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Field of Dreams? or… it could be just an empty ballpark!

Field of Dreams? or… it could be just an empty ballpark!. COACH May 2004. Agenda. the proposition why this matters case studies what the stakeholders said moving forward. The proposition.

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Field of Dreams? or… it could be just an empty ballpark!

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  1. Field of Dreams? or…it could be just an empty ballpark! COACH May 2004

  2. Agenda • the proposition • why this matters • case studies • what the stakeholders said • moving forward

  3. 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

  4. 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

  5. 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

  6. 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)

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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/$$

  13. 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

  14. 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!

  15. 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!

  16. Questions?Bill Pascal P. Eng., CMACTO, Canadian Medical Associationbill.pascal@cma.caMary Gibson

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