The following is a guest blog post by Heather Haugen PhD from Atos Digital Health Solutions.
Several years ago, a reputable IT vendor offered our organization a trial version of their software in exchange for our feedback. The software provided equipment monitoring that would be valuable to us. Initially, we were excited because the functionality aligned with our needs and the application was robust enough to grow with us. It seemed that the software would fulfill our need. The new software system served IT directly, so our Director of IT led the implementation and kept our senior management team updated on the progress. We were impatient to get access to the dashboard of data the vendor promised. But months later, we were still waiting.
The price tag had lured us in, but we quickly realized the high cost in maintenance and labor required to make the application truly valuable. This story drives home a concept that we all understand, but often overlook; sometimes we underestimate the “care and feeding” required to maintain a valuable investment, putting the entire project at risk. In fact, we all need to remember the importance of sustainability after the initial excitement about an investment’s value. It is common to under-appreciate the effort it will take to maintain the value of our investments.
Let’s consider the shift in thinking required to move from implementing an Electronic Health Record to maintaining high levels of adoption over the life of the application. Many organizations focus on the implementation cost without truly appreciating the long-term cost of maintaining these large, complex systems. We often see this in healthcare organizations, no matter what size. Costs that are often underestimated include IT resources required for system maintenance; recruiting and retaining talent for new areas; ongoing training for new employees; upgrades for resources, training, and hardware; time and resources for optimizing systems and workflow; and expertise in finance and reporting needed to gain the value promised by the EHR.
In the world of EHR adoption, we often spend too much time focusing solely on implementing new software solutions. We know how to prepare well for the go-live event, but after go-live, organizations typically discontinue the investment of time and resources required to see the process through to the adoption phase. When this happens, users tend to fall back on work-arounds and ineffective workflows, and new users receive insufficient training. The process of adoption requires a radically different discipline, where the real effort begins at go-live.
After we successfully implement a new technology, our tendency is to move on to the next project. In a world where it is common to juggle multiple projects, we actually feel some relief in moving it off our list of highest priorities. What we need is a plan to sustain the long-term changes required. A sustainment plan addresses two important areas. First, it establishes how the organization will support the end users’ ongoing needs for the life of the application. This includes communication, education and maintenance of materials and resources. Second, it establishes how and when metrics will be collected to assess end user adoption and performance. By planning and executing a sustainment plan, we can avoid the steady deterioration in end user adoption that otherwise occurs over time.
Effective sustainability plans require resources, time, and money. Keep in mind that adoption is never static; it is continually either improving or degrading in the organization. Without a plan for training sustainment, a series of upgrades can quickly lead to decreased proficiency among end users, completely eroding the value of the application over time. Leadership must plan for and fund the investment in sustainment because the ultimate goal is improved performance. Many organizations only achieve modest adoption levels after a go-live event. To truly achieve sustained adoption levels, it takes relentless focus on improving quality of care, patient safety, and financial outcomes. The most successful sustainability plans are part of the organization’s initial budgeting and planning stages for EHR.
Sustainment means more than maintaining the status quo. If sustainment becomes a passive process, it is a waste of resources. The difference between a highly effective sustainment plan and one that is just mediocre is metrics. Consistently measuring end-user knowledge and confidence creates a barometer for proficiency levels and provides the earliest indication of adoption, or use of the application according to best practices. Ultimately, performance metrics are powerful indicators of whether end users are improving, maintaining, or regressing in their adoption of a new system. If the warning that proficiency is slipping comes early in the process, we have an opportunity to react quickly to address the problem. Knowledge and confidence metrics ensure that the organization is progressing toward high levels of adoption, overcoming barriers, and achieving the efficiencies promised by EHR adoption. Metrics allow us to adjust quickly and proactively; they are the first indicator of falling back into old behaviors that are inconsistent with sustainable adoption.
Metrics also keep us on track when performance does not meet expectations. Let’s consider two different scenarios to illustrate this idea. In both scenarios, the go-live event was successful, but specific performance metrics did not meet expectations. In the first scenario, the system is being used inefficiently. This may be due to inadequate training and subsequently lower end user proficiency. Measuring end user proficiency allows us to identify “pockets” of low proficiency among certain users or departments and ensure they receive the education they need to become proficient. Once users are proficient, we can refocus our attention on the performance metrics. The second scenario is less common and also more difficult to diagnose: our metrics show that users are proficient, but specific performance measurements are still not meeting expectations. In this case, we need to analyze the specific metric. Are we asking the right question? Are we collecting the right data? Are we examining a very small change in a rare occurrence? There may also be delays in achieving certain metrics, especially if the measurements are examining small changes. Normal delays can wreak havoc if we start throwing quick fixes at the problem instead of staying the course and having the confidence in the metrics that will bring about desired results.
Ultimately, leaders must commit the resources, time, and effort to adoption that lasts long after go-live ends.
About Heather Haugen
Heather Haugen is the Chief Science Officer for Digital Health Solutions for Atos. She is also the author of Beyond Implementation: A Prescription for the Adoption of Healthcare Technology.
Inbal Vuletich serves as the editor for Atos Digital Health Solution publications.
About Atos Digital Health Solutions
Atos Digital Health Solutions helps healthcare organizations clarify business objectives while pursuing safer, more effective healthcare that manages costs and engagement across the care continuum. Our leadership team, consultants, and certified project and program managers bring years of practical and operational hospital experience to each engagement. Together, we’ll work closely with you to deliver meaningful outcomes that support your organization’s goals. Our team works shoulder-to-shoulder with your staff, sharing what we know openly. The knowledge transfer throughout the process improves skills and expertise among your team as well as ours. We support a full spectrum of products and services across the healthcare enterprise including Population Health, Value-Based Care, Security and Enterprise Business Strategy Advisory Services, Revenue Cycle Expertise, Adoption and Simulation Programs, ERP and Workforce Management, Go-Live Solutions, EHR Application Expertise, as well as Legacy and Technical Expertise. Atos is a proud sponsor of Healthcare Scene.