JAMIA: Team approach boosts IT adoption
“Evidence suggests that when carefully implemented, health IT has a positive impact on behavior, as well as operational, process and clinical outcomes,” stated researchers from Virginia Commonwealth University (VCU) in a case report published online June 9 in the Journal of the American Medical Informatics Association.
At the VCU Health System (VCUHS), in order to overcome the barriers posed by traditional methods of implementing clinical applications, the VCUHS created an Office of Clinical Transformation (OCT). “The OCT was established as a data-driven entity with the goal of converging clinical, educational, financial and research activities through the application of medical informatics,” wrote lead author Colin A. Banas, MD, assistant CMIO from the department of internal medicine at the School of Medicine at VCU.
The VCUHS dedicated 7 percent of its IT operational budget to the OCT and relied on the OCT to prioritize and make configuration decisions about its EHR.
Within six months of introducing digital documentation, 1,491 physicians had converted to electronic-based documentation with a 99.7 percent sustained adoption rate, according to the researchers.
“OCT members included faculty physicians who underwent formal biomedical informatics training and received protected time (ranging from 25 to 50 percent) as 'physician informaticists.' "
“The CMIO served as the physician champion, devoting 75 percent of his time to transformative endeavors while remaining clinically active for the remainder. He also continued to carry out his traditional CMIO activities, such as strategic planning,” Banas and colleagues wrote. Nurse informaticists provided balanced and equal leadership and were led by the Chief Nursing Information Officer, they wrote.
“These clinician leaders played vital roles in translating clinical needs into technical specifications. Dedicated analysts provided technical subject matter expertise and valuable input regarding feasibility during software configuration discussions.”
The OCT had six councils working across three domains (diffusion on innovation; impact assessment and metrics; and interoperability and outreach) to increase the usage and adoption of the EHR. “The deployment strategy included three phases: a preparatory phase focused on training and technical application, an adaptive period designed to engage clinicians at their own pace, and a practice transformation phase for optimization of the application after implementation,” the authors wrote.
During the preparatory phase, one of the six councils, the Online Documentation Council (DOC), reviewed deployment strategies and focused on the production of documentation tools. Providers were encouraged to create digital documentation according to personal preference across three available tools (blob text, structured text and dictation). The DOC negotiated configuration decisions across specialties, the researchers noted.
“During implementation of the electronic documentation tools in the adaptive period, providers were encouraged to convert to an electronic note writing process; however, conversion was not yet mandatory,” the authors stated, adding that early adopters identified flaws in the configuration of the application and adjustments were made to ease the adoption for subsequent users.
“In all, 94 super-users were recruited and provided additional guidance during the adaptive period. Over 80 percent of the providers had chosen to convert to digital documentation 2 weeks ahead of the mandatory conversion date.”
The authors noted limitations to the case report. For example, the investment required to establish the OCT was substantial. “However, there are many instances of failed implementation of EHRs due to clinician resistance because of deployment of non-intuitive software. Therefore, it was reasonable to invest a modest amount in successful implementation strategies with clinician empowerment.”
“Our experience with EHR adoption is that an OCT was a vital component that helped to ensure provider input and engagement,” the authors concluded. “When faced with the challenge of EHR adoption, other institutions may wish to consider similar initiatives to avert implementation failures.”
At the VCU Health System (VCUHS), in order to overcome the barriers posed by traditional methods of implementing clinical applications, the VCUHS created an Office of Clinical Transformation (OCT). “The OCT was established as a data-driven entity with the goal of converging clinical, educational, financial and research activities through the application of medical informatics,” wrote lead author Colin A. Banas, MD, assistant CMIO from the department of internal medicine at the School of Medicine at VCU.
The VCUHS dedicated 7 percent of its IT operational budget to the OCT and relied on the OCT to prioritize and make configuration decisions about its EHR.
Within six months of introducing digital documentation, 1,491 physicians had converted to electronic-based documentation with a 99.7 percent sustained adoption rate, according to the researchers.
“OCT members included faculty physicians who underwent formal biomedical informatics training and received protected time (ranging from 25 to 50 percent) as 'physician informaticists.' "
“The CMIO served as the physician champion, devoting 75 percent of his time to transformative endeavors while remaining clinically active for the remainder. He also continued to carry out his traditional CMIO activities, such as strategic planning,” Banas and colleagues wrote. Nurse informaticists provided balanced and equal leadership and were led by the Chief Nursing Information Officer, they wrote.
“These clinician leaders played vital roles in translating clinical needs into technical specifications. Dedicated analysts provided technical subject matter expertise and valuable input regarding feasibility during software configuration discussions.”
The OCT had six councils working across three domains (diffusion on innovation; impact assessment and metrics; and interoperability and outreach) to increase the usage and adoption of the EHR. “The deployment strategy included three phases: a preparatory phase focused on training and technical application, an adaptive period designed to engage clinicians at their own pace, and a practice transformation phase for optimization of the application after implementation,” the authors wrote.
During the preparatory phase, one of the six councils, the Online Documentation Council (DOC), reviewed deployment strategies and focused on the production of documentation tools. Providers were encouraged to create digital documentation according to personal preference across three available tools (blob text, structured text and dictation). The DOC negotiated configuration decisions across specialties, the researchers noted.
“During implementation of the electronic documentation tools in the adaptive period, providers were encouraged to convert to an electronic note writing process; however, conversion was not yet mandatory,” the authors stated, adding that early adopters identified flaws in the configuration of the application and adjustments were made to ease the adoption for subsequent users.
“In all, 94 super-users were recruited and provided additional guidance during the adaptive period. Over 80 percent of the providers had chosen to convert to digital documentation 2 weeks ahead of the mandatory conversion date.”
The authors noted limitations to the case report. For example, the investment required to establish the OCT was substantial. “However, there are many instances of failed implementation of EHRs due to clinician resistance because of deployment of non-intuitive software. Therefore, it was reasonable to invest a modest amount in successful implementation strategies with clinician empowerment.”
“Our experience with EHR adoption is that an OCT was a vital component that helped to ensure provider input and engagement,” the authors concluded. “When faced with the challenge of EHR adoption, other institutions may wish to consider similar initiatives to avert implementation failures.”