Operational Engagement and Ownership in an EHR Implementation
An EHR implementation is often the largest and most transformative project undertaken by a healthcare organization. The implementation program is a conglomerate of projects involving technology infrastructure, software applications (EHR and many 3rd party applications), and people. The vendors have great recommendations, success examples, and methodologies surrounding the technology and application configuration, workflow, testing, and training. However, the vendor recommendations on the people side of the project can be less robust. While there may be some specific engagement activities around design, validation, and testing; there is little attention paid to change management and culture. People not only make up the bulk of the capital and operational expense of the project but are also the wildcard for success. The people side of the program includes operational engagement, organizational and individual change management, communication, and culture shaping. This white paper describes some of the key factors needed on the people-side of the program to ensure success.
Success Factors Related to Operations
Operations Owned/IT Driven
It is often the wish of the organization to have operations “own” the EHR program. This is the right mental frame of mind for the organization as the operational side of the house (both clinical and business) will be the ones using the system and incorporating it as a tool into their daily work processes. However, that does not mean that the implementation team needs to be built outside of IT. Typically, the IT department has the experience and skills to run a project and the software/hardware work will fall upon their shoulders. Decisions regarding configuration and workflows should be made through the expertise of the operational stakeholders involved in the project. Similarly, the steering committee and advisory councils should be led and comprised primarily of operational experts.
Support from the Top Down
From the CEO down through all layers of leadership, there needs to be a clear message to the importance and priority for the organization to be successful in this transformation. This is one of those hard-line messages where you are either on the bus or it’s your time to hop off and choose a new employer, especially for organizations that have struggled with success in the past through subculture upwellings or individual leaders who have successfully stopped a project through stonewalling. Failure is not an option and every leader must be on board. Below are a couple of examples of support and engagement from the top:
- The CEO of a 2 hospital health system had mandatory stand-up meetings with all of the organizational leadership down to the front line managers where he used the clear message regarding the strategic direction and plan. He actually used the message that you are either “on the bus” or you should begin looking for a new job.
- The CEO of a 30+ hospital system set up and led weekly meetings every Monday to work through roadblocks with 3rd party contracting during their implementation. This CEO would pick up the phone and speak with his peers at the 3rd party companies to escalate and gain the traction needed to keep the project on track.
Build and Use a Set of Guiding Principles
Having a common set of principles to refer to and ground all those involved in the project is critical to keeping the program on budget and within the scope defined. We recommend sharing these guiding principles in every governance meeting for several sessions until they become ingrained into all participants minds. Having guiding principles can de-escalate controversy on additions to scope, use of niche solutions that duplicate what the larger EHR can also do, and improve decision making. Typical guiding principles include statements around:
- A focus on the patient
- Use of the model or foundational system from the vendor to limit custom work
- Use of the integrated EHR if the functionality is available and it meets most (not necessarily all) of the needs
- Standardizing workflows and content across the enterprise
- Building for a future of growth and innovation
- Operational ownership and responsibility
- Fiscal and project responsibility to Budget/Scope/Timeline
About the Author
Adam Tallinger, RPh MHA CPHIMS
Vice President, Provider Solutions
In his role at Divurgent, Adam serves as a client executive, manager to consulting services, partners with sales in new pursuits, and assists in new service development.
As a highly experienced licensed pharmacist with over twenty-seven years of experience in electronic health record implementation, IT management, program and operational leadership, informatics, and healthcare operations, Adam brings a holistic view blending the needs of our clients, their affiliated providers, and the patients they serve. Specific experience includes enterprise, inpatient, and pharmacy systems implementation, project management, system design and development, operational change management, culture shaping, leadership advising and coaching, documentation development, end-user training, and application support. Adam has successfully led large IDN EHR implementations in both private and academic organizations. In addition to the not-for profit’s industry, he is a trusted advisor in the international, for-profit, and government healthcare spaces. He excels at enhancing patient care through the incorporation of technology as a partner, setting and leading to expectations, and building a proactive learning culture.
Adam views clients as partners, where exceeding expectations and building long-term relationships are the norm. In addition to managing the technology in healthcare IT projects, Adam is passionate about the human capital aspects of projects. Paying attention to change management, operational readiness, communication, and culture shaping are all factors to improve success in delivery.
Adam earned his B.Sc. at Oregon State University in Pharmacy and practiced as a critical care pharmacist for 13 years. He also has a Masters in Healthcare Administration with a concentration in Informatics and is a Certified Professional in Healthcare Information Management Systems.
