Lessons learned

Momentum is building around the world for the adoption of electronic health records (EHRs) and related information technology (IT) to improve the quality, safety and operating efficiencies of health care. Provinces across Canada are pursuing EHR strategies and rollout plans, and one recent report from Canada Health Infoway described a short-term goal of covering 50 per cent of the population with an electronic health records system by 2009.

Besides Canada, the United Kingdom, France, Italy and Singapore, are well advanced with initiatives to build national EHR systems and other health care IT tools. And in the United States, President Bush and Congressional leaders have endorsed EHRs as a critical component of solutions aimed at dramatically enhancing care while reducing costs.

But despite the enormous opportunities, the effective use of IT in health care has proved challenging. Some reports suggest that the success rate for clinical IT projects in actually achieving their stated objectives may be less than 50 per cent.

For clinical IT to fulfill its potential of helping to transform health care, an understanding of success factors is critical. To that end, Accenture recently collaborated with the Vanderbilt Centre for Better Health to identify the critical success factors for clinical IT adoption. The study suggests a number of key strategies that appear to have a significant effects on the adoption of new technologies by clinicians.

The Seven “Secrets” of Successful Clinical Change Vanderbilt researchers interviewed nearly 50 executives and clinicians at 22 hospitals and health systems in five countries, including three organizations from Canada, that are in the process of implementing clinical information systems (EHRs, Computerized Provider Order Entry (CPOE) and clinical decision support). Perhaps the most important finding is that, regardless of the formal relationship to the institution, physician engagement and support is a critical variable in the overall success of an implementation.

Maybe not big news, we know.

What is news from this research is how few people really do this well. But the research showed very clearly that the organizations that took this step into account had a far greater likelihood of success than those that did not. Most actually revisited this idea, and the ones listed below, only when an implementation failed and they had to regroup.

We also know that doing this right takes more time and effort, and therefore costs more money at the start. But experience suggests that it is more expensive to have an initiative fail after year than it is to start slowly. From this insight, and the experiences and perspectives of other successful initiatives, seven lessons for implementing clinical IT projects emerged:

1. Alignment of clinical and administrative leadership First and foremost, clinical and executive leadership must agree on the goals and expected results of clinical IT projects. In fact, our research found that executives and clinicians are most likely to agree when a clinical IT initiative is presented as part of an overall strategy.

2. Effective, early engagement of clinicians Real and substantive involvement of the clinicians in early planning – and throughout the project – is essential. Clinicians expect their input to weigh heavily on the selection, design and deployment of the system. In choosing physician input, it makes strategic sense to enlist medical leaders who have influence over broad groups of their peers as champions for the project as well as IT-savvy physicians who may be more willing to act as early adopters.

3. Unique relationship between physician and the institution As the face of the medical institution to patients, physicians have an undeniably unique role. For example, they often bear the major burden in adopting EHRs, CPOE and other new IT systems. These systems often require physicians to make changes to their ingrained work practices if they are to accomplish safety and patient care objectives.

It has been well documented that attempts to mandate physician use of IT tools can lead to resentment, lack of trust and even behaviour that undermines the initiative. Instead, leading organizations have begun focusing on ways to help physicians understand how the tools can improve their practice and patient outcomes. Many organizations reported that sharing information about the improved information access, ability to coordinate patient care and other benefits achieved by early adopters helped persuade many “wait-and-see” doctors to use the new technology.

4. Unwavering commitment to success Leaders can champion a successful project by showing strong resolve, and holding project managers accountable for progress. Institutional leaders who spent time at the outset identifying potential challenges and developing strategies for dealing with them fared better than their peers. In particular, leaders must emphasize that the clinical implementation project represents a strategic imperative for the organization and that there is no turning back.

5. Deploy to new places when the benefits are clear to clinicians Organizations have successfully used a variety of deployment approaches, from going live simultaneously across an entire institution to moving across units over time. Whatever the deployment strategy, however, many health systems did not implement the new system until a critical mass of clinical leaders in that specific unit, practice, service or facility agreed that the technology would benefit the group. To win this critical mass of support, many organizations facilitated collaborative sessions between administrators, IT leadership and clinicians and only went ahead when there was agreement that implementation would be a win for all parties.

6. Individualized approaches to training and support While some organizations started with classroom training for clinicians, virtually all 22 organizations in the study have migrated to individualized training and support. Given their severe time constraints, physicians respond better to training that adapts to their schedules. When several organizations began sending trainers to physicians for one-on-one help, their willingness to adopt the system rose dramatically. Moreover, using the actual system in real-life patient care settings improved the actual — as well as the perceived — effectiveness of the training.

7. Tight Feedback and Enhancement Cycles The ability and commitment to gather and incorporate feedback from users after the initial rollout is vital for continued clinical use of the system. Organizations that quickly enhanced technology based on the experiences of early adopters improved the system, its benefits and its credibility. Paying attention to the feedback provided by clinicians on how to make the system produce even greater benefits for patients, clinicians and the institution is a key strategy for driving adoption as quickly as possible.

The innovation of technology promises better and more consistent patient care with fewer problems and costs. Regardless of the country where new technology is being implemented, the more of these critical success factors that a hospital can incorporate into a large-scale technology implementation, the more likely it will be to drive adoption and produce better outcomes for clinicians and patients.

Jerry Garcia (jerry.m.garcia@accenture.com ) leads Accenture’s Health and Life Sciences unit in Canada, serving health care organizations, governments, and life science clients (pharmaceuticals, research and bio-medical)