Keys to Managing a Successful EHR Transition

Three years ago, Houston Methodist’s eight hospitals and thousands of physicians took on the task of replacing their existing clinical systems with an integrated EHR.

Along with challenges of managing several locations, multiple staff roles and responsibilities, and coordinating with a large IT team, leadership at the health system was charged with the dual goal of getting the new system unveiled while also maintaining legacy systems to keep healthcare operations going.

At this year’s Health Information and Management Systems Society conference (HIMSS17) in Orlando, Florida, Penny L. Black, Houston Methodist’s IT director of clinical systems, and Alan Perkins, a principal at consulting firm The Chartis Group who assisted in the transition will detail how the large health system made it through the transition. Their session, “Managing a Legacy Team in an EHR Transition,” is scheduled for Tuesday, Feb. 21.

Physicians Practice recently spoke to Black and Perkins about their experience at Houston Methodist and the keys to success that might assist smaller healthcare entities in taking on a similar project.

Q.Houston Methodist is clearly a large health system. What can smaller medical practices learn from your experience?

Penny L Black: We counted on leadership to utilize open communication and transparency. We utilized good project management and change management - these two things are key. And, if you can, partner with consulting firms that share your goals and values. I think all of these concepts apply, no matter the size of the organization.

Employees function well in situations with familiar cultural values, so when you bring on partners that share those values, then the relationship tends to just flourish and you don’t have to deal with potential conflicts that might normally arise such situations.

Alan Perkins: Communication really is key because it enhances transparency and trust. This is a principle that applies not just to the IT staff, who may be responsible for developing and deploying the software, but also the practice staff who will be using the software. So it’s important to develop a communication plan and standard communication mechanisms - employee meetings, newsletters, special events, etc. It’s important that all of these communication venues emphasize, “We are all in this together,” and emphasize the inclusiveness, not only of the entire IT team, but also the inclusiveness of the entire project team and the people utilizing the system.

In all these communications, it’s important to underscore the significance of everyone’s role in the effort. This isn’t an IT initiative, it’s an enterprise initiative and we all need to work together to make it successful in order to realize the value an EHR provides in achieving the strategic business imperatives. I think the way in which you communicate that, done consistently with the organization’s values, done in a transparent and consistent way, will strongly enhance the success of the transformational effort, whether [it's at] a large organization or a small organization.

Q. How to you achieve practice buy-in and overcome apathy about a new EHR system?

Perkins: By making clear what the end state is and why this will be beneficial to [everyone in a practice] in the end. It’s important, also, to acknowledge that change is difficult and this is going to be a challenge, but that you are going to be with them all along the way - you’ll provide training, you’ll be available to answer questions, and you won’t leave them to figure it out on their own. You’ll have a plan that they are a part of and that you’ll be working with them to successfully implement a program, at the end of which, they’ll have a system more useful, better supportive of their job function, and hopefully easier to use and ultimately beneficial to them and in improving patient care delivery.

Q. When do you start rolling out some of these transition plans?

Perkins: The timeline depends, of course, on the scope of the project and the amount of change being brought to the practice. I’d say that one of the very critical aspects of planning is the training plan. People want to know how they are going to gain the necessary expertise, knowledge, and understanding of the system required to do their jobs once this system has transitioned. And they need to understand also how they are going to get that training in the context of continuing to do their current jobs. It’s very important that you tell them when they are going to get training, how much they’ll get, and how that training is going to dovetail with their ability to do their current jobs up until the day of transition.

Black: I think that establishing in advance any change in daily responsibilities is incredibly important. That way, people know what they are getting into and there are no surprises after the conversion. So along with the training, if there are changes with roles or responsibilities, they need to be communicated and even practiced up front.

Perkins: Another thing that’s critical with communication is that it must be bi-directional. It’s not just a matter of making it clear to the practice staff when they’ll get training and what the new features and benefits of the system will be, it is also important that there is bi-directional communication and that those who are charged with implementing the system and designing it have regular venues in which they can listen to practice staff’s concerns so they can be addressed in a timely manner.

Q. Is it best to have one point person for this communication or a committee to turn to for questions and concerns?

Perkins: One key principle is that everyone who is affected by this change, by this enterprise system implementation and transformation initiative, needs to be able to identify: Who speaks for me? So if they themselves are not directly communicating with the implementation team, they need to understand who is speaking on their behalf and to whom they should take their concerns. So as long as everyone affected can identify the person or persons who represent them, as long as they feel confident they have some avenues to bring concerns to the team at large, that will diminish their anxiety and help them feel that this system change isn’t being done to them, but instead is something they are participating in.