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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 14: Building Physician Support for EHR Efforts
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Question posed to members:
More broadly, what are you doing to gain physician support for your IT efforts (particularly those whose only affiliation is admitting privileges)?
Comments:
“We have a physician governance committee that provides input and oversight to our community-practice EMR implementations (under our program allowed by the Stark safe harbors). We also have a faculty-based physician advisory committee that helps guide our in-house EMR optimization efforts. While these are all generally ‘governance’ functions, we have found these to be effective ways for physicians to engage with IT and feel they have a voice in design and implementation, particularly as it affects their medical practice.”
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“Listen to what they want and try to deliver with the functionality we are driving (like giving them SSO, follow me, etc.). Communicate, face-to-face, about impacts to them. Give them staffing help for adoption. Explain why we are doing things that hinder their work (security, better documentation, etc). Find a champion in every area.”
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“Physician governance structure approved by MEC with champion from MEC and another young physician co-champion.”
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“Working with outreach and marketing teams to enable a more intentional exchange of information to support the caregiver needs as patients move between organizations. In some cases, EMR services are also offered.”
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“We have physician advisory councils that are used at each of our facilities to discuss items and keep projects moving. I have also provided education sessions throughout the year at our CME sessions which has raised awareness, and buy-in for our projects. We also structure teams where we pick the super-user physicians from our staff based on the project. This keeps the faces changing and does not burn out the physicians. Finally, we have built strong working relationships between our physician and IT staffs over the years. We leverage those relationships in these trying times to gain support.”
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“We have had physician steering committees in place since 2000. They have provided guidance to the implementation of all of our clinical systems. In most cases, they have been focused around a specific topic. Our most active sub-committee at this time is focused on CPOE. We also include several physicians on our steering committees responsible for guiding deployment of our clinical solutions. We are in the process of re-creating a ‘general’ physician IT steering committee. The general committee was disbanded in 2006 in support of more focused committees. However, with the increase automation, we believe it is once again time to re-engage a more general physician group. The physician reporting directly to me is responsible for managing this committee. Physician input has been one of the key factors in our success in implementing the various systems we currently have in place.”
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“Active participation in several committees.”
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“We’ve established a Physician Advisory Council that meets weekly. Any physician – attending, resident, hospitalist – can participate. We introduce new functions at those meetings, ask for feedback, listen and respond to complaints and concerns, etc.”
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“At the community hospital level have relationships with the medical staff is critical for a CIO and the IT team. There is often times physician champions that may or may not be reimbursed for time spent. We have engaged a physician advisory team lead by the CMO with the CNO, CIO, pharmacy and others on that team. As the CIO, I am also part of the medical executive committee, quality committee and have staff members/IT leadership involved in several other committees.”
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“We have two nurses with the title Clinician Advocate who work with the CMIO on the units about 50% of the time. In addition, we recently contracted with a third party to do ‘in office’ training with the physicians prior to a major upgrade.”
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“We have a multidisciplinary team called Advanced Clinical Team with includes nursing, physicians, IT, and HIM department representation to discuss issues and opportunities with existing or proposed IT solutions.”
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“We currently have an IT Advisory Board where we meet with other healthcare CIOs within the region. Members of this group include physicians and we discuss trends within the industry and current / future projects for the hospital. We also have a Clinical Informatics Committee and a physician serves as chair for this group.”
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“We have the endorsement of our MEC; publicize the effects of using standardized order sets (reduced length of stay; increased compliance with core measures) which, at least in our environment, has worked successfully.”
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“There are multiple committees, medical executive meetings, and one-on-one encounters with physicians, to help educate and influence physicians.”
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“We have a Physician Advisory Group actively involved in CPOE, order sets, documentation, planning and coordination. They have done site visits to similar sized organizations that are where we wish to be and they are involved in the MU project, especially in the design stage for physician processes. We have a major communications campaign under way to ensure everyone is informed and being invited to participate.”
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“CMIO is meeting with them, getting buy-in for new clinical IT projects.”
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“We are investing in one-on-one training for them at their convenience and we are making a significant effort to send training resources to their offices to ensure their office staff knows how to use and has access to the necessary clinical information.”
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“We have conducted a couple of meetings focused on EHRs and health information exchange. I am working with the regional extension center to sponsor a briefing to local practices. The hospital is exploring the purchase of a Meditech hub for use by community physicians in order to share patient health information, consult orders, and medical results. When it comes to the implementation of hospital systems, updates/briefs are provided at medical staff meeting, informational newsletters, practice manager briefings, and one-on-one training sessions.”
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“We are in the process of hiring a Medical Director (CMIO) and Clinical Informatics Director (CNIO) for this regional implementation. We consider the clinical leadership key to the entire process. The doctor.-to-doctor and nurse-to-nurse dialogues are the single greatest influence on buy-in for our stakeholders. No matter how much experience and skills you bring to the project, your credibility in the clinical arena will never be what these two clinical leaders will bring.”
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“This one is tough. We have a group of community physicians that form the Physician Advisory Group. It is headed up jointly by the CIO and the physician champion. We have them break out into groups to focus on specific areas for in depth input like virtual desktop, physician eSignature, physician documentation/dictation, HIE, etc. We will soon have a CMO that will help with ensuring we have the team/process/etc. for input from the physicians.”
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“I am offering them the participation in a HIE and funding the EMR in their private office as a means of physician alignment by making it easier for them to do business with me.”
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“Nearly all of our docs are ‘voluntary’. We take multiple approaches – heavy participation in EMR design and implementation, onsite trainers and facilitators, etc. I can imagine some docs asking ‘what’s in it for me?’ as we ask them for more changes to achieve MU.”
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“So far, the physicians that are involved in CPOE at the hospital have been very supportive of our efforts. They understand our need to have electronic orders and the benefit they and their patients receive from using the system instead of handwriting the orders. They the decision support that is built into the system and
the speed that medication orders can be completed by the pharmacy. This means that their patient's needs are met more quickly. Pharmacy loves it because they have less work to do when a med. is ordered. Medical records love it because all orders are signed, dated and timed. Our EMR at the hospital has been well received by all of the clinicians because they can view it, sign it and work their deficiencies from their office or home. That allows them to spend less time at the hospital Later this year we will begin the implementation of electronic documentation of hospital progress notes. Right now they are handwritten. I am interested to see how well this is received.”
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“For external physicians we have a second paid physician to represent to the hospital the outside physician needs.”
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“When we implement each of our hospitals, there are a series of physician engagement meetings monthly. Each has a different topic, all have dinner and drinks provided, and about the third or fourth month we add meaningful door prizes while concurrently breaking down the larger group into specialties with hands-on time in the test system. The opportunity for the physician to ‘drive’ as well as begin to construct some of their preferences goes a long way to engagement, while still being encouraged and follow-up by the CMIO.”
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“The short answer is we are leveraging the ARRA/HITECH requirements to the hilt, along with Joint commission requirements for signed, dated, and timed orders, which are always a problem with paper records, We do not mandate use of our clinical system, but 95%+ of our clinicians use it to retrieve information. The last mile for us is CPOE. Currently approx 35% of our total orders are entered via CPOE, and we are active with the medical staff committees to transition to an ‘organic’ process that is driven by the medical staff, and not IT or admin....although we have not done so yet, many members of the medical staff are discussing the date when we will mandate its use. Establishing support with the physician group for us started with placing increasing amounts of clinical information on our system where they gradually started using the system to retrieve information, finding it easier and faster, particularly from home. We’re creating financial incentives with wireless laptop purchase support tied to level of
CPOE usage, and are continuing to create additional incentives to increase use, including sharing of MU funding. We are also beginning to discuss changing our compensation plan from one that is heavily volume driven to one that is performance driven, including incentives for EMR adoption.”
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“Provided training incentives and supplemented time, provided one-on-one training at the unit from our 15 person training team, and special training opportunities at dinners and breakfasts.”
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“In the near-term, it’s been work through the CMIO and others to train, modify order sets, continue to PDCA the workflow and associated screens in the application, etc. Remember, we’ve had CPOE here for three plus years already. We don’t have physicians with ‘only’ admitting privileges, but we do have a large number of providers (pediatricians) who refer patients to our specialists (who admit). They receive those patients ‘back’ once discharged, of course. We continue to work on outreach programs that improve our communication flow, and thus improve the continuity of care. Looking forward to a real HIE eventually.”
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“We are currently working with our hospitalists and other staff physicians to gain traction and acceptance with CPOE, etc. We are not currently working extensively with the physicians with just admitting privileges. We think that we’re a small enough facility (99 beds) that acceptance by staff physicians will carry weight with other physicians using the hospital.”
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“We are doing the items mentioned above. In addition, we have a Physician Support Services Team that serves as a liaison between the physicians and IS regarding what their needs are, how to maneuver in the system, how to connect remotely, and any other concerns they may have. We have a very robust communications plan aimed specifically at this group. They use multiple methods of communication in multiple venues. We have an FTE totally dedicated to this role.”
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“Our hospital system is doing many things to gain physician support: a) we hold a monthly Physician IT Council meeting for input on new IT strategies and to keep them informed of progress of that strategy; b) we pay for physicians to serve on the CPOE design teams; c) in addition to the full-time CMIO, we have have two paid half-time physicians that are specifically helping with implementation of our HIE, ambulatory EMR, PHR and Acute Care Physician Documentation projects; d) we have a physician-led advisory committee just for the HIE and PHR projects; e) we have offered an ambulatory EMR to non-employed physicians under the relaxed Stark regulations; and f) we are linking external EMRs to our HIE to more easily provide hospital-based data to physicians.”
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“We have established a Physician Steering Committee in additional to our Medical Informatics Committee. We are engaging them in decision making and educating them on how they will be impacted by CPOE and documentation. We are also meeting with Medical Executive Committee monthly and our quality committee of the medical staff. Not all of them are engaged but we have given them every opportunity to get engaged. Also through the chief’s and chairs we have communicated their responsibility to engage the members of their departments.”
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“Our hospital Physician Champions and Clinical Informatics Teams that are hospital based will work with our hospital execs in this area.”
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“Mostly trying to deliver good quality services and functions and trying to connect any additional effort or value on their part with some benefit such as additional reports or pre-filled documentation based on data that they may need to enter for some required function such as problem lists.”
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“Our facility has a hospitalist group, so at this point we are going to focus on this group. We will begin our install of CPOE this fall and once we are further along, then we will begin discussions with the physicians. We are running reports now on the physician usage and the senior team will begin to work with those who are lagging behind. We don’t want to start too soon with communication to the physicians. Our team has found it better to wait until closer to the time. We also plan to implement the approach that ‘CPOE is only available to the hospitalist group’. We are attempting some reverse psychology!”
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“We have added a CMIO to our initiative. With most of our implementation behind us, the question of ‘why’ seems so obvious. We simply couldn't have done it effectively without it. Physician to physician issues can become a non-issue and dealt with in a much more effective manner. Proving one-on-one physician support when needed and gaining overall support from the physician community is amongst the key roles they play. Also, providing physician perspective to meetings and system build was much more efficient with this model. It precluded us from trying to get time on a physicians schedule and then trying to bring them up to speed on the issue at hand. Additionally, meeting with them to concentrate on the benefits, as well as providing subsidies for office EMR software.”
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“We have 160 salaried physicians and we are first focusing on them. Many of our independent physicians use our hospitalists program. However, we try to reach out to everyone thru our MEC. We also selected a system that two out of three of this town’s providers will use. Thus the water level is rising and we hope to take advantage of that.”
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“We are currently planning for both bar coding medication administration and CPOE; physicians will be heavily involved in every step of the way, from gap assessment to workflow and processes planning to implementation.”
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“Physician Advisory Committee, along with the physician champion role.”
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“This is something that I’ve been doing for years. The key is communication on a variety of levels using a variety of media.”
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“We employ over 50% of the medical staff in a physician multi-specialty practice. We've set up a MD Informatics Team who we work with on all physician related initiatives. Outside of that we are looking at changing our credentialing practices to include use of IT systems.”
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“IT has a presence in the physician executive committee, and uses that for high-level announcement & discussion of issues. From that, we branch to more specific targeted meetings with individual physicians, or with groups. We also publish information to the physicians when useful so they can stay educated in non-real-time, and don’t have to attend more meetings. We give the top level of IT support to physicians, including (in our small town, and with our small number of physicians) even performing house calls to generate positive PR.”
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“CMIO was a big step in this process. Also, continue to provide education to the physician staff on MU, our implementation plan, etc.”
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“Our CMIO chairs a number of collaborative forums; IT leadership attends all of these meeting. He is the only individual in the system to obtain personal email addresses from providers to distribute his series of ‘snippets’ emails that address IT news, short cuts, commonly made errors, etc. based on calls to IT and other venues. Our CMIO is also on the MEC and reports IT updates in the MEC as well as all quarterly medical staff meetings. The CMIO and I (CIO) attend monthly ‘Lunch and Learns’ with hospitalists’ staff. All medical staff is expected to minimally review clinical information – we do not allow printing documents and sign off verbal orders on-line. We partner closely with the VPMA to provide compliance reports used to encourage participation as well as to sanction if necessary.
We won the battle convincing the organization on the value of CPOE to drive patient safety and outcomes. From the systems’ board down throughout the organization, we are on board and support provider adaption. All staff is expected to assist a provider whenever and wherever is needed. We also have a dedicated physician trainer in IT who will go anywhere, any time. She offers classroom, at the elbow, and drop-in support. Last quarter the MEC agreed to mandate CPOE when we reach total orders entered by providers reaches 75% of total orders.
Bottom-line: a) obtain corporate alignment; clearly not an IT project but a corporate priority to better support the community; b) create a vision; c) provide supportive atmosphere and resources to enable providers to adapt to change; and d) sanction as last resort.”
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“We have a strong cadre of super users who assist physicians that do not frequently see patients in the hospital.”
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“We have a Physician/IT Steering Committee that reports to the overall IT Steering Committee. We report at the Department of Medicine meeting each month. We provide educational sessions and communications every other month at the General Med Staff meetings. We provide specialized education sessions for physicians, conduct physician orientation, and involve physicians on IS Core Teams whenever possible.”
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“We explain to them that they really don’t have a choice. We are being forced to move this way for many good reasons and they are going to have to learn to use the technology. We do our best to hand hold them individually as we roll out the technology. This is part of the reason why it takes so long because they can’t adapt quickly to new technology. You give them a little bit at a time.”
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“We have implemented in the IP side, so we will use the same processes and procedures we did there, which were successful.”
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“As a community hospital, we have no ability to enforce adoption, short of a Board directive, so we must gain support as you indicated. The CPOE physician leadership committee I mentioned above has suggested several ‘enticements’ for CPOE adopters, some of which are actually doable. The CPOE physician leadership committee requested a special view from our vendor for CPOE physicians only, which we’ve done. They also asked for the ability to dictate Progress Notes (because they hate to type), which we had to do for all, not just the CPOE docs. We have a communication newsletter and weekly e-mail updates that go to physicians, but progress on CPOE adoption is very slow. The latest thing they’ve requested is electronic medication reconciliation, which is a sore point for everyone. We will be able to provide that following completion of our next code upgrade at the end of July, so that is eagerly anticipated. However, it may be a case of ‘careful what you wish for.’
Without a significant carrot or club for the independent physicians, we doubt we will achieve much more than 25% CPOE adoption from the geek MDs. The government has long been remiss in not aligning physician and hospital incentives for payment. Although this is an attempt, we view it as very weak. Most active surgeons will not cross the street for $40,000, let alone enter their own orders in their office. We find they are all adding extenders of some sort - i.e., physician assistants or nurse practitioners, to place orders for them in the hospital and generally dragging their feet in their offices until the government pinches their Medicare payments enough to really hurt. They have an uncanny ability to deny reality.”
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“We are now deploying an ambulatory EMR/HIE and communicating regularly to our 150+ provider subscribers and to the local PO (all community providers) regularly.”
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“The use of hospitalists within our hospitals have grown significantly over the last few years, which is a great consistent set of physician resources to implement more standardized clinical practices and we will be using them for this purposes, but affiliated physicians must be incorporated within the over all process and there is no one single way or model to address them and you must customized your efforts to include them based upon the on-going relationship they have with your entity. We use a combination of methods, but we have set up a physician IT support unit via Medical Staff Services unit to provide the training and relationship connections to our community physicians.”
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“Communication, involvement in design sessions, order set development, training and preference building, offering solution in the affiliated practices.”
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“We are really driving for physician ownership of the project. It comes from a mandate from our medical staff to stop having one foot on the dock (paper record) and one on the boat (EMR). The medical staff executive committee is committed to making the system work for all physicians regardless of level of interaction with the organization.”
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“Have created a network clinical informatics committee co-chaired by CMO and CMIO to meet monthly review progress and gain insights sin to CPOE and other clinical system rollouts. Committee is made up of physicians nursing from each of ht five hospitals, CMO from employed physician group and key administrative folks (approx 20 people). His committee is a subcommittee of network it committee.”
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“Rolling out e-prescribing options and creating online data groupings specific to the physician preferences for reviewing information on line. All physician documentation on line to date has been strictly voluntary – no mandates.”
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“Working inside out. Starting with the nurses, residents, hospital based MDs, etc., which makes the hospital clinical experience more complete. Then approach with: is someone at the hospital willing to help? Make sure they realize the hospital is committed to an electronic decision support EHR/EMR. There have been discussions about providing EMR solutions, connections directly from the hospital and eventually using the ARRA and RHIO model to both connect and drive certain local compliance.”
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“We are working with our hospital at the corporate level to incorporate their clinical integration model. That includes outreach to affiliated independent physicians through access to an EMR and support. For the owned practices we are already developing interfaces from their clinic EMR to our hospital EMR (another vendor). We also currently offer a physician portal to all physicians for remote access to hospital data.”
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“Our physician leadership and medical staff executives have been actively involved in our vendor evaluation and selection process for a new hospital information system. Once we have selected our new system, we will be appointing a physician champion to work with all the medical staff for implementation of CPOE.”
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“Our Steering Committee has physician champion from each of the participating hospitals. The medical director talks with them monthly and we work to make them actively participate in the monthly Steering Committee meeting. The level of engagement at the sites directly correlates to the level of commitment the physician champions demonstrate.”
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“We have extended an offer (and paying a stipend) to 12 physicians to assist in the development of the orders they will be placing. They have presented each month in the Medical Executive meeting their progress and monthly at the physician group as a whole. Our target was 100% CPOE by June 20, 2010 as we move into our new bed tower and it involved all hands on desk including the physicians. A side note: The VPMA was awesome. Every sight should have such a champion!”
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“We only have employed physicians.”
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“We have formed a physician advisory council that meets monthly to discuss issues surrounding system design, system access, work flow, training needs, etc. We are also looking forward to Phase II of our project (CPOE) in 2011 and 20123 and have formed a multi-facility physician committee to research and develop standard order sets for the integrated system. The key is to make each effort meaningful for the participants so that it is perceived as a good use of their time. In our case, the physicians are clearly engaged in both efforts and are recognizing, in some cases for the first time, the value of being an integrated delivery system.”
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“After go-live there was no paper chart available for patient data. Physicians had to use the EMR. A small group of physician activists began using CPOE from the beginning. These were not employed physicians. In 2009, the Medical Executive Committee mandated CPOE by all physicians as of January 1, 2010. Naturally there was grumbling in the beginning, but one on one training by physicians and training staff eventually overcame the trepidation of the group. Since go-live there has been an on-call person to help physicians with EMR needs.”
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“Engaging them in oversight activities (membership on the PAC), training and extending access of the systems to their offices, improving capabilities for them including cell phone coverage, single sign-on, and remote access, and offering office EMR assistance.”
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“Physician Portal, mobile rounding, physician advisory committee, regular updates at MEC, and hands on one-on-one training. Plus, regular physician round table.”
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“We have created a Physician Services IT team, which is dedicated to supporting our physician practices. This group is accountable for all our ambulatory venues, including oncology and home health. They are developing the relationships and understanding necessary for us to have an effective technology platform for physicians in their office practices and to understand the workflows and requirements. We also initiated a System Physicians IT Steering Committee, with members who are provider-based and also members from aligned, non-owned practices. This group has been charting our system-wide EMR strategy, and has completed the selection process for our enterprise EMR. I co-presented this strategy with physician representatives at our annual system summit with our Board members, system and physician leaders. We have provided educational sessions and have a group site to share whitepapers, etc, to help our physicians become more conversant with the EMR landscape. The group has created sub-groups to work on key aspects of the EMR, including quality reporting, and these have been instrumental in developing physician-based definitions of requirements that extend across the various venues of care. Our physician team recently recognized the need to engage more directly and collaboratively with nursing, and has a dinner meeting planned with the facility CNOs to talk about how to approach this work effectively. We are sponsoring these collaborative sessions and are also kicking off teams to develop the business case for the system-wide EMR with physician members of each business case group for presentation to our Board. We are also working with this group to develop a broader communication plan to the rest of the physician community as we go forward.”
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“Looking at a way to provide them with a sponsored EMR.”
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“Embryonic at this point:
- forming a physician advisory group
- using various communication tools to keep them informed
- CMIO starting to reach out to various constituencies, etc.”
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“We have formed a Physician Advisory Group to oversee and validate the future state with our new EMR.”
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