HCA Healthcare CIO: Get docs on board before EHR rollout

If you want to learn about rolling out electronic health records systems, HCA Healthcare is pretty good case study. The Nashville-based organization is rolling out EHRs to more than 250 of its hospitals and outpatient centers in 20-hospital waves to the tune of about $1.9 million a pop.

Which is not to say that it's been easy: Launch that may EHR projects and you're bound to make some mistakes. Chief among them? HCA (at first) made it voluntary for physicians to participate and allowed them to opt out of training, Richard Tayrien, M.D., HCA's chief health information officer, told the audience at this week's Institute for Health Technology Transformation (iHT2) summit in Ft. Lauderdale.

 "We've not ben nearly as intentional as we need to be," he said. "We have drug it out way too far."

Failing to coordinate physician adoption with your go-live effort is a huge waste of resources, he added. Even 30 days after launching a system is too late: By then you'll have lost valuable momentum.

The good news is you don't have to convince every single clinician to use the system--you can be targeted in your efforts, Tayrien said.

He told the audience what HCA did to turn things around—the organization now enjoys an 80 percent adoption rate--and offered advice about how to engage physicians in EHR roll-outs. Among his suggestions:

  • Get personal. Interpersonal communication is more effective than mass media. Get the attention of well-connected, highly motivated and engaged physicians and use them as a conduit for peer-to-peer communications.
  • Identify influencers. HCA has found clinical decision-making volume is a good barometer of influence. They examined pharmacy orders over 12 months and targeted physicians with the highest volume of orders as potential EHR champions. Ninety percent of the docs identified as influencers should be ready to go before go-live, he added.
  • Track training. At HCA, a dashboard tracks training progress daily. It shows which docs are scheduled for training, which ones have completed training and flags no-shows. Actionable reports that can drill right down to the individual physician "galvanize the teams," Tayrien said.
  • Teach change leadership.  HCA conducts a week-long "boot camp" for C-suite leaders, physicians, nurses, quality leaders and others to immerse them in the change management process.
  • Show the benefits. Physicians' perception of the change is paramount, of course. So you also have to point out opportunities in the change, such as reducing cycle time, improving process fidelity and eliminating steps and points of failure.
  • Make it visual. Tayrien showed the audience a pharmacy workflow chart that showed the 30 steps in the process from written order to delivery of meds. Best case scenario, the process takes about two hours, he said.The next slide showed the same workflow chart with big red Xs through the 12 items that the new system would eliminate. The new process reduces the time 300 percent to 39 minutes, eliminates not only 12 steps but also 12 failure points and introduces five quality checkpoints. The chart and the numbers are visual and impactful, he said—docs will remember them.
  • Make a sandbox. When you're trying to get docs interested in an HER system, you can't talk in abstractions, Tayrien said. HCA created the fictitious St. Xavier hospital, named for a beleaguered project manager, so that docs could play with its virtual EHR system without fear of mucking things up.

It's an understatement to say that docs can be hard to please--Tayrien notes that they complain that training takes too long … and that there's not enough of it. But organizations should see training and preparation for go-live as an opportunity to talk to docs about how to optimize processes. When do you have a chance to sit down and talk to docs? And when will you get that chance again?

"Probably never," he said.