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Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a This material (Comp Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a This material (Comp 12_Unit 9 a) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU 24 OC 000013.

HIT Implementation Planning for Quality and Safety Learning Objectives─Lecture a • Critique an implementation HIT Implementation Planning for Quality and Safety Learning Objectives─Lecture a • Critique an implementation team and the role it plays in ensuring quality. • Analyze effective implementation planning. Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 2

Transition “It isn’t the changes that do you in, it’s the transitions. ” (William Transition “It isn’t the changes that do you in, it’s the transitions. ” (William Bridges, 2009) Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 3

Effective Implementation Teams Team Characteristics Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Effective Implementation Teams Team Characteristics Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 4

Effective Implementation Teams Team Characteristics • “Contact is not enough. ”(Sargeant, et al, 2008) Effective Implementation Teams Team Characteristics • “Contact is not enough. ”(Sargeant, et al, 2008) • Effective teamwork requires: – Communication – Understanding & respecting team member roles – Understanding the clinical practice setting – Having practical “know-how” – Recognizing that teamwork requires work Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 5

Effective Implementation Teams Team Characteristics • “Contact is not enough. ” • Effective teamwork Effective Implementation Teams Team Characteristics • “Contact is not enough. ” • Effective teamwork requires: – Communication – Understanding & respecting team member roles – Understanding the clinical practice setting – Having practical “know-how” – Recognizing that teamwork requires work Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 6

Effective Implementation Teams Team Characteristics • “Contact is not enough. ” • Effective teamwork Effective Implementation Teams Team Characteristics • “Contact is not enough. ” • Effective teamwork requires: – Communication – Understanding & respecting team member roles – Understanding the clinical practice setting – Having practical “know-how” – Recognizing that teamwork requires work Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 7

Effective Implementation Teams Team Characteristics • “Contact is not enough. ” • Effective teamwork Effective Implementation Teams Team Characteristics • “Contact is not enough. ” • Effective teamwork requires: – Communication – Understanding & respecting team member roles – Understanding the clinical practice setting – Having practical “know-how” – Recognizing that teamwork requires work Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 8

Effective Implementation Teams Team Characteristics • “Contact is not enough. ” • Effective teamwork Effective Implementation Teams Team Characteristics • “Contact is not enough. ” • Effective teamwork requires: – Communication – Understanding & respecting team member roles – Understanding the clinical practice setting – Having practical “know-how” – Recognizing that teamwork requires work Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 9

Effective Implementation Teams Lessons Learned • Organizational Decision Making and Project Management – Empower Effective Implementation Teams Lessons Learned • Organizational Decision Making and Project Management – Empower project leaders who are close to the ground – Ensure close coordination of operations, clinicians, and IT – Beware of scope creep – Begin with the end in mind – Engage “bridgers” Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 10

Effective Implementation Teams Lessons Learned • System deployment and roll out – Don’t try Effective Implementation Teams Lessons Learned • System deployment and roll out – Don’t try for perfection…it won’t happen. – Pilot, improve, roll out, and improve – Value the curmudgeons – Get feedback and use it – Look for the opportunity and the easy win Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 11

Effective Implementation Teams Lessons Learned • System deployment and roll out – Training never Effective Implementation Teams Lessons Learned • System deployment and roll out – Training never ends – Implementation never ends – Users are beta testers – Be nimble, be quick – Patient care comes first Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 12

HIT Implementation Strategies Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT HIT Implementation Strategies Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 13

HIT Implementation Strategies: Single Vendor • Accountable care organization delivery model requires ability to HIT Implementation Strategies: Single Vendor • Accountable care organization delivery model requires ability to capture and share data across all care modalities • Enterprise architectures avoid the need to develop and maintain complex bidirectional interfaces between disparate applications. • Strategy used in primary care settings Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 14

HIT Implementation Strategies: Single Vendor Benefits • Contract management • Financial management • Competency HIT Implementation Strategies: Single Vendor Benefits • Contract management • Financial management • Competency development • Software maintenance Health IT Workforce Curriculum Version 3. 0/Spring 2012 Limitations • Often necessitates radical change • Professional resistance • Failure: significant financial losses • Curtails future ability to change to another vendor Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 15

HIT Implementation Strategies: Best of Breed • May have different vendors for the acute HIT Implementation Strategies: Best of Breed • May have different vendors for the acute care EHR, ED, ambulatory EHR, and surgery environments • Usually found in academic medical centers • Requires interfaces for exchanging data between these disparate systems, creating additional capital and operating costs to upgrade and maintain Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 16

HIT Implementation Strategies: Best of Breed Benefits Limitations • Avoids massive business process reengineering HIT Implementation Strategies: Best of Breed Benefits Limitations • Avoids massive business process reengineering • Closely aligned with service-specific requirements • Higher quality • Competitive advantage • Fragmentation • Requires wide range of skills to manage multiple applications • Compliance risk with financial implications Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 17

HIT Implementation Strategies: Best of Suite • Organization selects an EHR vendor to provide HIT Implementation Strategies: Best of Suite • Organization selects an EHR vendor to provide the clinical IT support for delivery care across all modalities beyond the acute care setting • Usually found in large urban hospitals and integrated delivery system within the last 10 years Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 18

HIT Implementation Strategies: Best of Suite Benefits • Retain/integrate legacy clinical applications • Reduce HIT Implementation Strategies: Best of Suite Benefits • Retain/integrate legacy clinical applications • Reduce need for disruptive work process redesign • Decrease professional resistance Health IT Workforce Curriculum Version 3. 0/Spring 2012 Limitation • Vendors have strong bargaining positions with respect to future contracting rates and customization flexibility Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 19

HIT Implementation Clinical Workflow • Process description – How tasks are done – By HIT Implementation Clinical Workflow • Process description – How tasks are done – By whom – In what order – How quickly • Set of relationship between all activities from start to finish • Movement of information across organization Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 20

HIT Implementation One Size Does Not Fit All Primary Care • Key factors: – HIT Implementation One Size Does Not Fit All Primary Care • Key factors: – Expectations of EHRs – Time and training required to implement and adopt the EHR – Emergence of an EHR champion or problemsolver – Providers’ readiness to accept the system Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 21

HIT Implementation Small Ambulatory Practices Barriers • Cost • Lack of standardization/ designed for HIT Implementation Small Ambulatory Practices Barriers • Cost • Lack of standardization/ designed for large practices • Technical support • Productivity reductions • Resistance to change • No perceived benefits for providers Health IT Workforce Curriculum Version 3. 0/Spring 2012 Steps for Success • Build in flexibility • Secure buy-in (local ownership of project and change process) • Create an actionable vision for change • Tailor each phase to the individual practice • Monitor goal achievement Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 22

HIT Implementation Vendor Selection in Primary Care Health IT Workforce Curriculum Version 3. 0/Spring HIT Implementation Vendor Selection in Primary Care Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 23

HIT Implementation Critical Access Hospitals • Critical Access Status requires: – Not-for-profit – In HIT Implementation Critical Access Hospitals • Critical Access Status requires: – Not-for-profit – In a non-metropolitan statistical area – At least 35 miles (mountainous areas: 15 miles) from a short-term general hospital – 25 or fewer acute-care beds • Improves financial ability to invest in HIT Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 24

HIT Implementation Critical Access Hospitals • Number of IT Staff – 34% have none; HIT Implementation Critical Access Hospitals • Number of IT Staff – 34% have none; 50% have 1 -2 • Use of external IT consultants – 91% use external consultants (50% to a large or great extent) Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 25

HIT Implementation Critical Access Hospitals • Outsourcing for IT services – 85% outsource, mostly HIT Implementation Critical Access Hospitals • Outsourcing for IT services – 85% outsource, mostly for highly technical work • Application service providers – 38% use ASP, but only 9% to a great extent Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 26

HIT Implementation Critical Access Hospitals • Organization has clear strategies, objectives, and plans • HIT Implementation Critical Access Hospitals • Organization has clear strategies, objectives, and plans • Management discusses ways to link IT agenda to organization’s strategies • Organization holds itself accountable for its performance • Efficient/effective IT governance is in place • Organization determines processes that require IT-enabled improvement/measures performance Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 27

HIT Implementation Hospitals • Multiple supporting initiatives are incorporated • Organization understands the complicated HIT Implementation Hospitals • Multiple supporting initiatives are incorporated • Organization understands the complicated nature of the EHR value proposition • Clinicians are continually engaged in improving systems and related workflows • Investment in infrastructure is supported • Organization invests in modest, thoughtful IT experimentation Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 28

HIT Implementation Planning for Quality and Safety Summary─Lecture a • Characteristics of effective implementation HIT Implementation Planning for Quality and Safety Summary─Lecture a • Characteristics of effective implementation teams include organizational structure, team processes, and individual contributions. • Six key drivers of implementation effectiveness include: purpose, goals, leadership, cohesion, communication, and mutual respect. • Contact is not enough. • Organizations can use single vendor, best of breed, or best of suite strategies. • There is no single right way to implement HIT. • HIT professionals can assist each organization to design an implementation plan that meets its unique needs. Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 29

HIT Implementation Planning for Quality and Safety Reference─Lecture a References • Bridges, W. , HIT Implementation Planning for Quality and Safety Reference─Lecture a References • Bridges, W. , Bridges, S. Managing Transitions. Making the Most of Change. 3 rd edition. Philadelphia, PA: Da. Capo Press. 2009 • Chin, H. L. The reality of EMR implementation: lessons from the field. The Permanente J, 2004 Fall; 8(4): 1: 7 Available from: http: //xnet. kp. org/permanentejournal/fall 04/reality. html • Dave, M. , Garets, D. Vendors with mature enterprise architectures lead the market. Washington, DC: The Advisory Board Company, July 9, 2010. • Ford, E. W. , Menachemi, N. , Huerta, T. R. , Yu, F. Hospital IT adoption strategies associated with implementation success: implications for achieving meaningful use. J Healthc Manag. 2010 May-Jun; 55(3): 175 -88; discussion 188 -9. • Glaser, J. Implementing electronic health records: 10 factors for success. Health Finance Manage. 2009 HIMSS. Survey of ambulatory practices. http: //www. himss. org/ASP/topics_Focus. Dynamic. asp? faid=158 • Mickan, S. , Rodger, S. Characteristics of effective teams: a literature review. Aust Health Rev 2000; 23(3): 201 -208. • Mickan SM, Rodger SA. Effective health care teams: A model of six characteristics developed form shared perceptions. J Interprof Care. 2005 Aug; 19(4): 358 -70. • Sargeant, J. , Loney , E. , Murphy, G. Effective interprofessional teams: “Contact is not enough” to build teams. J Contin Educ Health Prof. 2008 Fall; 28(4): 228 -234. • Terry, A. , Thorpe, C. F. , Giles, G. , et al. Implementing electronic health records. Key factors in primary care. Can Fam Physician. 2008 May; 54(7): 730 -736 • Whittenburg, L. Analysis of nursing workflow documentation in the electronic health record. J Healthc Inf Manag. 2010 Summer; 24(3): 71 -5. ) Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 30

HIT Implementation Planning for Quality and Safety Reference─Lecture a Images Slide 4: Effective Implementation HIT Implementation Planning for Quality and Safety Reference─Lecture a Images Slide 4: Effective Implementation Teams – Team Characteristics. . Adapted from Mickan and Rodger by Dr. Anna Maria Izquierdo-Porrera Slide 13: HIT Implementation Strategies. Dr. Anna Maria Izquierdo-Porrera Slide 23: HIT Implementation Vendor Selection in Primary Care. Dr. Anna Maria Izquierdo-Porrera Health IT Workforce Curriculum Version 3. 0/Spring 2012 Quality Improvement HIT Implementation Planning for Quality and Safety Lecture a 31