Healthcare needs a recombobulation area – a place designed to catch one’s breath, collect one’s thoughts, and reset for the work ahead. That’s one of the many ideas explored in the recent release of Beyond Implementation: A Prescription for the Adoption of Healthcare Technology. The book, which is the second edition of an Amazon Best Seller for Hospital Administration and Care, recognizes the significant challenges the industry has navigated over the last seven years and sets the groundwork for improving outcomes through healthcare technology. Authors Dr. Heather A. Haugen and Charles L. Fred explore the concept of a recombobulation area through a humorous, yet realistic lens.
The need for a recombobulation area is apparent considering the changes that have occurred since the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. Today at least 90 percent of hospitals have attested to Meaningful Use criteria for Medicare and Medicaid in 44 states. As of 2013, two-thirds of Medicare-eligible providers attested to Meaningful Use Stage 1. Both figures underscore the remarkable shift our industry has made from the culture, habits, and beliefs engrained in the old paradigm of paper medical records.
The progress is even more remarkable considering the influx of new legislation. Providers have grappled with changing government mandates and regulations aimed at improving outcomes through value-based, rather than fee-for-service-based, care. The HITECH Act, Physician Quality Reporting System (PQRS), and Medicare Access and Chip Reauthorization Act (MACRA) continue to force providers to adapt to new regulations and reimbursement models – all while learning how to perform their daily work proficiently in a new clinical information system.
Another challenge is the trend of replacing existing legacy systems with new enterprise applications. Healthcare organizations are increasingly looking to replace electronic health record (EHR) systems for more integrated and functional applications. The reasons for this trend include the need for more comprehensive applications, the lack of adoption of older systems, and vendors no longer supporting legacy systems. The transition between applications presents significant challenges for providers and clinicians, who must unlearn old habits, keyboard shortcuts, and workflows. In many cases, the change is complex and time-consuming, and because users know the old system better they often resist the transition altogether – requiring a greater focus on and effort around the factors that drive EHR adoption.
Despite the tumult of the last few years, healthcare now stands capable of truly transforming clinical and financial outcomes through technology. Healthcare organizations across the country are beginning to work on initiatives that improve quality, safety, and productivity. Buzzwords that once seemed far-reaching and ambitious are now realistic initiatives and outcomes. Additionally, the once-pervasive resistance to EHRs has evaporated as providers, clinicians, and patients alike value and desire the data they contain. Overall, healthcare has successfully navigated and unseated the old status quo.
To truly improve outcomes, healthcare organizations must continue to make progress in adopting their EHR systems – which serve as the foundation for more ambitious initiatives such as population health management and accountable care. A disparity still exists between implementation and adoption of advanced functionality of these systems. A recent College of Healthcare Information Management Executives (CHIME) focus group finds that providers continue to struggle with adopting clinical decision support (CDS) and computerized provider order entry (CPOE) – two critical functions of the application. While 84 percent of providers have CDS installed, only 41 percent have demonstrated adoption of the functionality. Similarly, 73 percent have CPOE installed, yet only 44 percent have adopted it. Healthcare organizations must work to improve these figures, as CDS and CPOE represent functions that are vital to improving quality, safety, and productivity.
Beyond Implementation examines the crucial factors that determine the adoption of clinical information systems. These include factors common to all organizations – effective leadership efforts, targeted education, performance metrics, and sustainment of the overall effort – as well as factors unique to each organization. Universally, organizations must shift from episodic thinking to establish a lasting focus on long-term adoption of these systems. The book shares practical insights and strategies to accomplish this work through the lens of some of today’s most accomplished healthcare organizations.
Despite the challenges that remain, our industry is fully capable of achieving the goal of improving clinical and financial outcomes. Our industry has successfully navigated the last frontier to emerge ready and prepared to continue the journey onward. As our focus turns to quality, safety and productivity measures, let’s take a moment to enjoy the temporary solace of our recombobulation area – where we can pause, reflect, and prepare for the adventure ahead.