Sunday, April 3, 2016

Some Factors Underlying Efficient Change Management

Recently I had a great discussion with a non-healthcare person about the role of Informatics in EMR implementation, and what kind of things CMIOs look for to estimate whether a particular EMR implementation will be successful or not.

The discussion was a great opportunity for me to really think about the big picture issues, and try to distill them into something more tangible to a non-healthcare, non-informatics audience. 

What it finally came down to, for me, was the successful planning and budgeting for the whole EMR implementation - both the go-live, and the eventual optimization and continued maintenance that come afterwards. It's not unlike buying a car - To be successful at car ownership, you have to budget for both the car (necessary at go-live) and the gas/maintenance (necessary after go-live to make the car go forward) :

While researching for this blog post, I found out this is one of the reasons why the mandatory price stickers on all new cars (known as the Monroney sticker) must contain both the price of the car and an estimate of the gas mileage :

Not only does this allow consumers to select cars with better fuel efficiency, it also helps a consumer answer the question "Can I afford this car?" before they actually buy it - A major factor for successful car ownership.

With most healthcare technology, it's pretty easy to budget for the car - vendors know this number well - but it's not as easy to budget for the gas. Vendors will often estimate the cost of optimization, upkeep, and maintenance for you, but how do you really know if their estimate is correct? Will you see the same gas mileage in your experience?

This then raises the question - What exactly are the factors that go into 'gas mileage' for an EMR? CMIOs, CNIOs, and other Informatics professionals struggle with these questions all the time, because they are important to help budget for successful EMR implementation :
  • Budget well for the ongoing optimization, maintenance, and upkeep - And your EMR implementation will likely be successful.
  • Budget poorly for the ongoing optimization, maintenance, and upkeep - And your EMR implementation may be fraught with struggle.
    What experienced Informatics professionals know is that a large part of the 'fuel-efficiency' of EMR ownership comes from the organizational change management - How well-suited is the organization to make change? Does it contain the infrastructure and configuration needed to support efficient change management? 

    These change management issues are so key to EMR implementation that in 2013, the website published this great primer on EHR change management :

     ...which provides a great high-level overview about change culture, along with some fantastic references. (A helpful document and a must-read for any healthcare executive considering an EMR installation or replacement!)

    But what are the other factors that experienced informatics professionals look for in change management? Are there other factors to look for that help better estimate your gas mileage, and thus your eventual cost of ownership? To help share some insights, I've created the following table, with some factors that I believe influence an organization's ability to manage change efficiently - In estimating the price of your gas, some factors to consider (in no particular order) include : 

    While this list is by no means comprehensive, these are some of the bigger factors that experienced Informatics professionals consider before advising organizations how to best budget for their EMR implementations.

    In the end, enterprise EMR success depends on correctly budgeting for the purchase, maintenance, and upkeep of your technology. It's not just your go-live that matters. Knowing the price of both the car and the gas before you invest will help you have a successful long-term implementation.

    This post is for educational and discussion purposes only - Please consult your own Informatics professional before budgeting for any technology purchases. If you have any feedback, thoughts, or other factors to consider, please leave them in the comments section below!