April 4, 2007
It has become clear that the way to achieve clinical quality improvement through healthcare IT is to engage clinicians in system selection and implementation. First, have a plan—developed as part of your strategic organizational plan with representatives of all stakeholders, potentially including consumers—for how you expect to implement all elements of an electronic health record (EHR) system.
Planning for the EHR, as part and parcel of other initiatives, keeps it from being only an IT project or only a clinical project. According to an article in the February 2007 hfm magazine, planning is critical because the clinical applications you choose to implement have significant dependencies—on other information systems, and on the people, policies, processes, and operations that are needed to support them.
Plan Components
The components of your strategic organizational plan to incorporate clinical information systems should address issues such as medication management, overall physician productivity, and physician acceptance of the systems.
Medication Management
For improved medication management, consider which should be implemented first—computerized provider order entry or a bar-code medication administration record, or even something else. Your plan ought to consider where your key issues exist: Are errors made most frequently in the ordering process or the administration of medications?
Productivity
For overall productivity improvement, consider why physicians especially may not access the electronic medical record that you've adopted to deal with all the paper in your environment. Could it be that accessing images of documents feels like the clerical task of pulling charts and often results in no better availability of information? Could it be that there are insufficient workstations, inadequate indexing, or too complex tree structures to make access easy?
Physician Acceptance
Will physicians use structured data entry templates and clinical decision support? You probably think that if you can't get physicians to accept CPOE, how could you ever get them to abandon their dictation? And you would probably be right—for now. But consider how an EHR without such capability compares with the systems that physicians are acquiring for their offices—which tend to return far greater value and are much more flexible and customizable than what most hospitals are considering.
Strategies for Engaging Physicians
In addition to an overall plan that lays out how clinical information system components will integrate with other aspects of your planning, take steps now to begin engaging clinicians long before the next IT application is selected or installed.
Some ways to do this include the following:
- Adopt a formal, ongoing process improvement program that integrates with all aspects of clinical performance in the organization
- Adopt clinical guidelines and evidence-based medicine to prepare for pay-for-performance programs
- Define and commit to achieving measurable goals—in all aspects of your organization, as well as for the EHR
- Require clinicians, including physicians, to participate in key decision-making phases of the EHR project and to help design, test, and learn the system
Stand Behind Your Expectations
A final way to ensure clinician engagement is to stand behind your expectations. Every time there has been a major change required of clinicians—whether DRGs, a new dictation system, or different staffing patterns—the dilemma has always been, "Do we absolutely require its adoption, or do we give in to those who resist change?" With an EHR, it is very easy to give in to those who don't want to use the system. But hospitals are finding that standing firm actually results in a better environment, where everyone is treated, and therefore viewed, as equals.
SOURCE: To Achieve Clinical Quality Improvement Through IT, Engage Clinicians, February 2007 hfm magazine
Additional Resources:
If you have questions or comments about HFMA Wants You to Know, contact editor Maxine Harrison.
HFMA Wants You to Know ISSN: 1540-0697. Volume VI, Issue 7. Copyright 2007, Healthcare Financial Management Association. All rights reserved.