Change Management in an ED EHR Implementation
By Sheila Andrews

Successful change Management includes two sides of the equation: the leadership perspective from the top looking down and the individual employee perspective from the bottom looking up. The following reviews ideas and considerations in developing a positive employee change perspective during the implementation of an electronic health record (EHR).

End user adoption is critical for a successful implementation; it is the employees who are ultimately responsible for organizational-wide change. Administering a readiness survey or assessment can be a useful tool to gather information and address concerns. Successful clients have found that forming a work team benefits culture and change management. The teams can consist of department directors, managers, and supervisors who meet and plan with the Build and Training Teams early and regularly to determine, who the decision makers are, how decisions will be made, and define an escalation process. Complex policy and procedure related issues commonly surface during an implementation; the decision solution process will flow more easily because of the work and relationship established by this work group. This group typically gives updates and receives feedback on workflow/build changes and is in an ideal position to clearly communicate plans about how the ED users will be prepared and supported when moving from paper to an EHR.

Communicate What?

Communicating the Training Plan is especially important to explain to the end users how they will be supported throughout the implementation cycle. End users will want to know how their work will be impacted and how to get their job done efficiently and effectively. This is a great opportunity to clearly emphasize that clinical practice isn’t changing; the method of documenting is changing.

Communicate specifics about training expectations and requirements and include milestones from the training plan, such as:

• Is Computer Based Training (CBT) required prior to attending (ILT) Instructor Led Training?
• ILT-How many classes, number of hours?
• How will the staff be enrolled for training?
• Will there be any proficiency evaluations when training is completed? If training is not completed and competency passed will employee sign-on be active at Go Live?
• Will there be access to a Practice Environment or playground after training? (One way to provide this support is to put Computers on Wheels in an ED conference room when staff begins to attend training. Consider staffing it with supervisors for several hours to provide encouragement to practice, answer questions and gauge acceptance)
• Share plans for random charting evaluations or on demand requests for demonstrations of “Show me, how you would…” during and after go live. (It is important to be explicit as to whether these events will be considered in the employee’s annual evaluation!)
• Use the classroom as a forum to provide feedback to the project team. Document any questions and suggestions during class and have the project team follow-up with answers in a timely manner

Communite How?

Capitalize on currently established communication channels. For example:

• Provide a 15 minute demo by the Build Team at the monthly ED staff and MD staff meetings to introduce software application feature functionality for patient tracking and charting
• Have Physician Champions and Super Users provide 15 minutes peer demos at monthly meetings to introduce software application feature functionality for patient tracking and charting
• Add a dedicated space in the weekly communication newsletters for software related topics
• Add a software webpage to the internal ED Website with information about the application. Content can include:
  • Current examples of completed documentation tools for Orders, Flow sheets, and Procedure Notes along with the ‘To Be’ electronic equivalent
  • Updates about training, features and functionality
  • Common questions and answers
  • Tip sheets for common workflows Admit/Transfer/Discharge and less common flows like Blood Administration
  • Contest winners for incentive
  • Dates and times for upcoming SmartTool ‘office hours’ in the ED Conference room. Providers can stop by and enjoy some one-on-one time to create and update user specific macros, preference lists and the like
  • Emphasize the importance of a having a positive attitude and a willingness to help one another. Just like practicing Emergency Medicine, this change and solution requires a team effort
  • Host a department pizza or ice cream event for the purpose of sharing updates, new functionality, tips and tricks
  • Host a monthly brown bag lunch with software tips, tricks and topics
  • Celebrate Success- post pictures that the staff members have taken of one another using the solution
  • A link to a slide deck that depicts benefits that will result from the transition
    1. Decrease delays in placing orders with CPOE
    2. Decrease number of pts D/C without vital signs
    3. Decrease number of pts D/C without being registered
    4. Improved care:
       • No more hunting for paper chart for returns to ED within 24hrs.
       • Fewer delays in care when all providers and support staff use an interfaced system.
    5. Decrease hours of chart audits by use of reporting capacities
    6. Easier compliance with Medication Reconciliation process

Other suggestions include:

• Place colorful fliers in staff areas that depict benefits that will result from the transition
• Start holding a daily huddle with software application updates
• Engage end users with incentives with daily or weekly drawings when training begins (gift cards, t-shirts, pens, badge holders, MP3 players, etc.)

Individual change management is an important consideration when implementing an EHR solution. For more information on how VCS can assist you in a successful change management process call us at (610)444.1233 or email us at vcs@getvitalized.com. You can also find more information about our services and solutions at our website www.getvitalized.com.