "hardens" the right behaviors and keeps the providers efficient and happier.
More than a 'non-event'
Health system, hospital, and medical group executives spend a large portion of their time and effort working directly with or for their organization's physicians. The relationship is critical, and physicians are not shy about sharing poor go-live experiences with their executive team. Good feedback from an executive team after a major go-live is, "From our point of view, it was a non-event." Great feedback comes later when clinician adherence is visibly stronger, thanks to intentionally supplementing the go-live team with the right clinical support.
The tool you need to prioritize clinician support for a smoother EHR go-live
Having clinicians on-site to work one-on-one with physicians can make or break a successful go-live. IT leaders should factor in the clinical resources that will be needed to supplement their internal technical teams and the technical support provided by the EHR vendor.
Our Clinical Go-Live Support Planning Tool takes into account the appropriate provider-to-provider ratio required to support an EHR go-live and calculates the clinical support that will be needed for every practice during each wave of your go-live.
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