We can lead a horse to water, but can we make him drink?
A colleague’s family member was recently admitted to the hospital after experiencing dizziness and disorientation. The person was transported by ambulance to the nearest emergency room, which was unfortunately not affiliated with their regular health system. At first, this was disconcerting for my colleague. As her relative’s designated advocate, she would have preferred that her loved one be seen by his regular doctors who are familiar with his health history. Though inconvenient, she reasoned that a transfer was not necessary. The admitting hospital has an excellent reputation for care quality and a transfer would have only made an already stressful situation even more nerve-racking. Besides, as an employee of the local HIE, she knew that her relative’s health history would be readily available, as both health systems are active participants with access to the community health record.
Following an initial examination by the attending physician, my colleague was asked to authorize a CT scan to assure that her loved one’s symptoms did not indicate a larger health issue. Coincidentally, the family member had had a CT scan a couple of weeks before, as part of a regular neuro workup. When my friend informed the nurse of this, and suggested that they access the test results using the community health record, she was told that it wasn’t possible. My friend pressed the point until the nurse told her she would double check. A few minutes later, the nurse returned and informed her that the doctor would like to take a look at the results of the earlier scan before ordering an additional test. The nurse then handed her an authorization form, and asked for a signature to grant permission to request the necessary information from the other hospital.
[I’m speculating here, but based on this interaction, I suspect that the nurse took my friend’s signed authorization form and faxed it to the other physician’s office, where someone else took receipt, pulled the file and faxed the test results back. So much for “real time electronic access to critical patient data”!]
This whole scenario brought home the reality that provider “participation” with an HIE is not equivalent to constructive utilization of the resources this technology provides. It begs the question, if the most revolutionary tools for enhancing patient experience, improving outcomes, and reducing the costs of care are readily available, but no one uses them, do they even matter?
The obstacle illustrated in this example is not a technical problem, it’s a cultural one. That is where the REAL work of creating an interoperable health care system lives; at the local, regional, and ultimately national level. As providers of HIE solutions and services it is incumbent on us to deliver solutions that solve real problems, and to do all we can to assure that they will be used. And yet, we can bring the horse to water, but can we make him drink?
One of the reasons this is so hard is that there is no “one size fits all” solution, and there is nothing less productive or more doomed to failure than trying to force a square peg into a round hole. We recognize that technology adoption moves at the speed of trust, and we work hard to earn it with every customer interaction. Helping healthcare providers move from the initial implementation to actively using the tools, and recognizing their value, is an evolution for every practice. We learn something new with each engagement that we then apply to future deployments.
So, based on our experience, what is a better formula for creating constructive utilization? Here are a few thoughts that might move us closer to the goal…
What do Users want from HIE?
Intuitive Technology – It is a reality that many business-focused IT systems sacrifice form for function, and are often designed from the vendor’s perspective rather than the end users. There is certainly a business case to be made for “functional”, and we can’t afford to stand around waiting for “pretty good” to evolve into “perfect”. But developers should also recognize that a user interface that is simple, intuitive and dare I say FUN, will have a much better shot at being fully adopted and actively used than one that is not.
Workflow Sensitivity – When you have seen one provider’s workflow, you’ve seen ONE provider’s workflow. Workflow impacts office staff and processes at all levels, and at different points within the practice. Identifying processes, understanding how they interact with each other, and tailoring the solution to meet their unique needs is key to acceptance, adoption, and constructive use.
Tangible Value – It seems pretty fundamental that a company’s value should be defined by the customer, according to the tangible benefits that they realize in using the product. But it’s easy to hyper-focus on a particular statistic, say the number of solutions deployed, as the driving metric for progress; regardless of whether the customer is actually realizing the intended value. To stay focused on delivering value, it’s helpful to define it in simple terms. One early yardstick used by GLHC was “How many fax machines were turned OFF as a result of a GLHC solution?” If technology isn’t making the provider’s life easier, and enhancing their ability to provide better patient care, then it has missed the mark.
Relational Perspective – Implementation of any health information technology system requires an enormous investment of capital, professional resources, and staff goodwill on the part of the practice. Approaching an engagement from a collaborative, consultative, and long-term perspective is critical to success. The best teams understand that the business development process doesn’t end when the statement of work is signed or even when the solution is deployed. That’s the point when the REAL work begins! The same time and attention paid to getting the business should also be applied to training, follow-up, and ongoing support.
What does HIE need from users?
Invested Leadership –The highest levels within the organization must understand the goals and value of the technology, and regularly express enthusiastic support for its use. Then this message should be clearly communicated both vertically and horizontally across the organization. The importance of presenting a unified message encouraging active adoption by all staff increases in direct proportion to the size of an organization, layers of management, and number of departments.
Realistic Expectations – Despite some amazing technological advancements made in the last 20 years, we’re still a LONG way from being able to have Mr. Scott “beam us up”… The same is true in health information technology. The ONC’s 2015 Update on the Adoption of Health IT reported that 97% of hospitals have certified EHR technology solutions in place as of 2014; an eight-fold increase since 2008. Equally impressive growth has been reported in patient access to electronic health information, and (in select states and regions) the capacity for providers to share patient data electronically. Despite this rapid pace of development and adoption, much more remains to be accomplished. While waiting for the next leap forward, a “glass half-full” perspective combined with a healthy dose of patience goes a long way towards maintaining realistic expectations.
Change Orientation – If implementing the Affordable Care Act has taught us anything, it’s that the brave new world of healthcare delivery is symbiotically tied to technology. When leveraged effectively, technology CAN enhance the experience for both patients and providers. Experts suggest that provider organizations that can adapt and embrace change, particularly as it relates to the ongoing evolution of HIT, are best positioned to realize the benefits – both in organizational efficiencies and in patient outcomes.
Integrated Training – Deploying new HIE solutions is challenging. Assuring that all stakeholders receive adequate training adds complexity, but is critical to successful adoption of the tools. Ideally, every employee who accesses the system should receive some amount of user orientation. Training modules can be tailored to the specific needs of each user (what a physician or senior executive needs to know is likely to be different from what a referral manager needs to know). Regularly scheduled onboarding orientations for new hires, as well as periodic refresher sessions to review any changes, upgrades, and/or patches that may have been installed are important to maintaining long term use. Whether these periodic trainings are delivered in person, via webinar, or with pre-recorded video tutorials, assuring that stakeholders are aware of system enhancements will help maintain engagement and ROI for an organization’s HIT investment in the long-term.
The ultimate goal of HIE is to have the right patient information, in the right place, at the right time; and in so doing contribute to achieving the Triple Aim. Are ALL those with skin in the game committed to that vision? Or are some just going through the motions so they can check the “Meaningful Use Achieved” box on a Medicare reimbursement form?
If my colleague’s recent experience is any indication, it seems clear that some significant collaborative effort is required to drive adoption and constructive ongoing use of available tools. We have offered some suggestions here, but what have we missed? What else needs to change in order to see a seismic shift in HIE engagement?
This article was originally published on Great Lakes Health Connect and is republished here with permission.