600 East Superior Street, Suite 404 I Duluth, MN 55802 I Ph. 218.727.9390 I www.ruralcenter.org

Health Information Technology (HIT):Change and Performance Frameworks

Terry HillExecutive Director

July 2010

The Challenge of ChangeThe Challenge of Change

SynerChange Chicago © 2010

Ch Wh W K !Change – What We Know!

• Increasing at an exponential rate• Increasing at an exponential rate

• Has both dangers and opportunities

• Assimilate change at micro organizational and • Assimilate change at micro, organizational, and macro levels

• Increasingly people are hitting their “future shock” Increasingly people are hitting their future shock threshold

SynerChange Chicago © 2010

F Sh kFuture Shock

That point in time when people can no longer assimilate change without displaying dysfunctional dysfunctional behavior

•Based on the work of Alvin TofflerSynerChange Chicago © 2010

G lGoal

• Raise the future shock threshold• Raise the future shock threshold

- Education

Increase resilience during change- Increase resilience during change

• Use fewer assimilation points during change

I l t h ff ti l- Implement change more effectively

SynerChange Chicago © 2010

Change as a ProcessChange as a Process

SynerChange Chicago © 2010

Ch PChange as a Process

PresentState

TransitionState Desired

StateState

SynerChange Chicago © 2010

T i i S Ch i iTransition State Characteristics

• Low stability• Low stability

• High emotional stress

• High often undirected energy• High, often undirected energy

• Control becomes a major issue

P t tt f b h i b hi hl l d• Past patterns of behavior become highly valued

• Conflict increases

SynerChange Chicago © 2010

Ch PChange as a Process

Learning

Present Transition

Learning

PresentState

TransitionState Desired

State

•Based on the work of ODR, Inc.SynerChange Chicago © 2010

B i HIT A iBasic HIT Assumptions

• Rural hospitals are extremely complex• Rural hospitals are extremely complex

• Electronic health record (EHR) adoption will be very difficult, requiring a multi-faceted, y , q g ,coordinated approach

• Reaching meaningful use will require profound change with a change-ready culture and effective, resilient leadership

Change is most effectively accomplished through • Change is most effectively accomplished through change management frameworks and business tools

S EHR I l iSteps to EHR Implementation

Pre‐EHR ReadinessPre‐EHR Readiness HIT Strategy and VisionHIT Strategy and Vision

EHR System Selection

EHR System Selection

EHR Project Initiation

EHR Project Initiation

EHR Implementation

EHR Implementation

EHR Operations

EHR Operations

-Policies -Vision - Define -Project -Project -On-going

-By-laws

-Process flows

Readiness

-Goals and objectives

-Benefits

requirements

-Identify vendors

Develop RFP

resource plan

-Project budget

-Governance

management

-Workflow design

Clinician

support

-Optimization

-Enhancements- Readiness assessment -Measureable

outcomes

-Develop RFP-Testing

-Clinician engagement

-Communication

-Upgradeplanning

KHA REACH TECHNICAL ASSISTANCE ROADMAP OVERVIEWThis roadmap will be used to develop a work plan modified for each organization to reflect its stage of EHR migration.

Meaningful Use/ImproveProject Mgr Training

Implement/OptimizePlanOrganize/Project Governance

Assess

Awareness

Implement/Optimize

System Build EHR Process Improvement

M.U. Attestation for 2011

M.U. Data Submission for 2012

IncentivesIssues ManagementChange ControlTeam Building

Contingency Planning

Vendor Implementation Gap Analysis

Job Descriptions & Documentation

Project Management

Steering Committee

Physician Champion

Facilitated Planning

Why EHR:Myths & Realities

REACH role

REACH process

What is EHR & Meaningful Use

(M.U.) Screen Layout

Clinical Decision Support (CDS)

Master Files/TablesFile Clean Up

Data/Codes Mapping

Templates/Order SetsIT Staffing & SpaceBenefits Realization

Cli i i S ti f ti

Roll Out StrategyImplementation Plan

Testing PlanTraining Plan

p y

Evidence-BasedG id li

Functionality

SMART Goals

Change Management

I.T. Acquisition Strategy

Total Cost of Ownership& Business Case

Stakeholder Visioning

Attitudes/Beliefs Survey

Readiness Assessment

Skill S

Leadership/Culture

EHR Vision(CDS)

Work Flows/Processes

Access Controls

Security Controls

Authentication & Certification for eRx

Unit Testing

Patient Safety

Quality Improvement

Monitoring GoalAchievement

Root Cause Analysis

Clinician Satisfaction

Patient Satisfaction

Hardware Upgrade & Maintenance

User Preferences

Ongoing Maintenance

Patches/Upgrades

GuidelinesStd VocabularyCore Data Sets

H/W Architecture DesignI/O Devices

Archive & B/UInteroperability

Work Flow/Process Analysis

Work Flow Training

Work Flow Review

Requirements Specs

Chart/Data ConversionFinancial Readiness

I.T. Staffing

Skills Survey

I.T. InventoryI.T. Strategic Plan/

Migration Path

Data Quality/Integrity Edits

Access ControlsEncryption

ReportsContinuity of Care Document (CCD)

Audit Logs

Patient Safety

Return on Investment

& MaintenanceCDS Maintenance

Health Info Exchange

Interoperability

HIO, NHIN

Public HealthInstallation

p yConnectivity

Privacy & SecurityDocumentation

M.U. Criteria

M.U. Testing

Integration Testing

Quality Reporting

HIPAA-HITECH Privacy& Security Assmt

Draft work plan

Readiness Documentation &

Feedback

If ready,

If not ready,

Select

Code of Conduct

Marketplace/Preferred Vendors/Demos

EHR Due Diligence

(Standard) RFPInterface Reqmts End User Training

Super User Training

Personal Health Record

Disease RegistriesPatient Centered

Medical Home

Biosurveillance

Clinical TrialsWork Flow/

Process Redesign

H/W (Certification)

Upgrades/Interfaces to Existing Systems

S/W Install

Network/TelecommPre-Load/Scanning &

Data ConversionRehearsal

Phase I – Go Live

Refine Work Plan

Process InterventionEHR Value PropositionOvercoming

Barriers

Site Visits

Reference Checks

Demos

Interface ReqmtsM.U. Checklist

Vendor of Choice

C t t N ti ti /GPO

POC Role Playing

EHR Training & Productivity

Regional Extension Assistance Center for HIT (REACH) for MN and ND

gPhysical Layout

Communicating w/Pts

Work Flow ChangesCustomer Commitment

Communication Plan

Subsequent Phases Go Live

Acceptance TestInterface Development

End User Support

Change Coaching

eRx & Quality Rpt for M.U.

DRAFT 2.304.29.10

Barriers

Medicaid M.U. Attestation

Contract Negotiation/GPO

Financing/Grants Asst

Approval to Buy

H/W Selection

Skills Building

Implemented and Supported

Valley of Despair

Leadership and

Good Choices and management

d l l

Implement EHRSupported

vity

Leadership and Management

Determines how long you’re in the valley of despair.

determines level of productivity

and satisfactionLittle or No HIT

oduct

iv

Choices, Planning, Execution

Determines extent of Slide Possible Future

Pro

Slide

Time

E i l f HIT Ad iEssentials for HIT Adoption

As identified by the National Rural HIT Coalition:As identified by the National Rural HIT Coalition:

• Leadership must be engaged

M di l t ff t b i l d• Medical staff must be involved

• Strategic planning is crucial to success

• Culture change is required

• HIT requires process redesign

• Networking is necessary

Ch ll i HIT Ad iChallenges in HIT Adoption

• Extreme HIT workforce shortages• Extreme HIT workforce shortages

• Education of staff and technicians

• Financial obstacles for HIT purchases and • Financial obstacles for HIT purchases and operations

• Rapid progress needed to achieve meaningful useRapid progress needed to achieve meaningful use

• Managing organizational change

Frameworks for Managing Frameworks for Managing Performance and Change

Baldridge Healthg

Balanced Scorecard

Studer

Baldridge Health Care Criteria for Baldridge Health Care Criteria for Performance Excellence Framework

2Strategic Planning

5Workforce Focus

1 71Leadership

3

7Results

3Focus on Patients, Other Customers and Markets

6Process Management

4Measurement, Analysis, and Knowledge

Management

D fi i i f B l d S dDefinition of Balanced Scorecard

The Balanced Scorecard is a framework •The Balanced Scorecard is a framework

that helps hospitals successfully carry out

a balanced set of organizational strategies

that drive both behavior and performance.

HIT Theme Strategy Map

FinanceIncreased margin to 

fund mission

Increased cost efficiency

Increased revenue

As financial stakeholders, how do we intend to meet the goals and objectives in the hospital’s Mission 

Statement?

Increased market share

Patient safety outcomes

Physician satisfaction Patient satisfaction

Community health outcomes

Customers & Community

As customers of the hospital’s services, what do we want, need or  outcomes

Internal Processes

expect?

As members of the hospital staff, what do we need to do to meet the 

needs of the patients and healthcare community?

Clinical processes Business processesOperational processes

Learning & Growth

A i ti h t

Ensure a skilled workforce

Establish an empowering work culture

Acquire needed HIT systems

As an organization, what type of culture, skills, 

training and technology are we going to develop to support our processes?

Acquire HIT expertise

LeadershipInstill change managementOngoing education

S d P i i lStuder Principles

• Commit to excellenceCommit to excellence

• Measure the important things

• Build a culture around excellence

• Create and develop great leaders

S d P i i lStuder Principles

• Focus on employee satisfactionFocus on employee satisfaction

• Build individual accountability

• Align behaviors with goals and values

• Communicate at all levels

• Recognize and reward success

T HillTerry HillExecutive Directorecut e ecto

National Rural Health Resource Center600 East Superior Street, Suite 404

Duluth, MN 55802Duluth, MN 55802(218) 727-9390 ext. 232

thill@ruralcenter.org