This article is part two of a three-part blog series with Dr. Michael McCoy.
Dr. Michael McCoy has diverse experience as a practicing clinician, an EHR vendor executive, IDN executive, and the first Chief Health Information Officer for The Office of the National Coordinator for Health Information Technology (ONC). He is currently Co-Chair of the Board of Integrating the Healthcare Enterprise (IHE) International, representing HIMSS.
How important is change management when it comes to successfully putting new systems in place in hospitals and healthcare organizations?
We’re still working through change even after putting new systems in hospitals. Having a system in place doesn’t mean it’s being used well. Part of the certified technology that 96% of hospitals and 78% of physician offices have is the technology to make online appointments. It has the technology to do secure communications with your provider or hospital. But just because something has the capability of doing it, doesn’t mean people working in the healthcare space understand the value in actually doing it. For example, think about when you’re selecting a bank. Would you want to pick a bank that doesn’t offer online banking? Would you be willing to physically go into the bank any time you want to deposit money or cash a check? Probably not. Yet we have that same kind of mentality going on in hospitals every day. You hear things like “I’ll be happy to send you your records as soon as you can fax me this form.” Whereas if you have an online healthcare portal, you can log in and request forms that way. There are a number of hospitals who still haven’t gotten that wake-up call about what’s expected of them in this day and age.
The same is true when it comes to getting access to your records in real-time. If you go to a physician and get a lab test done, they might say “Ok we’ll get you your lab results in a three or four days.” However, if you go the lab itself then as soon as the lab result is complete, it’s posted online for you to see. If you want to see it the instant after it’s available, it’s there. It makes no sense for physicians to slow down that process. There are physicians that still argue that they need to see the results before notifying the patient because they might misinterpret the results. I personally disagree with this mindset for a number of reasons. First, if you properly counsel the patient in advance about why you’re running the test, they’re going to know what to expect when the results come back. This also helps prevent some problems with missed tests by results getting passed from doctor to doctor. When patients have access to their own results, the likelihood of a missed test goes down significantly. There are far more examples of patient harm occurring from lack of communication than any demonstrable evidence of problems from overcommunicating with a patient. That’s a philosophy and a culture shift that is underway.
How do you help hospitals who are particularly change-averse?
True culture change has to be led from the top. It’s possible to use a bottom-up approach, but it’s much more challenging and is highly unusual. The reality is that leadership needs to say, “Okay everyone, we need to move on and move into the next century. We need to communicate with our patients better. We need to look at how we can provide better value. We need to have an accountable care organization and a network that allows us to be cost effective and deliver high quality care.” If you have medical staff on your team that aren’t willing to get on board with the change, it’s better to lose them than allow them to hold your entire hospital or practice back.
Here’s an example from the Veteran’s Administration (VA). The VA decided to put in the EHR, Vista, several years ago. There were a number of physicians that said, “I don’t want to practice ‘cookbook’ medicine. I don’t want to have to follow a guideline or checklist.” The VA had a mass exodus of physicians and close to 25% of physicians left. The VA Secretary said that it turned out to be a great thing. Because they put in the EHR and got their physicians to follow the pathways and protocols, their productivity increased and their outcomes improved. They didn’t even have to hire people to replace the ones they lost, because the team was that much better off. Sometimes getting rid of people who are holding you back may be more productive than trying to mollify them. It takes a strong leader to make that happen, but it is possible. The challenge is that people get stuck in a mentality of “We must do things this way.” But if you have a team that’s fully invested in the change, then the change can be made successfully and sustainably.
[Look for the final part of this three-part blog series next week!]