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Foundation Members:
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CHIME Presents:
The CIO’s Guide to Implementing EHRs in the HITECH Era
CHIME Member Comments on
Chapter 9: Communication Dispels Fears Surrounding the EHR Conversion
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Question posed to members:
How have you communicated where the organization is in the EHR implementation process over the life of the project, from selection to training to go-live?
Comments:
“This responsibility is also shared by CIO and clinical executive sponsors. We worked EHR selection and budget development like other major initiatives, informing the board and management committees and management as appropriate at various milestone junctures. Given the import of the EHR to our overall clinical strategy, marketing/communications worked with us early on to develop a communication campaign. We routinely provide both 30,000 feet updates and practical system demonstrations to board and board committees, physician governance and committees, and combined management/leadership audiences. Training/go-live communication is much more tactical whereby hands-on training is usually provided in a closed loop manner, the to-be-expected pattern is communicated, and a support center (war room) as well as on the ground support resources are positioned and deployed.”
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“With a few small exceptions, our hospital is well past the selection process and has a strong core vendor policy in place. However, as new functionality is planned and implemented, we have been making an effort to train participants in the planning and design stages to our standard project management methodology and the need to manage scope.
Project status is reported with varying degrees of detail depending upon the audience. Executive receive a brief verbal summary of key projects that indicates current status, any challenges, and actions being taken to manage those challenges. IS resource managers have detailed access to project information. General users are kept aware of projects and the benefits they will provide. As the project moves to training, they are migrated to a higher level of detail appropriate for their level of use.
We are now working on better establishing and tracking project benefits on an ongoing basis once projects are implemented.”
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“During our initial big bang EHR implementation, our CEO kicked off the project with a town hall meeting for all employees and medical staff to attend. At that meeting, the project phases were outlined and it was clearly stated that we were going to follow suggested best practices by our vendor unless we came across a patient safety, cost efficiency, ore revenue issue. During the implementation, we posted progress thermometers on our intranet and throughout the facility showing our progress. Each affected department had an assigned project team member and those team members were also chartered with updating their individual departments at department meetings. We also had at that time, a board IT Oversight Committee that monthly to review progress.
Post go live, we conducted weekly town hall meetings lead by the CIO to address issues and concerns from the staff. Additionally, we launched an EHR change management committee that met every two weeks (now monthly) to prioritize fixes and change requests based upon the new system.
Post CPOE go live, we have been posting usage statistics and CPOE stats in the physicians lounge and this gets reported at our board quality committee meeting.”
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“Communication has included emails to executives, directors and supervisors. Presentations have been made at IT Steering Committee and Department manager meetings. Verbal discussions at Department Managers, Clinical Leadership and Quality Council meetings. House wide email communication as appropriate.”
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“Poorly. We’re in the selection phase and it’s been a challenge. We’re really utilizing the physicians in the selection process (new idea) and they are each unique. Whereas all employees check hospital e-mail regularly, some physicians check their hospital e-mail, some only personal e-mail, some through their office manager, many want that face to face discussion.”
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“We communicate with project team members. We also publish an update each month in the employee newsletter. We e-mail updates as needed whenever project scope or timeline changes significantly. At the beginning of the project we distributed a couple of special publications to all staff describing the upcoming project, the rationale for doing it, and the planned milestones.”
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“Multiple presentations at multiple meetings, newsletters, published timelines, celebrations of successes and milestones – you name it and I use it, there is no such thing as “over communication” when it comes to an EHR project. I also make it clear that a “go-live” is not the end of the road – we will constantly be optimizing and upgrading applications over time to improve workflow and functionality.”
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“We have had a multi-disciplinary, clinically-driven hospital information evaluation team meeting periodically during our vendor selection process, have included the executive team in briefings, and have launched a steering committee for carrying forward the selection through contracting/implementation.”
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“We use regularly recurring “town hall” type meetings with proper time allotted for questions and answer. We also try to be absolutely transparent to all employees who are curious or anxious about the changes. On the hospital and clinical side, we try to listen more to their concerns & needs and back in those inputs into our on-going planning sessions.”
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“Physicians and others have been using portions of an EMR now since early 2005. Physicians have been signing documents electronically and they and others have been looking for clinical results from the lab and radiology (to include images from PACS) increasingly since that time. Physicians and their office staff have the capability to access their patients’ hospital EMR from their remote location when it is requested. Also over this time we have added speech recognition in Pathology and Radiology which further improves the reliance on electronic documentation and direct entry but the provider of care. Our next step is to add nurse documentation.
At each step, familiarization briefings and one-on-one training is provided to our physicians. Familiarization and information briefings are provided in the form of staff news letters, specifically focused email, handouts, medical staff meetings, office manager meetings, and office visits. The one-on-one training is provided at the time of implementation or just after. We endeavor to involve at least one physician who take the lead in the area being most impacted by the electronic enhancement. They become the physician spokes person and champion for the effort at hand. Presentations have also been provided to the board of directors; there are a number of physicians on the board.
This steady rise in reliance and access to electronic patient information has assisted us in taking each next step. There are local providers who have been vocally supportive throughout this process and contributed to further adoption. For those working inside the hospital, each new step has been positive and supported. For some of our independent, community physicians we are not moving fast enough. For others, the entire electronic health record is unproven and has the perception of being a tax on their productivity. For the majority of our independent physicians, they are taking a wait and see approach.”
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“Our approach was to create a mascot – ELMR. Through the course of the project, ELMR matured from an infant to an adolescent, teenager, young man and mature adult. His progress mirrored the progress of the project.”
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“Yes, this is/was a continuous process.”
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“I have a running ghant chart that is shared with all staff and presented to the board, various board committees and the full management team on a regular basis. The chart shows all major IT projects and the inter-dependencies of those projects.”
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“We don’t create special meetings – we always leverage exiting meetings/forums. The organization always gets updates about any part of the process that will have a user impact from the CIO and CMIO – we stay very consistent with this.”
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“We communicated only the progress on the current project at the time. We’ve found that physicians are not concerned or interested in where we plan to be over 6 months into the future. They are most interested by what will affect them soon (now). Who knows, maybe they are right. We’ve been on this journey for 15+ years. Many of the physicians have retired since we started.”
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“We communicate the status of all our projects via our SharePoint project portal. Everyone can see the updates at anytime through the portal. Updates also get sent to people via email when any updates get posted to the portal. The project steering committee meets monthly and receives updates at the meetings.”
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“As a health system of 34 hospitals it is key to communicate often, in many different ways. This communication started with the selection process (why, who was involved, when will a decision be made, how can input be provided). We also use a "pay it forward and backward" strategy where the hospital who is actively implementing receives help from the next hospital for training and go-live support. This help is then returned when hospital B is implementing and hospital helps. This is working very well BUT we must all remember that go-live is not the end of communication. It is only the beginning. We are continuing newsletters, intranet updates, optimization and customization sessions for physicians, and weekly
debriefing of support calls to look for trends and education opportunities.”
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“We have defined a roadmap with key milestones and measures. These milestones allow all participants to see the “you are here” dot in the larger picture. This feeds the WIIFM (What’s In It For Me?) need of all participants and engages them in the process as they can relate their role in the larger picture and their current position in the journey.”
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“Our has a formal project called The Clinical Transformation Project, which began in 2006 with direction from the Board of Trustees and led to a wide variety of information technology projects (and funding) to support the infrastructure and ancillary systems that would be needed for the core EHR system, as well as for the EHR system itself. The Board of Trustees has been updated on the project approximately 3 or 4 times per year. The Board of Trustees also has a sub-committee, called the IT Board Committee, that is updated 6 times a year on the progress of the project. The actual project involves several dozen non-IT employees who are involved in numerous workflow redesign and software configuration activities, and they are liaisons to their home departments. There is an internal intranet site devoted to the project which is updated regularly for all employees and physicians to read. Project Team members also are guest speakers at various department meetings, as well at Medical Staff meetings. The project's status is a topic at the enterprise-wide, Quarterly Managers Meeting, a meeting of some 400 managers throughout the enterprise. There is also a vice-presidential-level "cabinet" meeting that meets monthly, and the EHR project is a regular topic. Lastly, there is an extensive training program for all users of the EHR, which includes classroom-based training, web-based training and one-on-one training---all of which set expectations for use of the system.”
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“As we developed our Roadmaps early on, we looked at various metrics to help us gauge our progress. After several calls with HIMSS Analytics to understand the EMRAM model we decided it was the best model available and representative of how we see the level of automation maturity, although we had significant debate if CPOE should go before barcode Med Mgt. We now have heat maps for each of our entities that are mapped to the EMRAM model. Incidentally we use the same construct when we layer in MU Stage 1. Although not perfect in terms of sequence, this has proven to be a very effective communication tool when explaining where are on the transformation journey and Leadership can readily relate to the EMRAM maturity model.
Our next step is to get more granular within the stages so we can more accurately map between workflow and automation capabilities.”
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“Our IT Steering committee became the governance committee for the project. Status was communicated to them for further distribution at their staff meetings. We also used publications and a web site to keep the organization apprised of status and what life would be like with the new tools.”
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“We have two physician champions that are meeting w/Physicians, going to the appropriate meetings, and putting out news letters to the staff. We also talk thru it at a monthly managers meeting to keep all of the hospital managers up to speed.”
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“Steering committee meetings, executive staff meetings, we have an executive IT advisory committee, management forums with the managers and employees and we also use our intranet to provide updates. Basically everywhere you can communicate, because you cannot over communicate.”
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“We used every committee that was clinical to get involved and report to. We made sure we were on agendas again and again. Clinical leadership knew who was involved and therefore who to talk to. Publishing things works for admin types, clinicians want to hear it from people that they work with. We tried to make sure that we had clinicians in all areas so someone likely knew where we were. We still did the formal committees, reports etc. Just wasn’t of value to the people that were really effected.”
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“A wise former boss of mine once said "just about the time you're sick of telling people something, some of them are just starting to get it!" Bottom-line, relentless communication is an absolute requirement for all major projects. We frankly don't do a great job in this area. So much of our time is spent doing projects that my IS leadership does not spend near enough time going to physician and department meetings, rounding on our users, publishing internal newsletters, updating our intranet page, hosting brown-bag lunch-n-learns, just being visible and available. I have challenged my entire team to spend more time in the departments and with the users they support. I've told them to take their work and find an available computer in the user area to do it. Weekly meetings are held with IS staff to make sure they are up-to-date on our plans and progress so they can pass this on.”
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“Our Marketing Department is an integral part of every implementation that we've had in our journey to implement our EHR. We use internal publications, a Physician Newsletter, our Intranet, our Physician Portal, and have the capability of sending messages to staff every time they log-on into our system.”
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“Basically, communication throughout all levels of the organization, visits to all divisions, sites, etc...”
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“Our vendor has provided a great resource that uses questions and answers and converts into graphical data that shows a lot of the process.”
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“I find in managing expectations, it is important to be realistic in expectations and mange the learning curve to allow people to come out the other side better. It is also important to realize that there will be many benefits that could not be imagined when the process started. We need a vision, we need a stretch goal, we need to hope for more than can be delivered and continue to work towards that "dream". Technology leaders must always be out ahead of the organization, leading the way to next level.
How do you prepare everyone, from the CEO to clinical staff, for what the experience will actually be like?
Total cost of ownership is an important tool, discuss the financial commitment that will be required over multiple years. staff up in areas of implementation, be realistic on when to expect returns and then be relentless on getting that ROI. Stay at the table, one cannot give up the first time someone has "hurt" feelings, or someone struggles with change. This is not a journey for the faint of heart. This is a journey for those willing to walk down a few alleys, get lost, ask for direction and who knows find a new place and become a leader in your own right. Discover new places, new ROI, and new relationships. The vendors get to earn some money and we get to provide better, more reliable, cheaper healthcare in our communities.”
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“Using outside resources we completed a readiness assessment. Presented the finding and recommendations to the IS Steering Committee and at a Board/MEC planning retreat.”
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“Yes.... trying to explain how to fill in the parts and extend into the community....... Have to field questions such as how much and how much longer..... usually need simple analogies to make the points.... when the paper record is gone.... when the clinicians can communication and execute clinical decisions and document them from on dashboard/screen.... Try to explain how much work is required to plan, build, test, train, convert and support each and ever initiative....”
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“We include updates in various current communication sources like the Leadership Letter, the CMO Update and standard update items at the MEC, physician leads committee and general systems ops meeting.”
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“We have an EMR steering committee, who is really the governance of the journey. In the selection process we took an involve nearly everyone and first decide about the differences between best of breed and best of class. We chose best of class. We carefully documented evaluations of the candidate systems and published the results. At the end of the day, the evaluations alone supported our decision, but the 5 year TCO was a huge plus. Do not get me wrong, price was not even a top five issue, but when all the top five swing in favor of the price leader as well, it is a huge win.
Senior Management is updated weekly as to the status. The Medical Staff monthly or more frequently if needed. The IT Medical Director, CNO, Informatics Nurse and I have a standing monthly lunch for strategy, planning and communications. Our Super Users are invaluable, we communicate with them regularly, mostly via the informatics nurse. Six years in, and we have had some managers retire. We send all new managers to our suppliers basic training early in their tenure. We must maintain and grow the knowledge base we had when we started. We cannot afford to allow attrition (all of which has been natural) to erode this base.
At the end of the day, it comes down to open, frequent, honest, meaningful communication. Bad news does not improve with time, when there is some, and there will be, get it out there. Joy has a way of telling its own story, but do not forget to celebrate victories. Everyone loves to celebrate a win, and sometimes they are tough to come by.
We do all the little things: newsletters, signage, progress Graphs etc, but the battle gets won with people talking to people. You simply have to make telling the story as much a part of your life as coming to work: You do it every day.”
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“Yes, regular reports to the steering committee and the Board of Directors.”
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“Managing expectations can be like herding cats when it comes to EHR as many have opinions of what they are, will be, should be, etc. I reality they come in many forms. What we focused on was the vision of being totally electronic and communicated where we are/were often. The electronic record evolves over time in functionality, customer understanding of the capability, people’s capacity to change and use the system, etc. Many demos were presented to users, educational sessions held, direct participation in meetings to present the system and so forth. During each stage of the implementation we started with a demo and discussion of what we should expect with this upgrade, patch, etc.
As CIO, I also hold regular I/S Steering meetings that include many members from across the organization, write monthly board updates, attend medical staff meetings, hold department manager strategy sessions and more. You must get information out there for people to inquire about, see, touch and also see some of the good, bad and ugly.
Think my comments above cover most of it. We also help regular celebrations for major milestones such as initial go live, after successful integrated testing, news media releases for the community, open houses, newsletters, posting on the intranet, internet and more.”
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“Through the PHO and Medical Staff meetings we provide periodic education and updates on progress, those practices that are implementing systems, and we provide one on one consulting with practices as requested.
We have formed a Managed Services Organization which offers services in the implementation and support of EHR as well as preferred rates for contracting with an EHR provider.”
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“- Weekly status e-mails
- stories in employee newsletters
- demonstrations at staff meetings
- information on intranet”
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“We are far down the path with our EMR implementation but we have used several means to communicate. Our intranet has been very valuable in providing information on our various phases of implementation. With our current CPOE project at the hospital we have set up a site on our intranet where we post all minutes to the sub group meets, we have created hyperlinks to various topics important to physicians so they can follow workgroup decisions. We have created a log and anytime they see this logo they know it has something to do with the project. This logo is on the front page of our intranet so when they click on it they come to the project page which looks like this:
You can see we have many options including a link to submit questions, and links to work team membership so they can contact member with questions, we post all minutes and presentations, and we provide hyperlinks to key topics (see left side bar). So for example if a physician wants to know what decisions have been made related to medication ordering they click on the hyperlink and all decisions are listed.
We have also created a news letter that goes out once a month to the medical staff’s personal email addresses and we include the PHR logo or the word “optimization” in the subject line and they know if it valuable information related to the EMR. Lastly we host large kick off sessions with a theme, so in June to educate all our staff on what CPOE is we are having a golf tournament in our conference center and combining fun games with opportunities to see demo’s of how the system will work.”
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“Based on our experience it is a lot of work to implementation and then no relief to “celebrate” after going live. People are used to working hard to reach a “finish line” but the truth is the EHR requires constant work, re-work, and redesign to adjust to the practice’s workflow. It does parallel other major system implementations and the organization needs to manage the support appropriately (especially post live) so that provider and staff satisfaction/dissatisfaction does not affect the patient experience. In other words, manage the PR because this is your brand now to the patient/customer.”
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“Yes. In the earlier stages, not that effectively. As the rollout progresses, better and better.”
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“We’ve done a better job prepping our senior leadership team, since we’ve had to make serious budget consideration for our migration to our vendor’s upgraded platform from our current arena. But we’ve been EHR for close to a decade in the hospital, and for three years in our outpatient clinic. Still, there is always much additional preparation for CPOE, EHR to the ED, and other evolution yet to come. Generally, we start with one-on-one discussions with the most affected department leaders; sort of a “divide & conquer” approach, but supplemented by information at the all-department-leader monthly meetings, and supplemented further by group e-mails to the management team. It is difficult to engage the brains of DLs who are not yet affected by upcoming changes. They have too much to think about, and don’t want to really spend time thinking about impact or improvement of the local EHRs. Hence, repetition is key, and giving them small doses (generally high-level) is the best early awareness.”
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“Through the use of the Table tents and monthly mailing. There have been two lengthy mandated presentations where we presented what has been done so far and installed question boxes on all campus’s by time clocks to seek out questions and ideas.
The range you are asking for was done through a joint effort that was multidisciplinary and included a half a dozen physicians, and all the ancillary departments and the various nursing departments. The complete team consisted of 60 people.”
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