Friday, September 4, 2009

EMR = Need for new hospital management tools

So I thought I'd write a little bit more about the cultural shifts that an EMR brings to a hospital. (I say this, after the remarkable success of our "Jedi Informatics" group that seems to be building as we move forward in navigating the culture shift.)

Have you read any blogs about EMR software? Recently I stumbled upon a group of ED physicians who were having a very public discussion trashing various EMR software vendors. I sat there, reading their testimonials, about "The ____ EMR was trash and we had to deinstall it!" and "Another EMR was awful and nobody is using it."

And then I thought... Are they serious?

Yes, I know (as a practicing physician) that EMR software, especially when you get into CPOE, can be a palpable culture shift. (To some, it's a speedbump - To others, it's an earthquake.)

Yes, I know there is some question about how long the efficiency-drag lasts, after implementing an EMR, and some physicians have questioned whether this drag makes the safety / organization worth it.

But then I wonder - How many of those implementations were improperly implemented?

As a former computer programmer, I can also tell you about programs which were well-designed, and well-constructed, but because there was no proper implementation plan, the software sat there, unused.

How many of you can testify about a particular program that "We spent a lot of money on, but nobody used"?

So again, reflecting on this group of ED physicians, who were relating similar stories - I wondered, "What kind of implementation plan did they have?!?!"

Ultimately, I guess, I seriously question : Was it their software, or was it their implementation plan?

As I continue to work in my CMIO role, I explore a lot of "computer complaints" which are perceived as "The computer isn't doing ____ right" - But after detailed exploration and analysis of these multiple complaints, more often than not it relates to :

1. An education / training issue
2. A workflow issue
3. A policy needs to be updated or modified.

... rather than an actual software issue. (Yes, the software appears to be malfunctioning, but when you do an analysis, the root cause of the problem often relates to 1, 2, or 3 above.)

(This is why, some people have asked me, "Why are you discussing so much management and policy? I thought you were supposed to be focused on the computers!?!")

So this brings up the problem : How is a hospital supposed to manage this sort of change? Are our traditional policy mechanisms (such as the Medical Executive Committee) nimble enough to adjust?

And this brings me to my points :
1. Hospitals that handle these changes nimbly will likely have successful EMR implementations.
2. Hospitals that are mired in their old policies/procedures, and fail to develop structures to adjust quickly, will likely have unsuccessful EMR implementations.

Or, more simply put : "Don't think of your EMR as 'an IT thing' - It's 'a hospital thing.'"

Having good leadership to help educate your department heads (like a CMIO) is a good way to ensure your managers understand the questions they'll be asked. Until then, I'll just continue to blog freely. :)

Will write more in my next post about what I'm doing to help adjust this part of the medical culture. :)


Michael H said...

You are correct about implementation being a bigger problem than the software itself. I know from 20 plus year in IT implementation. What is not discussed often is the "Change our behavior" amount all of us. A project is not successful if it's installed and operating properly, yet only 1% of all users using it. The most important part of implementation is after being roll out, the follow up meeting, training, and policy change follow up. A successful implementation is after roll out, use it by everyone and made the necessary change on policy and additional bug fix. An I making sense?

cf said...

Great post...and a great blog. We've added it to our md-to-md resource page of our website for our readers as well.
Carol Flagg