Navigating Through The Waters of Provider Buy-in During An Implementation

August 2017

With the Meaningful Use revolution long underway, and most organizations well into the utilization of Computerized Physician Order Entry (CPOE), countless organizations find themselves asking: could we have done a better job obtaining provider buy-in during the implementation process? So often this is a point of reflection due to the fact that this area is complex, multi-layered and unique to each organization.  Additionally, it just so happens to also have a profound ability to sway the successful implementation pendulum one way or the other.  The bottom line is that there is no one size fits all approach to follow and regardless of the approach taken, there will always be some providers that are unhappy with aspects of any EHR system.  Pleasing everyone is impossible, and in healthcare there will always be specialty services that do not quite fit into the mold of the rest of the organization. The best thing to do is set a tone of strategic inclusivity from Day 1 (or before if possible) of the implementation kick off in an attempt to get everyone involved early and often.

When a new implementation commences, the core teams are usually the first teams to be assembled. The individuals included in the core teams are considered the subject matter experts (SMEs) and will most likely be doing the majority of the system build and workflow development. Included in this group will be the analysts from the different departments, including the ancillaries, who may still work on the floors part time to stay in the loop regarding processes and workflows. Managers and directors are also frequently included in the core team(s), as they by default will be a part of the more significant meetings that require decisions to be made. These leadership level positions do not always have the knowledge of the more granular aspects of the processes and workflows in place, but will without fail bring in those that do when it comes time to make a decision. It is important that the analysts, managers, and directors all have a working relationship with the providers, in order to effectively work together and collaborate ensuring acquiescence on all fronts.  It is paramount that the analysts and managers/directors do not make assumptions in a silo surrounding key areas in which the provider should be consulted.  When this happen, the road to maximum provider buy-in can become an uphill trek.

Depending on an organization’s current state, existing committees will be periodically evaluated to ensure the correct individuals are being involved from the beginning.  Having the correct provider presence on the various committees is critical and should be included in any current state assessment.  Typically, there will be a designated physician champion(s) or Chief Medical Information Officer (CMIO) that is in charge of the provider considerations during an implementation.  Choosing the appropriate resource to fill this role can be crucial to the success of an implementation. As part of the scope of this role, the individual chosen will be involved in the CPOE meetings that review the pieces of the system that affect all providers. These meetings will be comprised of discussions surrounding physician documentation, order sets and other functionality the providers will use and access. It is absolutely paramount that these discussions include feedback from all areas, and how that is accomplished will determine the overall success of the implementation from the provider perspective. The way providers review content differs greatly from not only specialty to specialty but from individual provider to individual provider.  The ease and effectiveness of review and feedback received surrounding these provider centric areas, is oftentimes reflective of the overall state of the implementation, therefore periodic and honest evaluation is key.  There is no catchall approach when it comes to how to best garner useful feedback from an organization filled with providers of different specialties and skill level as this depends largely on the system selected, the third party vendors utilized, the current state of the organization’s HCIS and existing committee structure.  With that said, careful attention and consideration given to the areas discussed below will without fail aid in accomplishing the maximum provider buy-in goal:

Identify Strong Technology Providers
There is oftentimes a staff portal available for users to access to aid in the review and commentary of any type of evidence-based content needing assessment. This exercise should be reserved for users that are more technically savvy and feel comfortable navigating computers and computer systems. So long as the level of computer proficiency is adequate, the user(s) will be able to utilize the portal as it was intended and give the necessary feedback.  Create a culture in which concrete deadlines are given and enforced to portal users, as to avoid things being placed on the back burner which can tend to occur with this type of review.  The individuals chosen to be portal users should also be kept in consideration for unit and parallel testing, as well as assisting in the end user training phase in some capacity. The strength of their technical savviness is crucial in being able to more easily encourage other providers to buy-in to the benefits of using the system, provide constructive feedback, and/or to simply assist in getting certain resistant providers to willingly use the system at all once it goes Live. Due to the knowledge base that the more technically savvy providers have from both their review of information via the portal and their general level of comfort when it comes to technology, it is logical that they will receive feedback or complaints from the providers who are struggling.  It crucial that a defined method of communication is put into place where this information can be passed onto the physician champion or CMIO and the implementation team in a constructive setting, so it can be acted on accordingly when appropriate.

Identify Strong Hospitalists
Even if a hospitalist’s technical capacity happens to be low, there is still great value in having strong hospitalists on your side. These are the “frontline” providers that deal with the system the most, so receiving their input is very important.  Since ensuring they give their feedback is vital, if the need arises to review the paper form of order sets or documentation, it is better to have them mark it up “the old fashioned way” than not use them at all if they happen to be weak at using technology.  Having strong hospitalists will ensure an extremely high percentage of what is needed by the rest of the organization is reviewed and feedback is given.  It is important again to utilize the physician champion or CMIO, to emphasize the importance of having the hospitalist review the information should they not be so forthcoming in offering assistance.

Specialties Are Special
As unimportant as it may seem to not include the specialty areas because of the low volume of documentation and orders, they are still essential in obtaining complete buy-in by the organization. Identifying a representative from each area and having them review the applicable documentation, order sets and other functionality will ensure nothing is missed or overlooked. This inclusion will also give the specialty providers a sense of ownership, which will benefit not only the implementation’s progress but also the unit and parallel testing phases and overall support and moral.  Having the physician champion or CMIO lead the charge in orchestrating the specialties involvement can result in maximum participation and again only benefit the success of the implementation.

Conclusion
Even though necessitating the participation and buy-in from providers for a sense of true adoption is nothing new, the approach to successfully achieving this needs to be newly evaluated with each implementation and/or optimization phase. Proper time allocation and clear consistent instructions given are crucial components in successfully utilizing a provider’s time.  Each task delegated should be one that has a stated deliverable resulting in a sense of accountability and accomplishment when completed; this is especially important with the order set review process as this can be drawn out over some time.  Identifying an effective physician champion or CMIO will assist in “breaking down the barriers” for the hard to reach providers.  The tone set by the physician presence at the top will inevitably trickle down to the rest of the organization.  Finding the right balance between managing, motivating, and explaining is something that is key to striking the right balance when it comes to attaining maximum provider buy-in.  Tasks that may seem trivial such as showing a less tech savvy provider how the system works in relation to a very specific piece of functionality or content being reviewed can make all the difference in the long run.  Each and every time a provider can conceptualize, in terms that they understand, a tangible benefit of the reason behind the change at hand they will be one step closer to the optimal buy-in threshold.  What it all boils down to is that as the sense of strategic inclusivity grows amongst the providers, so does the chances of them authentically buying in to the process.  This is the key to unlocking the door to receiving the amount of honest and helpful feedback needed to be able to build a system that can be used in a productive and safe way.

About The Author: John Vergato has over 10 years of implementation, optimization, and sales experience with Healthcare Information Systems, specializing in numerous proprietary software vendors. He has a distinct understanding of the healthcare IT environment, assisting in the support and implementation of all sizes of organizations, from critical access hospitals through Independent Delivery Networks with as many as 14 facilities.  He has his CPhT Certification and has shared his knowledge through presenting at user conferences across the country.