A Prescription for Achieving Long-Term EMR Adoption
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A Prescription for Achieving Long-Term EMR Adoption

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Dr. Haugen presents how the economic, political and social pressures on the healthcare will inevitably change the shape of this industry. Topics include how the HITECH Act provides us with an ...

Dr. Haugen presents how the economic, political and social pressures on the healthcare will inevitably change the shape of this industry. Topics include how the HITECH Act provides us with an opportunity, but requires significant changes in how we implement Electronic Medical Records (EMR) to ensure the transformation results in increased healthcare quality, error prevention, reduced healthcare costs and increased efficiency. The terms implementation and adoption are often used interchangeably, but the outcomes from them are very different. Moving from an EMR implementation focus to an EMR adoption focus requires a significant overhaul in how we think, how we lead, and how we behave.

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  • Now let’s dive a deeper in the real difference in how we approach these challenges…

A Prescription for Achieving Long-Term EMR Adoption A Prescription for Achieving Long-Term EMR Adoption Presentation Transcript

  • A Prescription for Achieving Long-Term EMR Adoption Heather Haugen PhD November 4, 2011 Corporate VP Research, The Breakaway Group Instructor & HIT Co-director, University of Colorado Your Logo Here; remove border San Luis Valley Health Information Technology Symposium, November 4, 2011
  • San Luis Valley AHEC Legal NoticeThe material in this tutorial is copyrighted as indicated in each slide footer and anyreferences made by the author.Companies and individuals may only use this material in accordance with copyrightsexpressly stated. Contact the speaker directly for further informationNeither the Author nor the Presenter is an attorney and nothing in this presentationis intended to be nor should be construed as legal advice or opinion. If you need legaladvice or legal opinion, please contact an attorney.The information presented herein represents the Author’s personal opinion andcurrent understanding of the issues involved. The Author, the Presenter and the SanLuis Valley AHEC do not assume any responsibility or liability for damages arising outof any reliance on or use of this information.NO WARRANTIES, EXPRESS OR IMPLIED. USE AT YOUR OWN RISK. 2
  • What is the single most significant barrier to end-user adoption in your organization? Lack of resources Prohibitive expense Applications are not intuitive IT owns the project Inadequate training Competing priorities 3
  • “There is no more delicate matter to take in hand, nor more dangerousto conduct, nor more doubtful in its success, than to set up as a leader in the introduction of changes. For he who innovates will have for enemies all those who are well off under the existing order of things, and only lukewarm supporters in those who might be better off under the new.” ~Niccolo Machiavelli 1532 4
  • Physician Adoption Research• Background – Recognized physician adoption as significant challenge to adoption of EMRs – Less than 17% of physician practice groups have adopted today (DesRoches). Approximately 1.5% of hospitals have comprehensive EHR (HIMSS Analytics, 2009) – Current literature doesn’t differentiate between installed system and a system being used for clinical benefit.• Research – Interviewed physician leaders representing 3575 physicians and 496 ambulatory sites – Our objective was to identify the barriers to adoption and develop strategies to overcome them 5
  • Physician Adoption ResearchConclusions 1. Implementation is not adoption. The implementation of an EMR is only a milestone on the journey toward full adoption. 2. Physician adoption is highly dependent on having engaged leaders. 3. Traditional training methods are ineffective for achieving proficient users. 4. Most organizations are not tracking meaningful metrics. 5. Sustainment of EMR adoption requires significant resources and must be maintained for the life of the application. 6
  • The Promise of an Electronic Medical Record “Has the potential to transform healthcare by providing clinicians access to comprehensive medical information that is secure, standardized and shared.” 7
  • Our Current Reality…• Fewer than 2% of hospitals believe they can meet the meaningful use criteria today (Jha, 2010) 8
  • EMR Implementation: Hospitals• Survey of 3049 hospitals (63% of acute hospitals)• 2% had comprehensive EMR, 11% had basic EMR• 17% implemented CPOE• 75% lab and radiology reporting• More likely to have EMR if: large institution, major teaching institution, part of large hospital system, urban area• No correlation with ownership status- public versus private• Barriers: 74% capital, 36% lack HIT resources• Facilitators: 82% additional reimbursement from EMR Jha et al., Use of Electronic Health Records in U.S. Hospitals, NEJM, 2009. 9
  • EMR Implementation: Physician Practices Practice Size Adoption• Smaller practices lag larger practices• Significant increase in adoption in last All U.S. practices 40.4% 3 years Solo practices 30.8%• 60% of hospital and health system 2 physician practice 41.6% owned practices use EMR, 40% of 3-5 physician practice 51% independents use EMR. 6-10 physician practice 63%• Specialties leading the pack: dialysis, pathology, nuclear medicine. 11-25 physician practice 71.6% Laggards: psychiatry and holistic medicine. 26+ physician practice 75.5% SK&A, Bi-Annual Survey, Physician Office Usage of Electronic Healthcare Records Software, Oct 2010 10
  • What Is Causing The Gap Between the Promise and Reality…“The difference between the promise and our real- world experiences is borne in the assumption that implementing an EMR and adopting an EMR are the same objective.” 11
  • Consider the marriage not just the wedding!Consider the marriage, not just the wedding! 12
  • Implementation Versus Adoption Implementation Adoption Emphasis Go-live (Event) Outcomes (Process) Ownership Technical / IT Clinical / Executive Success Criteria Technological Integrity Role-based Performance Management Focus Project Milestones & Cost Quality Of Care Workflow Expectations Repair Redesign Clinical Involvement Negligible – Short Term Critical – Long Term End User Attitude Apathetic Or Prejudiced Adaptable Metrics Project Milestones Outcomes Training Design Demonstrate Feature Role-based Simulation, & Function Task CompletionSustainment Post Go-live Left To Chance Primary Management Focus 13
  • Peter Senge: Systems Thinking Archetypes: Limits to Growth Fixes that Fail 14
  • Understanding The System 15
  • Physician Adoption ResearchConclusions 1. Implementation is not adoption. The implementation of an EMR is only a milestone on the journey toward full adoption. 2. Physician adoption is highly dependent on having engaged leaders. 3. Traditional training methods are ineffective for achieving proficient users. 4. Most organizations are not tracking meaningful metrics. 5. Sustainment of EMR adoption requires significant resources and must be maintained for the life of the application. 16
  • Having Engaged Leaders is Unconditional• Tone at the top• Governance• Importance of clinician leaders• Staying engaged for the life of the application A “reinforcing” system 17
  • Physician Adoption ResearchConclusions 1. Implementation is not adoption. The implementation of an EMR is only a milestone on the journey toward full adoption. 2. Physician adoption is highly dependent on having engaged leaders. 3. Traditional training methods are ineffective for achieving proficient users. 4. Most organizations are not tracking meaningful metrics. 5. Sustainment of EMR adoption requires significant resources and must be maintained for the life of the application. 18
  • Revolutionize “Training” 19
  • Focus on Proficiency Not TrainingTraining: Proficiency:• One time event • Accumulation of experience• Classroom/Scheduled • In work environment• Scheduled • Anytime/anywhere• Goal: mastery • Goal: fluency• Generic content • Role-based content, 80/20 rule 20
  • Precise and Fast, Simulators by Role and Task Flight Simulation & The Breakaway Method™ 21
  • Proficient by Role- Fast 22
  • Physician Adoption ResearchConclusions 1. Implementation is not adoption. The implementation of an EMR is only a milestone on the journey toward full adoption. 2. Physician adoption is highly dependent on having engaged leaders. 3. Traditional training methods are ineffective for achieving proficient users. 4. Most organizations are not tracking meaningful metrics. 5. Sustainment of EMR adoption requires significant resources and must be maintained for the life of the application. 23
  • Metrics• End user adoption - Knowledge and certification• Utilization metrics• Performance metrics- clinical and financial outcomes - Quality and safety - Meaningful use - Productivity - Cost of ownership/maintenance 24
  • Utilization MetricsSurvey of CHIME CIOs • n = 45 • Hospital characteristics • 89% >100 beds, 40% >400 beds • 60% fully or almost fully implemented EHR • Adoption defined as 75% of physicians using the functionality according to prescribed best practices 25
  • Utilization Metrics Functionality Installed Physician AdoptionClinical Documentation 91% 40-55%Testing & Imaging Results 91% 90-100%Clinical Decision Support 84% 41-65%Computerized Provider Order Entry 73% 16-64% 26
  • Performance Metrics 27
  • Physician Adoption ResearchConclusions 1. Implementation is not adoption. The implementation of an EMR is only a milestone on the journey toward full adoption. 2. Physician adoption is highly dependent on having engaged leaders. 3. Traditional training methods are ineffective for achieving proficient users. 4. Most organizations are not tracking meaningful metrics. 5. Sustainment of EMR adoption requires significant resources and must be maintained for the life of the application. 28
  • Lifecycle of AdoptionOptimization ADOPTION Fluency Threshold Proficiency Readiness Implementation Utilization Upgrades/Additions 29
  • Sustainment 30
  • This Just In…Clinical Outcomes• Review of current literature• 1995-2004 Chawdry et al• 2004-2007 Goldzweig et al• 2007-2010 Blumenthal et al - 154 studies - 96 (62%) positive improvement in one or more aspect of care - 142 (92%) positive or mixed positive (overall positive, at least one negative conclusion. Blumenthal et al. The Benefits of Health Information Technology: A Reviwe of the Recent Literature Shows Predominately Positive Results. Health Affairs, March 2011. 31
  • Factors Influencing Negative HIT Results• Lack of clinical leadership• Staff skepticism• Leadership turnover• Unrealistic schedule• Vendor products not ready on time• Workflow issues Blumenthal et al. The Benefits of Health Information Technology: A Reviwe of the Recent Literature Shows Predominately Positive Results. Health Affairs, March 2011. 32
  • EHR- A Competitive Advantage 33
  • Please fill out your evaluations on this talk andleave the completed form in the box next tothe door before you leave today.Please send any questions or comments to:hhaugen@thebreakawaygroup.com THANK YOU! 34