Health Information Technology (HIT): Change and ... · Root Cause Analysis Clinician Satisfaction...
Transcript of Health Information Technology (HIT): Change and ... · Root Cause Analysis Clinician Satisfaction...
600 East Superior Street, Suite 404 I Duluth, MN 55802 I Ph. 218.727.9390 I www.ruralcenter.org
Health Information Technology (HIT):Change and Performance Frameworks
Terry HillExecutive Director
July 2010
The Challenge of ChangeThe Challenge of Change
SynerChange Chicago © 2010
Ch Wh W K !Change – What We Know!
• Increasing at an exponential rate• Increasing at an exponential rate
• Has both dangers and opportunities
• Assimilate change at micro organizational and • Assimilate change at micro, organizational, and macro levels
• Increasingly people are hitting their “future shock” Increasingly people are hitting their future shock threshold
SynerChange Chicago © 2010
F Sh kFuture Shock
That point in time when people can no longer assimilate change without displaying dysfunctional dysfunctional behavior
•Based on the work of Alvin TofflerSynerChange Chicago © 2010
G lGoal
• Raise the future shock threshold• Raise the future shock threshold
- Education
Increase resilience during change- Increase resilience during change
• Use fewer assimilation points during change
I l t h ff ti l- Implement change more effectively
SynerChange Chicago © 2010
Change as a ProcessChange as a Process
SynerChange Chicago © 2010
Ch PChange as a Process
PresentState
TransitionState Desired
StateState
SynerChange Chicago © 2010
T i i S Ch i iTransition State Characteristics
• Low stability• Low stability
• High emotional stress
• High often undirected energy• High, often undirected energy
• Control becomes a major issue
P t tt f b h i b hi hl l d• Past patterns of behavior become highly valued
• Conflict increases
SynerChange Chicago © 2010
Ch PChange as a Process
Learning
Present Transition
Learning
PresentState
TransitionState Desired
State
•Based on the work of ODR, Inc.SynerChange Chicago © 2010
B i HIT A iBasic HIT Assumptions
• Rural hospitals are extremely complex• Rural hospitals are extremely complex
• Electronic health record (EHR) adoption will be very difficult, requiring a multi-faceted, y , q g ,coordinated approach
• Reaching meaningful use will require profound change with a change-ready culture and effective, resilient leadership
Change is most effectively accomplished through • Change is most effectively accomplished through change management frameworks and business tools
S EHR I l iSteps to EHR Implementation
Pre‐EHR ReadinessPre‐EHR Readiness HIT Strategy and VisionHIT Strategy and Vision
EHR System Selection
EHR System Selection
EHR Project Initiation
EHR Project Initiation
EHR Implementation
EHR Implementation
EHR Operations
EHR Operations
-Policies -Vision - Define -Project -Project -On-going
-By-laws
-Process flows
Readiness
-Goals and objectives
-Benefits
requirements
-Identify vendors
Develop RFP
resource plan
-Project budget
-Governance
management
-Workflow design
Clinician
support
-Optimization
-Enhancements- Readiness assessment -Measureable
outcomes
-Develop RFP-Testing
-Clinician engagement
-Communication
-Upgradeplanning
KHA REACH TECHNICAL ASSISTANCE ROADMAP OVERVIEWThis roadmap will be used to develop a work plan modified for each organization to reflect its stage of EHR migration.
Meaningful Use/ImproveProject Mgr Training
Implement/OptimizePlanOrganize/Project Governance
Assess
Awareness
Implement/Optimize
System Build EHR Process Improvement
M.U. Attestation for 2011
M.U. Data Submission for 2012
IncentivesIssues ManagementChange ControlTeam Building
Contingency Planning
Vendor Implementation Gap Analysis
Job Descriptions & Documentation
Project Management
Steering Committee
Physician Champion
Facilitated Planning
Why EHR:Myths & Realities
REACH role
REACH process
What is EHR & Meaningful Use
(M.U.) Screen Layout
Clinical Decision Support (CDS)
Master Files/TablesFile Clean Up
Data/Codes Mapping
Templates/Order SetsIT Staffing & SpaceBenefits Realization
Cli i i S ti f ti
Roll Out StrategyImplementation Plan
Testing PlanTraining Plan
p y
Evidence-BasedG id li
Functionality
SMART Goals
Change Management
I.T. Acquisition Strategy
Total Cost of Ownership& Business Case
Stakeholder Visioning
Attitudes/Beliefs Survey
Readiness Assessment
Skill S
Leadership/Culture
EHR Vision(CDS)
Work Flows/Processes
Access Controls
Security Controls
Authentication & Certification for eRx
Unit Testing
Patient Safety
Quality Improvement
Monitoring GoalAchievement
Root Cause Analysis
Clinician Satisfaction
Patient Satisfaction
Hardware Upgrade & Maintenance
User Preferences
Ongoing Maintenance
Patches/Upgrades
GuidelinesStd VocabularyCore Data Sets
H/W Architecture DesignI/O Devices
Archive & B/UInteroperability
Work Flow/Process Analysis
Work Flow Training
Work Flow Review
Requirements Specs
Chart/Data ConversionFinancial Readiness
I.T. Staffing
Skills Survey
I.T. InventoryI.T. Strategic Plan/
Migration Path
Data Quality/Integrity Edits
Access ControlsEncryption
ReportsContinuity of Care Document (CCD)
Audit Logs
Patient Safety
Return on Investment
& MaintenanceCDS Maintenance
Health Info Exchange
Interoperability
HIO, NHIN
Public HealthInstallation
p yConnectivity
Privacy & SecurityDocumentation
M.U. Criteria
M.U. Testing
Integration Testing
Quality Reporting
HIPAA-HITECH Privacy& Security Assmt
Draft work plan
Readiness Documentation &
Feedback
If ready,
If not ready,
Select
Code of Conduct
Marketplace/Preferred Vendors/Demos
EHR Due Diligence
(Standard) RFPInterface Reqmts End User Training
Super User Training
Personal Health Record
Disease RegistriesPatient Centered
Medical Home
Biosurveillance
Clinical TrialsWork Flow/
Process Redesign
H/W (Certification)
Upgrades/Interfaces to Existing Systems
S/W Install
Network/TelecommPre-Load/Scanning &
Data ConversionRehearsal
Phase I – Go Live
Refine Work Plan
Process InterventionEHR Value PropositionOvercoming
Barriers
Site Visits
Reference Checks
Demos
Interface ReqmtsM.U. Checklist
Vendor of Choice
C t t N ti ti /GPO
POC Role Playing
EHR Training & Productivity
Regional Extension Assistance Center for HIT (REACH) for MN and ND
gPhysical Layout
Communicating w/Pts
Work Flow ChangesCustomer Commitment
Communication Plan
Subsequent Phases Go Live
Acceptance TestInterface Development
End User Support
Change Coaching
eRx & Quality Rpt for M.U.
DRAFT 2.304.29.10
Barriers
Medicaid M.U. Attestation
Contract Negotiation/GPO
Financing/Grants Asst
Approval to Buy
H/W Selection
Skills Building
Implemented and Supported
Valley of Despair
Leadership and
Good Choices and management
d l l
Implement EHRSupported
vity
Leadership and Management
Determines how long you’re in the valley of despair.
determines level of productivity
and satisfactionLittle or No HIT
oduct
iv
Choices, Planning, Execution
Determines extent of Slide Possible Future
Pro
Slide
Time
E i l f HIT Ad iEssentials for HIT Adoption
As identified by the National Rural HIT Coalition:As identified by the National Rural HIT Coalition:
• Leadership must be engaged
M di l t ff t b i l d• Medical staff must be involved
• Strategic planning is crucial to success
• Culture change is required
• HIT requires process redesign
• Networking is necessary
Ch ll i HIT Ad iChallenges in HIT Adoption
• Extreme HIT workforce shortages• Extreme HIT workforce shortages
• Education of staff and technicians
• Financial obstacles for HIT purchases and • Financial obstacles for HIT purchases and operations
• Rapid progress needed to achieve meaningful useRapid progress needed to achieve meaningful use
• Managing organizational change
Frameworks for Managing Frameworks for Managing Performance and Change
Baldridge Healthg
Balanced Scorecard
Studer
Baldridge Health Care Criteria for Baldridge Health Care Criteria for Performance Excellence Framework
2Strategic Planning
5Workforce Focus
1 71Leadership
3
7Results
3Focus on Patients, Other Customers and Markets
6Process Management
4Measurement, Analysis, and Knowledge
Management
D fi i i f B l d S dDefinition of Balanced Scorecard
The Balanced Scorecard is a framework •The Balanced Scorecard is a framework
that helps hospitals successfully carry out
a balanced set of organizational strategies
that drive both behavior and performance.
HIT Theme Strategy Map
FinanceIncreased margin to
fund mission
Increased cost efficiency
Increased revenue
As financial stakeholders, how do we intend to meet the goals and objectives in the hospital’s Mission
Statement?
Increased market share
Patient safety outcomes
Physician satisfaction Patient satisfaction
Community health outcomes
Customers & Community
As customers of the hospital’s services, what do we want, need or outcomes
Internal Processes
expect?
As members of the hospital staff, what do we need to do to meet the
needs of the patients and healthcare community?
Clinical processes Business processesOperational processes
Learning & Growth
A i ti h t
Ensure a skilled workforce
Establish an empowering work culture
Acquire needed HIT systems
As an organization, what type of culture, skills,
training and technology are we going to develop to support our processes?
Acquire HIT expertise
LeadershipInstill change managementOngoing education
S d P i i lStuder Principles
• Commit to excellenceCommit to excellence
• Measure the important things
• Build a culture around excellence
• Create and develop great leaders
S d P i i lStuder Principles
• Focus on employee satisfactionFocus on employee satisfaction
• Build individual accountability
• Align behaviors with goals and values
• Communicate at all levels
• Recognize and reward success
T HillTerry HillExecutive Directorecut e ecto
National Rural Health Resource Center600 East Superior Street, Suite 404
Duluth, MN 55802Duluth, MN 55802(218) 727-9390 ext. 232