The EMR: How to do it better and lessons learned Jennifer Frank, MD Appleton, WI April 27, 2007

EMR Implementation Cost People Timeline Set-Up Training Go-Live Workflow

People Extraverts Introverts Thinking Feeling DonFrancesco D. Preparing employees for EHR changes is like inviting Martha Stewart to dinner. Advance 2004. Extraverts: talk about what is going on, have a voice that is heard, be involved and have a visible role in the change Introverts: time alone to reflect what is going on, written or one-on-one communication, time to think about their opinion before brainstorming meetings, time to assimilate changes before taking action Thinking: show that: logic was made in the decision process, leadership is competent to manage change, change is fair and equitable Feeling: show that impact on people was recognized, leadership cares, values underlie the change, appreciation and support will be given during the change

Sample Timeline T-180 days: Start looking for an EMR T-175 days: Purchase an EMR T-174 days: Buy hardware T-173 days: Tell everyone about EMR Stuff happens…… T-30 days: Remind everyone about EMR T-29 days: Establish training schedule T: Implement T+1: EMR Utopia

Pay attention to Staff Morale as well as your own

Training Understand workflow Distraction-free training Spread out training so it sinks in Mental preparation “When employees are in the dark, they tend to think dark thoughts.” Train the trainer Creeping disability Lowes R. EMR success: training is the key. Medical Economics May 7, 2004.

Patient-Physician Interaction Spatial Relational Educational Structural

“I feel like my typing is interfering with my relationship with a patient, I stop typing – only then I’ve got a lot of typing to do later on.” Ventres 2006

Clinicians’ coping with the computer in the room Type while patient is talking Alternate between typing and talking Immediate documentation after the encounter Putting off documentation until later

Relational “There are times when it’s obvious you’re going through a structured way of dealing with a presenting problem. It’s click, click, point, and your note is done. Then there are these much more complex, human interactions. It just isn’t appropriate to be sitting there typing at the time.”

Physician Style Informationally-focused Interpersonal style Managerial style “Nothing about me without me”

Educational “The question is how to provide quality care. There are a lot of different components involved; some are electronic, others not. The EHR is but one part of a larger system.”

Educational Issues Physician comfort with computer Patient understanding of EMR Medical students/resident use of EMR Patient education

Structural “The algorithmic part of medicine feeds into the resistance against the EHR. From my perspective, that’s a huge benefit of the EHR with patient interaction. I can say ‘Here we have all these protocols set up. Let’s pull them up.’”

Structural Cookbook medicine facilitated by EMR Duplicate costs Degrees of acceptance

Lessons Learned Complex link between IT and organizational strategy. Great leadership has extraordinary value. Clinical informatics systems can deliver great value. Making healthcare professionals members of the IS team is essential.

More Lessons Learned First-rate implementations require skill and talent in a few critical areas. Planning, relationship, support Back to school Glaser JP. Lessons learned. Healthcare Informatics Online, September 2002.