Posts Tagged ‘Dale Emerson’

EHR Adoption and Change Management

Friday, August 13th, 2010

- By Dale Emerson, Hielix

Health Information Technology (HIT) is frequently associated with efficiencies and cost reduction / avoidance plans. Electronic Health Records (EHR) technologies will serve as the foundation for a creating a number of these efficiencies.  However, these technologies will not attain the efficiencies desired if providers do not adopt EHR technologies and use them as a part of their clinical workflow.  Only by significantly increasing provider adoption rates can these efficiencies be realized.

HIT and EHR adoption will be driven by the willingness of physicians and other health care providers to adopt and use new technologies.  In many ways, this makes HIT and EHR adoption a large-scale change management project.  Success is dependent on the acceptance, adoption, and use of EHRs and HIT technologies by healthcare providers at all levels. Experience teaches us that this level of education is important to the implementation process whenever action is required at the stakeholder level.

Perhaps the biggest problem facing providers and hindering the rapid adoption of EHR technology is a change in workflow or a change in the way a clinician delivers care. Workers like some level of routine in their daily tasks and predictably in work flow processes. Whenever change is introduced into the workplace, it disrupts the normal flow of work and may cause people to resist.  Even when workers understand the rationale for the change and may even agree with it logically, emotionally they will remain skeptical.  Frequently, workers are not shown how the change impacts them directly.  Will I be able to perform the new work tasks as well as I could the old tasks? If I don’t perform as well, will that impact the results of my work?  These and other questions may cause people to resist or even fight the introduction of EHR technology.

It is important to address these concerns and offer solutions.  Adoption of EHR and HIT technologies will be much easier if strategies are utilized to address and overcome stakeholder concerns early in the process.

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Health Information Exchange HIE and the Community

Monday, June 14th, 2010

- By Dale Emerson, COO of Hielix

In our work in Health Information Exchange (HIE), we are often asked to help gather information for and from the community on HIE, garner community support for the HIE, and help drive the adoption and migration of and to Electronic Health Records, or EHRs.

Our experience in and with HIE has allowed us to develop a set of Community Readiness Assessment and Education tools to determine stakeholder and community needs and readiness for HIE, as well as to begin the process of building support and consensus for HIE.

Regardless of your tools for such an assessment, it is critical to engage and involve the community with the HIE, answer any community/provider questions, and to gather information.  Key information, questions, and learnings are:

1.) Begin the consensus building decision process by identifying the various value propositions for the key stakeholders

2.) Provide community education about HIE and its importance to the future of health care in the state, region, and community

3.) Understand the current IT capabilities of the various stakeholders

In your process, it is critical to gather information from various stakeholders and consumers including but not limited to:

·      Vision, mission and values
·      Strategic plans for HIE
·      HIE capital and operating budgets
·      Privacy and security plans / concerns

By meeting with a broad group of stakeholders from across the community and region/state, and by engaging these stakeholders, you can gain an understanding of the wants, needs, questions, and concerns of the HIE stakeholders and community as a whole.

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Sustainable HIE

Tuesday, April 13th, 2010

- By Dale Emerson, COO of Hielix

Research into both the successful and unsuccessful HIE efforts across the country over the past several years revel two facts:  1) HIE’s that were created using internal stakeholder funding have a higher probability of success and 2) the costs / benefits of HIE are not distributed equally to all stakeholders.

The overall success in building sustainable HIE’s rests on two key factors:

Determining the optimal mix of funding from multiple sources

Reaching agreement on a plan for the equitable sharing benefits

First, internal stakeholder funding is the single best financial resource.  Creating believable financial models that address the value proposition for each stakeholder is the first step in identifying internal funding sources.  Showing an ROI that is connected to the value proposition will engage stakeholders faster than any other motivating factor.


Secondly, because benefits are not distributed equally, the financial model must show who benefits the most and the least.  Some stakeholders may benefit from significant cost savings in some areas while others may see their costs increase slightly.  It is important to reach consensus on how these costs / benefits will be shared between stakeholders.  That is why it is critical to develop trust early in the process.

Overall, HIEs need to secure funding from a variety of sources, including grant funding, private funding, and participant funding.  Familiarity with all of the published studies and other documents related to funding as well as with all of the current funding models in use today will pay dividends for your HIE and your sustainability model.

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Moving HIEs from Design to Successful Operation

Tuesday, March 16th, 2010

- By Dale Emerson, COO of Hielix

In our work with Health Information Exchange, we have found there are generally two categories of stakeholders involved in HIE.  The first (and smallest group) have been actively involved for some period of time to facilitate the development of HIE in the state or region.  This first group knows about, and believes in, HIE.  The second group consists of all the other potential stakeholders across the state or region who have limited knowledge of HIE, lack trust about its impact, but control the critical components (patient health records) required for HIE.  It is this second group of stakeholders that needs to be engaged in the HIE process.

Typically, there are several stages of HIE development and the information that should be collected in each stage, including:

- The engagement of the second group of stakeholders described above.  These stakeholders tend to have limited knowledge about HIE, but have deep concerns about its impact on them.  The expected result in this stage is the readiness to begin building trust between divergent stakeholders.

- Actively engaging the second group of stakeholders in the broader expansion of statewide HIE.  The expected result in this stage is a technical requirements document that will be used to design the HIE infrastructure.

- Utilizing the analysis from stages one and two to architect a working model for statewide HIE.  The expected result in this stage is a completed architecture and supporting documents ready to allow vendor selection.

- Moving from the planning stage to the actual exchange of data.  The expected result in this stage is an operational HIE.

- A basic, operational HIE ready for growth.  The expected result in this stage is a sustainable HIE where annual revenues exceed annual expenses.

These stages are components of an evolutionary process and many changes will be required as you move forward with Health Information Exchange.  Please remember that a strong, yet flexible change process to accommodate an ever-changing environment will be necessary as well as you move forward with Health Information Exchange.

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Health Information Exchanges (HIE) and Sustainability

Tuesday, February 16th, 2010

- By Dale Emerson
Sustainability is the ultimate goal for any HIE. The success and sustainability of an HIE is built on three key factors:

- Developing trust between HIE stakeholders and using that trust to obtain important financial data and information.

- Creating realistic, believable, and supported financial models to obtain the buy-in from all stakeholders.

- Providing various tools to respond to changes in the environment and make real time modifications to the financial model.

In order to create a believable financial model, stakeholders need to provide data and information about their current and planned operations. In many instances, stakeholders may be competitors and therefore reluctant to share their data and information. Using a third party that is viewed as a trusted resource by all stakeholders is critical to obtaining the required data and information. In order to be believable, it must be sanitized using a process of obtaining the information, analyzing it, reporting it and discussing it, while maintaining the confidentially of the information for each stakeholder.

Once the financial model is built, there must be a mechanism for changing it as the environment changes. In addition, it must accommodate input in various forms from diverse stakeholders. “Dashboard” type applications and tools are relatively common in the private sector, and can be easily adapted for use in healthcare. They will allow decision makers to input data and information, change assumptions and strategies, and immediately see the impact on the underlying financial model.

In summary, it is critical to start with solid data and information. This can only be obtained if a certain level of trust exists with the stakeholders. Therefore, it is important to start the HIE process with an open and transparent process that builds trust from the beginning. When trust is developed, then reliable and believable financial information can be collected, analyzed and reported.

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Health Information Exchange (HIE) and Change

Monday, January 18th, 2010

By Dale Emerson, COO of Hielix

HIE is not about technology – technology certainly helps but HIE is more about change. David Blumenthal, National Coordinator for Health Information at Department of Health and Human Services recently stated “People working in health IT should think about electronic health records, not as a technology project but as a change management project. Components of Meaningful Use include sociology, psychology, behavior change and the mobilization of levers to change complex systems and improve their performance”. Healthcare is now facing one of its biggest challenges in history as they convert to electronic records. The benefits seem obvious – better care coordination, lower costs, and higher quality of care. So why are healthcare providers not rushing to embrace HIE? It seems that many of them have been waiting for this whole computer fad to pass and for paper and pencil to resume its natural place as the leading technology. However, the more likely cause is people’s natural resistance to change.

Change forces to people to adopt new ways of doing their jobs. Routine in work related tasks has a calming effect on workers. Workers like to know what is expected of them and they take pleasure in knowing how to do their jobs satisfactorily. Whenever change is introduced into the workplace, it disrupts the normal flow of work and may cause people to resist the change. Even when workers understand the rational for the change and may even agree with it logically, emotionally they will remain skeptical.

Frequently, workers are not shown how the change impacts them directly. Will I be able to perform the new work tasks as well as I could the old tasks? If I don’t perform as well, will that impact my employment? Will I still have the same power and prestige in the organization? Will the change eliminate my job? Will I still be working with the same people who I know and trust? Does my superior know how the change will impact them and what does that mean for me? Faced with these questions, it is easy to understand why HIE has taken so long to gain traction. In order to help people with change, we offer six key concepts that will help make the transformation easier.

- Create a compelling vision that people can easily understand and embrace.

- Be open, honest and transparent in how you relate to your staff. Good communications is the most important attribute you have to help you manage through the process.

- Provide individual leadership and it starts with you. Change affects everyone, including you so lead by example.

- Change involves risk. Follow a sound change management process to reduce these risks and improve the probability of success.

- Be prepared to stay committed through the whole process. Any change process will have ups and downs and will meet some level of natural resistance so you have to be prepared to follow the plan even when it all seems to be so hard.

- Get the right resources to help you. You will certainly need support internally and maybe externally. Find the early adopters and get them to help lead the change effort. Reach out to a neutral, external resource that can help you change and offer an unbiased view of your world.

Following these simple tips can really accelerate the adoption of HIE in your organization. While these tips are simple in concept, they can be very difficult in reality so understand the challenge, be prepared to face it and your odds of success will improve.

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