Field of Dreams? or…

it could be just an empty ballpark!

COACH

May 2004

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Agenda

the proposition why this matters case studies what the stakeholders

said moving forward

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The proposition

effective engagement and support of the end users is absolutely critical to the goal of getting information technology used to improve patient care, quality of professional life & health system management

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Why this matters

Standish Report findings (1999) investment in IT application development is

HUGE $250 billion US/year; 175,000 projects

failure rate unacceptable 31% of projects cancelled before they get completed 53% will cost 189% of their original estimates Only 16.2% “on time, on budget”

three key overall success factors: end user involvement, clear statement of requirements, executive management support

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Why this matters (cont.)

November 2001study* re: key factors in forecasting EMR/EHR implementation success over 150 factors identified only 2 identified consistently associated with

successful implementations top management support clinician involvement

*Sittig, D; The Importance of Leadership in the Clinical Information System Implementation Process

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Why this matters (cont.)

spending ~ 2% of healthcare budget on IM/IT too low anyway if we screw up over 50% of these we’re really

in trouble! risk losing credibility with/support of senior

policy makers, funders and end users disenchanted users (once we lose them,

they’re twice? 4X? harder to get back)

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Case studies Danish national system (MedCom)

grew from modest clinician-driven project key success factor: getting opinions and ideas from

general practitioners’ professional organization AND from practising GPs

New Zealand extensive physician use of computers and EMRs in

improving health status through HealthLink strives to be responsive to physicians as primary obligation;

many initiatives result from primary care physician demands

replaced alternate product (after millions of $) which failed when they tried to connect to GP computer systems

officials had little/no understanding of general practice environment

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Case studies (cont.)

Cedars-Sinai 2003 Hospital believed it had sufficiently involved

physicians in design/implementation process by working with 40-physician medical executive committee

turned off CPOE after complaints from hundreds of physicians – cumbersome, didn’t follow physician workflow

underestimated impact on ancillary departments, complexity of implementation and work involved in transitioning to CPOE

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Case studies (cont.)

Upstate New York Veterans Healthcare Network* in < 5 years, went from poor performer to a leading

performer among VA 22 networks conscious attempt to empower frontline employees

by: increasing patient outcomes focus adopting a learning environment increasing frontline autonomy encouraging grass-roots innovation developing esprit de corps among frontline workers

*Timothy J. Hoff/IBM

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Process used interviews:

standardized interview template

interviewees payers(i.e. CIOs),

physicians/physician organizations, vendors, other – over 35 key players in the Canadian health infostructure scene

coast-to-coast coverage

synthesis and analysis of results

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What the stakeholders said… significant convergence among views of payers, vendors, end-users, CIOs

end-user engagement seen as “absolutely critical”, a “no brainer”, “essential”, “crucial”

agreement on critical success factors: commitment to process - trust is earned all parties need to be prepared to change their “going

in” position – requires “active listening” acknowledgement of interdependence recognition and acceptance of different drivers creating a climate of mutual respect

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Stakeholders (cont.)

performance “spotty” across the country generally poor reviews at the national level balancing province-wide system needs with one-on-one medical

care creates challenge only two provinces have issued a strategic IT plan vendors not generally involved/seen as the enemy cultural differences (project managers vs end users) get in the way

of effective end-user engagement need to migrate from “create and direct” to “facilitate and

empower AB generally perceived to be engaging stakeholders

process slow and painful but making real progress

growing awareness, increased attention/$$

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Moving forward interest-based approach start having the conversations, building the

relationships now allow adequate time for engagement jointly define clear statements of requirements engage end-user organizations on strategic and

implementation issues; work with informed end-users at the project

level at ALL stages of the process

engage skilled facilitators

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Moving forward the job’s not done with implementation

build in a “feedback loop” after implementation ensure end-users aren’t “out of pocket” for

their time include those who are going to deliver the

product….e.g., the vendors (VCUR) use consistent processes we need to talk about this….nationally,

provincially and locally!

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Recap

effective end-user engagement is critical if we want IT used to improve health outcomes

we need to ensure what we’re designing/building/implementing works for those who use the IT systems to deliver care

we need to do a better job of involving end-users….now!

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Questions?

Bill Pascal P. Eng., CMACTO, Canadian Medical Association

bill.pascal@cma.ca

Mary Gibson CAConsultant

marygibson@shaw.ca