Workflows can make or break a health IT initiative at hospitals and health systems because they dictate the difficulty of adoption of new technology. The less congruent an HIT system is with a physician’s workflow, the less likely the physician is to use it. Case in point: A recent KLAS survey found that poor integration with clinical workflow was one of the major barriers to clinical decision support success among healthcare providers.
Lauren Fifield, senior government affairs advisor at athenahealth, said physician clients’ compliance for meaningful use measures was lowest for those that required new workflows. For example, at the beginning of September, athenahealth providers’ compliance for providing clinical summaries for patients was 31.5 percent while compliance for checking drug interactions (in providers’ workflows) and exchanging key clinical information electronically (performed by athenahealth) was 100 percent. Ms. Fifield attributes this difference to the different compatibilities with providers’ current workflows. Furthermore, after athenahealth conducted usability testing and provider training to make the clinical summary workflow more intuitive, the success rates of providers rapidly improved. As of Nov. 19, 92.2 percent of the company’s Medicare eligible providers were satisfying the clinical summary measure.
Hospitals and health systems, then, should be careful to design workflows that are compatible with new technology. Eric Johannesson, manager of IT program management at Elliot Health System in Manchester, N.H., offers five tips for building workflows for new HIT systems in hospitals.
1. Think of HIT implementation as an opportunity to optimize workflows. Mr. Johannesson, who is also chair of the Management Engineering-Process Improvement Committee at HIMSS, says one of the problems in HIT implementation is that people often view the technology as a disruption to current workflows instead of an opportunity to optimize and create new workflows. “Approach implementation of health IT as an enabler of clinicians’ workflows rather than something they need to fit in or adapt to,” he says.
Instead of simply automating existing manual processes, Mr. Johannesson suggests starting from the beginning to evaluate inefficiencies in current workflows and identify ways to eliminate them. “Initially, like most kinds of changes, there’s going to be a slow-down and [then a] ramp-up again for efficiency — definitely the elimination of unnecessary workflows, steps and inefficiencies that have plagued the healthcare system forever,” he says. However, HIT should not be regarded as forcing new workflows on physicians, but instead as facilitating workflows to improve patient outcomes, according to Mr. Johannesson.
This approach to HIT can change the willingness of physicians and employees to change their patterns of working, for buying into HIT is essentially “buying into the philosophy of transforming the way they practice,” Ms. Fifield says.
2. Bring clinicians on board. Restructuring workflows with HIT requires the involvement of the hospital’s clinicians from the beginning. Their participation will ensure the new workflows are feasible and help gain their buy-in. “Getting people involved so they’re really engaged in helping to drive change is going to be critical in helping adapt and evolve in [these] systems,” Mr. Johannesson says.
Although gaining buy-in from physicians, nurses and other staff is one of the biggest challenges when implementing HIT and changing workflows, there are strategies hospitals can use to gain their support. First, hospitals need to explain to physicians and staff the benefits of HIT for them and their patients. “[They] need to develop a communication plan that presents a compelling vision of the future for clinicians and patient outcomes,” Mr. Johannesson says. “Clearly outline what it is you’re trying to accomplish as a clinical organization and really drive that forward to the rest of the clinician groups and ancillary staff.”
Hospitals should also identify physician champions — those who are interested in process change and new systems — to persuade their colleagues to support HIT and reevaluate their processes. “It has more of an impact than a bureaucratic person telling [them] to do this or that,” Mr. Johannesson says. “More value is seen and [it’s] taken much more readily than when it’s being pushed on them.”
3. Map current workflows and eliminate inefficiencies. Once physicians are on board, the HIT team and the physicians need to conduct an end-to-end analysis of the existing workflows that will be affected by the new technology. Then, the clinicians and IT team should design new workflows that would improve efficiency and facilitate HIT adoption. “You have to look to leverage the system that you’re implementing, but also look for opportunities in that process where the system might help to streamline and eliminate steps in the process,” Mr. Johannesson says.
For example, computerized provider order entry changes how physicians order prescriptions. When Elliot Health System implemented CPOE, the IT team worked with the physician champions to develop specified order sets that would be available to them on the system, according to Mr. Johannesson.
4. Practice and train. As hospitals design new workflows, they should give physicians and employees an opportunity to practice using the new processes with the new technology and suggest any adjustments before the system is brought on-line. For example, Elliot Health System offers physicians and staff a “playground:” a model of the new technology that can be used without affecting the hospital network. “We were able to create a mirrored environment of an existing system with CPOE capabilities. As we made modifications, it was available to [physician champions] helping to design changes in the system. It created that first level of validation before [it] went to true testing,” Mr. Johannesson says.
Physicians and employees will also need to be trained to use the HIT and new workflows. Mr. Johannesson’s system developed a “super user” model in which provider champions received extra training so they could support other physicians and staff. This peer-to-peer approach was effective because the trainers and trainees had a shared background and could more easily communicate than they could with people coming from outside the organization.
5. Provide support. After the HIT system and new workflow processes are implemented, hospitals should provide adequate support to ensure adoption throughout the organization. Support should be particularly robust immediately following implementation, but should continue for several months as people transition to new practices. This level of support should be provided regardless of the amount of prior training. “No matter how much training [you had], when you’re actually there with a patient in front of you, it’s easy to forget,” Mr. Johannesson says. “Providing on-the-floor support was a significant part of our implementation.”