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Upgrading Healthcare’s IT Systems Without Downgrading Productivity
By Jon Roberts

As the recent HIMSS conference made clear, the money set aside by the Obama administration to boost EHR adoption is attracting the eyes of some very serious businesses. No matter the promise, it is essential to not overlook the challenges we still face implementing IT systems in healthcare. What’s needed is some clear thinking about where HIT is and what we can do to improve how we implement these systems in the future.

The thrust of the government’s effort to encourage IT adoption is aimed at subsidizing the enormous cost associated with purchasing, installing, and maintaining an IT system. The benefits to doing so, however, are still debatable and problems can abound: Timelines for training and go-live are constantly set back, which takes away from other initiatives that have been designed to improve care. Productivity drops, sometimes dramatically. Overtime increases. Seasoned clinicians decide the new system is just the signal they need to retire. Ironing out the kinks of the new system takes years and when that happens, we’re operating roughly at the same levels that we were before we began this endeavor.

Why is this so? What have we learned as an industry about implementations that we can use to improve future efforts? Roughly, the following is what a traditional IT implementation effort looks like:
• system build;
• training; and
• go-live and post–go-live support.

• System build: The major providers of large-scale IT solutions have years of experience helping design and customize systems to meet their clients’ needs. Starting with a basic platform, teams are deployed to understand how different departments will need to have the system “tweaked” to suit them. During this phase, frontline staff members have the opportunity to provide input into system design.

• Training: Assign a few people from each department to become super users. While everyone will get a good deal of off-site classroom training, super users will get extra training so they can be a resource to regular end users after the system is up and running. Training consists of walking through a user manual and learning the various functions of the system as appropriate. Most often, staff will have paid time allotted to practice using the system in an on-site computer lab where there will often be super users and members of the implementation team present to help navigate through problems.

• Go live and post–go-live support: A great deal of effort is put into understanding the order in which different departments should be up and running. Some departments can operate independently and some cannot. That’s pretty complicated. Once each department goes live, we invest an enormous amount of resources to have help available to the end users while they actually use the new system and take care of patients. This is when, as previously stated, productivity drops dramatically and the hidden costs of the new system begin to be realized.

There are problems, however, with the above approach, and to get the most out of IT systems, we need to start thinking differently about implementation and support.

There are three ways in which the above traditional framework can be improved:

1. Redesign the teaching program so the emphasis is about how staff members take care of patients rather than how the technology works. Traditionally, we teach people how to use a new technology by walking them through an exploration of all its functionality. Instead, we should focus on how staff can use the technology to do their job.

2. Have a systematic methodology for addressing problems and engage your staff in the process. Errors are inevitable and staff that do the work everyday will be better prepared to identify and fix them.

3. Allow staff to encounter as many problems as possible before the system goes live, not after. The sooner in the process we test our work and identify errors, the better. An ideal process should have many iterations of system testing, error identification, and resolution before going live.

Hospitals that have used these principles for their implementations have seen improved productivity, fewer errors and complaints, and happier staff compared with hospitals that use traditional implementation methods. Hopefully, for the sake of staff, taxpayers, and most importantly patients, the HIT crowd can learn from this new way of thinking.

— Jon Roberts is a partner at Rule 4 Consulting.