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Anthony Oliver: Thank you very much, operator. Good afternoon everyone. On behalf of the
Health Resources and Services Administration, Iíd like to welcome everyone to todayís
Health Information and Technology, Health Information Technology and Quality webinar
titled: Leadership Tips During a Health IT Implementation. Before we begin todayís presentation,
Iíd like to make you aware of the HRSA Health IT and Quality website. These sites contain
tool boxes, additional resources, and archive copies of previous webinars. An archived copy
of todayís presentation should be available for viewing within in two to three weeks.
Viewers can submit any questions for assistance to Healthit@hrsa.gov. Requests to receive
electronic copies of todayís slide presentations can also be obtained by sending a message
to this email address. Todayís participants should be aware of the new clinical quality
and performance measures toolkit, which can be accessed via the HRSA Health IT and Quality
website. Also, a new addition of the HRSA Health IT and Quality newsletter was recently
released. This can also be obtained on the HRSA Health IT websites. Participants may
also view the new Health IT and Quality Grantee Spotlights, which are available on the respective
websites. Please mark your calendars for the next HRSA Health IT and Quality webinar titled:
An Overview of Meaningful Use Stage Two Final Rule for Safety Net Providers, which will
be presented on Tuesday, September 18th at 1:00 pm Eastern time. Please note that this
will occur on this coming Tuesday, not on a typical Friday as we normally present our
webinars. I will now turn the webinar over to Dr. Yael Harris, who is the director of
HRSAís Office of Health Information Technology and Quality, who will introduce todayís presenters.
Dr. Harris. Dr. Harris?
Yael Harris: Thank you, Anthony. Sorry, the mute button wouldnít turn off. Thanks everyone
for joining us, thank you to the HRSA grantees and the members of the Safety Net community
for joining us for todayís webinar, and thank you to the speakers. Todayís webinar entitled:
Leadership Tips During a Health IT Implementation, will focus on the importance of leadership
in successfully steering organization through a Health IT implementation. Todayís speakers
are established leaders who have conducted more than 70 Health IT implementations across
health centers, rural health clinics, and critical access hospitals. The presenters
will focus on the importance of leadership in helping staff, clinicians, patients, Safety
Net provider boards, and other partners adjust to and overcome the barriers that typically
accompany a health IT implementation and may slow down success. Before I introduce this
afternoonís presenters Iíd like to read a disclaimer. HRSA would like to add that
this webinar is intended as a technical assistance resource based on the experience and expertise
of independent consultants as well as HRSA grantees. Its contents are solely the responsibility
of the authors and do not necessarily reflect (inaudible) views of HRSA. In addition, HRSA
does not indorse any health IT spenders or software symptoms, including those that may
be featured in this webinar.
Now join me in introducing and welcoming this afternoonís presenters. For staff presenting
for the National Rural Health Resource Center we have two great individuals. Terry Hill
has more than 29 years of professional experience working with rural healthcare providers and
their communities. He currently serves as a CEO of the National Rural Health Resource
Center based in Duluth. In that capacity of numerous (inaudible) funded rural health initiatives,
including the Technical Assistance and Services Center, otherwise known as TASC, for the Medicare
flexibility program, the National Rural Health IT Collation, and the Mississippi Delta Rural
Health Hospital Performance Improvement Project. Terry has laid several national demonstration
projects in topic areas including quality improvement and health information technology.
He currently serves as adjunct faculty at both the University of Minnesota Medical School
and the College of St. Scholastica, where he teaches courses on performance management
and leadership. He has authored numerous articles on a wide range of rural health topics, and
has testified before the U.S. Congress. Joining Terry will be Joe Wivoda, who is the CIO of
the National Rural Health Resource Center. Joeís been working in information technology
since 1990 with the health information - - with health information technology since 1993.
His work in the Minnesota and North Dakota regional extension centers includes Meaningful
Use assessments, readiness assessments, workflow analysis and redesign project management,
quality reporting, and tool design. Along with National Rural Health Resource Center
staff, he also provides technical assistance to 41 rural Health IT network development
grantees across the nation.
Finally weíve got Greg Wolverton, who is the CIO for White River Rural Health Center,
and heís been in this business for the past 10 years. In this role he oversees the implementation
of White Riverís first unified electronic medical record and practice management system,
a project to which White River received the prestigious HIMSS Davies Award of Excellence
for Health Information Technology in 2008. Mr. Wolverton also managed a substantial expansion
of the Federally Qualified Health Centers delivering network in 2010, and he now leads
a knowledge management systems group that delivers services to over 56 sites in two
states. Mr. Wolverton has served as a member of the HRSA National Quality Faculty, as well
as a Senior Examiner on the National Board of Examiners of the Governors Quality Award,
and is a member of the Arkansas Institute for Performance Excellence. In addition, he
serves on the HIMSS Ambulatory Community Health Organization Committee, and is the current
chair of the HIMSS Nicolas Davies Committee Health Organization Awards Committee. Heís
also a HIMSS fellow and was recently selected as a member of the HIMSS Innovations Committee.
Doug Smith next will be presenting. He serves as a CEO of Greene County Health Care, a diversified
health care corporation with an annual budget of $12 million. Greene County Health Care
is a health care home providing integrated care including medical, dental, behavioral,
and enabling services to over 30,000 people here in North Carolina. Mr. Smith is also
the CEO and CIO of Community Partners HealthNet, a health center controlled network of 16 community
migrant and rural health centers. In this capacity he has overseen several implementations
and integrate IT systems for member networks that have improved their ability to capture
data and provide better patient care. He is also responsible for development and operation
of an ASP model health center control network, which provides both electronic health and
dental records and practice management systems. I want to thank the HRSA grantees and Safety
Net community for pursuing this event. Thank our speakers for taking the time to share
their expertise and leadership with you. And Iíd like now like to turn the event over
to Terry Hill. Thank you, Terry.
Terry Hill: Thank you very much, Yael, and hello everyone. We are rep - - Joe and I are
representatives of the National Rural Health Resource Center and kind of in that capacity
we work all over the country in a variety of different projects, but most of it is focused
on rural and we represent regional extension centers. We basically have come into contact
with and have dialogued with probably hundreds of healthcare leaders across the country,
particularly rural healthcare leaders. Weíve done some research in this area as well and
we have a major focus on leadership and kind of building leadership. And as Yael mentioned,
I also am part of faculty that is looking at kind of the - - kind of business applications
and management applications here as well. So basically what weíre going to talk about
is what we have learned as we have talked to, like I said, probably hundreds of healthcare
providers and hospital leaders, public health, long-term care, et cetera, and try to give
you a little bit of a summary of their feedback. In essence, basically what we learn over the
years, and as Yael said, Iíve been working in rural health for 29 years, and itís always
about the leadership. If leadership, as a health leader said in this article recently
is thereís no exact formula to follow and implement in the HR system, but one ingredient
to success appears to be complete on qualified sport of the CEO and the senior executive
teams where weíve seen really good implementation in hospitals in clinics, in particular it
has to do with the leadership. The leadership has been prepared, leadership is aligned,
and leadership is supportive. So one of the things we know, this is a very difficult process.
Very often we underestimate the complexity or the scope of this, and so first of all
we just need to acknowledge itís difficult and itís going to require profound change.
In essence, it is a change process more than it is a technology process, and the impact
is going to go throughout the organization.
And what do we know about change? Because managing change becomes the primary leadership
challenge as weíre bringing electronic health records and other technology into our organization.
First of all, we know that change is increasing at an expediential rate. What happened in
the last 12 months, well weíll see as much change in the next six months and it continues
to go faster and faster. Thatís not all bad, it has both dangers and opportunities, but
really how we assimilate that change and how we actually kind of bring it into the organization
and manage it, becomes key to successful application of electronic health records. And increasingly,
in this I can just tell you from personal experience, as we go out to rural hospitals,
we see more and more of them that are kind of reaching their future shock thresholds.
And future shock actually, the concept comes from a book that was written by Alvin Toffler
years ago, and basically itís the point when people can longer assimilate change without
displaying the dysfunctional behavior. We have this enormous change happening in our
entire healthcare system. Weíve got reform. Things are becoming more and more complex.
For example, there are thousands, tens of thousands of conditions, medical conditions
we know about over 4,000 different medical procedures, 6,000 drugs to prescribe, and
thousands upon thousands of processes. Thatís extremely complex, and as Peter Drucker, whoís
one of the management gurus said, ìHospitals are the most complex organizations in the
history of mankind. Clinics are complex; healthcare organizations in general are very complex.î
So what can we do then? If we are, and again, itís just like we just canít take it anymore.
Just too much stuff coming down, whether itís ICD-10, whether itís electronic health records,
when itís privacy, itís all of these major, major changes. And particularly with our customers
who are primarily rural providers, we can raise the future shock threshold. Education
and awareness, for example, people need to understand why weíre going through this,
and that change actually is going to happen and itís going to happen quickly, and we
can be a part of it and we need to know weíre going. We can increase the staff resilience
during that change; we can make them change ready. We can reduce the obstacles in change,
and we can also increase the incentives for change as well. And Iím going to show you
some tools and resources that can be used.
Basically weíre starting here, and all too often we forget to do this. We need to really
as the leaders say, ìWhat do we really want to accomplish here?î Itís not just get the
incentives money, itís not just to have computers and having all our healthcare providers using
them effectively and our patients accessing that information. It really is about the bigger
goals of patient safety and greater efficiency, et cetera. And then we really need to know,
to plan out that transition stage, because itís not going to happen overnight. I can
assure you that if weíre fortunate enough to get all of the incentive money that transition
state is going to stay around for quite some time. And culture itself takes years to implement.
So what happens during that stage is something weíre seeing now as we go out to healthcare
organizations is low stability, itíll often turnover. Physicians may quit, for example,
going somewhere else because itís so difficult where they are. High emotional stress. High
and often undirected energy, and control becomes a major issue, and sometimes conflict increases
as well. So as weíre moving through here, hopefully what weíre doing is weíre learning
over time. Itís painful. Weíre building in remedies to the breakdowns and then weíre
looking for those opportunities. The opportunities are going to come in terms of being successful,
thereís going to be financial rewards. Weíre going to address some of the patient safety
issues, et cetera. But this all has got to be sold to the staff. If the IT folks are
the only ones engaged, weíve got major problems, and weíve seen major problems over and over
again as this is rolled out. This is a slide Iíve got, I love it. Dr. Norman Okamura from
the University of Hawaii presented it and allowed me to take it. He actually sent it
to me so I guess I can use it. But basically it talks about in every HIT project that weíre
aware of, youíre going to have to go through a valley of despair. In essence, our productivity
is going to go down. Weíre going to have people in disruption and change, and just
as I mentioned before, itís predictable and it needs to be managed. And what Dr. Okamura
said is that the recovery out of the valley of despair, which is the preferred future
on this slide, is something that is going to be dependent upon leadership and management
and actually laying out a clear path to the future and communicating that path as we go.
Now these are just basically essentials for HIT adoption. We often bring people from all
over the country in to talk about what did we learn when we put in electronic health
records? We get the early users and the early adopters in place and this is basically what
theyíve told us. Leadershipís got to be engaged. I want to keep hitting that. Medical
staff should be engaged as quickly as possible, and there are special approaches to medical
staff that weíve learned along the way. Strategic planning is crucial. Over and over again we
ask whatís your strategic plan as youíre rolling this out, and very often itís either
kind of fuzzy or itís not really clear what weíre trying to do in terms of these strategies.
Culture change is going to be required, and really another big, big thing we hear over
and over again that we didnít pay enough attention to process redesign and we needed
more work on that side of it. And then finally networking in collaboration is necessary.
I mean almost by definition weíre talking about collaboration, whether itís a health
information exchange or itís a rural, an HIT network, or electronic health records
just in general are going to connect everybody up. And again this is another of our favorite
slides here is that if you, letís say Meaningful Use is the end of that maze, what weíve learned
is that leadership comes together, we learn from each other, peer support, a lot of things
here that weíre really going to need to do to work together. Again, feedback from early
electronic health record adopters, it was a much bigger project than we expected. It
took a whole lot longer than we expected. We should have spent more time on preparation
and planning, and again we should have spent more time on workflow processes and education
as well. We also know that on the backend, and I think Joeís going to be talking more
about that, we need to plan for that backend support both from a cost standpoint and from
a personnel standpoint.
Now Iím going to just take just to introduce these frameworks. What I can promise you is
that if you take a more balanced, if youíre using frameworks this is a - - when youíve
got complexity, what Iíve learned through all my management training and background,
is that frameworks are immensely helpful. And just going to introduce these and just
invite you to take a look at them. If you want more information we have our contact
information at the end, but weíre building and have toolkits in all of these areas that
might be of help, but Iím not going to have enough time to talk to you in any detail right
now. One of the areas is Baldridge Health Criteria for Performance Excellence Framework
is basically a whole framework that can be used for an entire organization or for something
as like a health information technology implementation. It takes the various parts of the system and
kind of puts them all together. It focuses on the workforce, the processes, the customers,
the physicians, and the providers, and the strategic planning and leadership, and sets
up a system for measuring. This does not have to be complex and weíre working right now
with some state and national quality organizations to develop frameworks that are absolutely
useful for the very small providers as well, again, more to follow on that. A second thing
has to do with Balanced Scorecard. Again, some of you are aware of this, but weíve
just found Balanced Scorecards to be incredibly helpful. And what you see here is a Balanced
Scorecard strategy map where weíre basically identifying the strategy based on learning
and growth, internal processes, customers in community, and finance as well. So we have
manuals, weíve got lots of resources here at our national resource center for those
of you that may be interested in this. Again, I recommend it to you highly because if you
do it and you put a little time and effort to it theyíre invaluable.
My final slide really looks at using systems frameworks here to kind of identify forces
and obstacles. We actually did something, Joe and I did a whole leadership planning
retreat this morning before we got on today and we just have used this, leadership has
used it over and over again. What are the forces moving us in a particular direction?
What are the obstacles? What are the processes? And look, HIT is just a part of this dimension.
Thereís also business technology, like I mentioned, and a part of that would be something
like the Balanced Scorecard or using the Baldridge frameworks, and thereís lean process improvement.
Thatís a business technology piece as well. And then finally thereís kind of this whole
social management thing which basically gets into leadership and changing culture and getting
your folks enlisted and itís recorded as well. And then ultimately itís about enhanced
quality patient safety, improve population health, and cost efficiencies as well. Joe,
Iím going to turn it to you.
Joe Wivoda: Thanks, Terry. In our work with hospitals, clinics, and other healthcare providers,
weíve really seen that the National Rural Health Resource Center a lot of the same themes
coming through and Terry touched on all of them. But the leadership agenda really has
to take into account the strategic planning, and that should be EHR, thatís that annoying
feature in Microsoft Office that fixes words for you. That should be EHR not HER. The cost
of the system, and Iím going to talk a little bit about total cost of ownership, which is
often times misunderstood. Give a quick overview of project management, the roles leadership
should take, and some recommendations on next steps. Strategic planning is so important
with the EHR, and I too often hear people, Iíll ask them why are you implementing electronic
health record and theyíll say, ìWell, we have to reach Meaningful Use,î or ìWe want
to get an EHR in before we get the financial penalties from Medicare and Medicaid.î You
know really it needs to be more than that. It needs to be part of your strategic plan
because you canít just put these things in without doing real organizational change.
And that includes assessment planning, you know developing that business case and then
selection. And that doesnít - - selection does not necessarily mean switching vendors.
That means selecting the processes that need to be improved. That means doing all sorts
of different selections. One thing I want to hit on here is that readiness assessment
piece that it makes a lot of sense for you to have some sense of how ready your organization
is for fully adopting an electronic health record because itís more than just double
clicking on setup and hitting next until it says finish. Thereís a lot to this, and the
organization as a whole needs to be ready for it. On our website at Ruralcenter.org
we have some readiness assessments that are available for download, for example. You know
so the question is where are you in the adoption path now? Are you implementing, evaluating,
or improving? And I often hear people that have gone live with an EHR and theyíre not
realizing the efficiency of it. And they say, ìBoy, I wish we would have spent more time
in workflow analysis and redesign.î Well itís not too late. That it has to be a continual
improvement, and as leaders you need to make that continuous process improvement part of
or include the electronic health record in all of your technology. That is just so important.
I want to leave you a quick plug for a partner of ours, the Rural Assistance Center. Theyíve
got a number of planning tools on their website that can be helpful, and itís their HIT toolkit,
which has all of the - - a number of the federally funded efforts that have been out there, all
of those tools in one place, along with some of the other websites out there. This is one
to keep on mind, RAC Online. They have some great tools.
I mentioned total cost of ownership earlier. It is very misunderstood what the cost of
an EHR is and most organizations that I speak with that itís easy to understand the licensing
cost, the implementation fees, and maybe the computers you need to buy for it. But often
times people are not going in with a complete understanding of what those recurring costs
are, including the annual maintenance fee, the requirement that youíre going to periodically
replace computer hardware. If you add 100 computers, that means in three years or every
year youíre probably going to need to replace about a third of those or a quarter. Best
practice is to refresh that hardware. So go in with both eyes open. The staff costs, that
there are staffing increases in some areas and changes in skill set will be needed. I
often ask people where do you think youíre going to see the savings in the EHR. And sometimes
theyíll say we expect to decrease our reliance on transcription, so they see a savings there.
Well you may be able to decrease the transcription, but youíll probably increase in other areas
such as IT support. So those staffing changes are not necessarily equal or less. You all
of course get lots of productivity during implementation and go live that if you do
your work on the workflow analysis and redesign, you should be able to make up. Savings, you
will not get savings without doing a major effort, a focused effort on workflow and productivity
improvements. I canít say that strongly enough. That during that process you really - - of
implementing the EHR you really need to look at that. You could see improved revenue capture
with the EHR, and you know you have an opportunity for offsite staff, having folks work from
home, working with your partners to share staff if youíre networking, that can be very
beneficial. Another area that leaders need to be aware of is project management. And
this is often misunderstood as well. And this doesnít mean that the CEO needs to manage
the project, thatís not what Iím talking about. The project management is a specialized
skill that you really need to have somebody whoís experienced and enjoys doing that,
not everybody does. Donít leave this up to the vendor. This is something that they really
need to have at least a portion of internally. Consider the community college high tech training
program if youíre not. There are some good tracks in there for project management training.
The leadershipís role in project management is really to be involved in the steering committee,
to take on a role of champion, remove those obstacles, engage in the staffing positions,
and understand the project. And basically get involved. It doesnít mean doing the build
or managing the project, but leaders need to be involved and aware of the project. And
those roles that you can take, some of them are listed here and Iíll talk a little bit
more about champions. Iím a big fan of executive champions and also executive rounding, which
Iíll talk about too. A champion, their primary responsibility is to be aware of the stats
of the project and remove those obstacles. Be able to answer the questions in the hallway,
as well as build engagement amongst different constituents, like physicians and staff. They
donít need to be actively working, but just aware and supportive of it. And this should
be somebody who can understand the project outcomes, not just the technology. The kneejerk
reaction is to grab the first executive that had an iPad or the first physician who has
an iPhone. It doesnít necessarily have to be the case. It has to be somebody that can
spend a little time on it and understand it and communicate it out to others. And I talked
about a lot of those. Communicating with physicians, again, staff meetings for the staff. Like
I said, Iíve seen a great benefit of executive rounding and being able to walk on the floor
and just casually ask people what is their involvement been with the electronic health
record, how is it going, what are you excited about, what are your concerns? That can give
a lot of benefit to the project. Listen, ask questions, and provide that support.
There are other champions that leadership will need to be involved in, or at least involved
in selection. And the primary ones are physician and nurse champions. That physician champion,
like I mentioned, should be somebody whoís well respected, willing to spend the time
and be able to communicate with others effectively. It does not necessarily need to be the most
technical physician. Avoid the kneejerk reaction to use the new physician thatís coming in
that doesnít have any of the current political baggage that might exist, or that maybe is
more technical. It has to be somebody whoís well respected that the others will listen
to. Same thing in nursing. You know usually itís the Chief Nursing Officer, but they
have to be somebody who can be actively working with the staff and engaging them. So your
next steps. Revisit that strategic plan. If you havenít done that, do it now with an
eye on the electronic health record. Just to repeat what Terry said, the EHR project
is not an IT project. Itís canít be led by IT. Itís an organizational project. IT
plays an important role. Iím an IT person. But this is not an IT project, this is an
organizational project. And your role as a leader is to be involved in it and to be a
champion and project that understanding of the project. Executive rounding with an EHR
focus, put another plug in with that. Take a look at that RAC HIT toolkit, thereís some
good stuff on there. And as well as our website has tools and we have a blog where we talk
about some of this stuff as well. At best, electronic health records can hardwire quality,
and thatís true. And the only way to do that is to really do that process design. So as
a leader, you need to make sure that that project as itís moving forward, that there
is an effort to incorporate real process improvement in the project and question that. Make sure
that thatís occurring; ask people on the frontline what theyíre seeing. And with that
Iíll hand it over to Greg Wolverton at this time. Thank you.
Greg Wolverton: Joe, thank you very much, I really appreciate it. A lot of things there
we both see eye-to-eye on. You know one of the things I think about health information
technology, innovation, and creating leaders and being leaders is actually having you our
team leaders, as Joe pointed out, and also Terry, that any EMR or EHR is not an IT project
so youíve got to look and wonder why generally IT people are selected to manage the project.
It is an organizational project, but itís one that requires a great project manager.
And thatís kind of where things go. One of the quotes that I really love and I tell everybody
this, Albert Einstein, ìThe only reason for time is so that everything doesnít happen
at once.î When we start thinking about electronic health records and leadership and governance
and everything that comes along with it, it becomes really nerve racking.
I talk a lot about sustainability, and I really like sustainability because what we really
have is a whole lot of factors that come in. Everything that we do with government work,
healthcare work, or any program work, you hear sustainability. You hear your finance
people, how do we sustain it; your quality people, how do we sustain it? You know there
are a whole lot of factors, as I said, social, economic, environmental, that becomes part
of sustainability. With all of these things we really have to understand as a leader that
we have to create models of sustainability that are also bearable and equitable. If itís
not bearable for our customers, and that could be internal and external, theyíre not going
to do a big take on it. Youíre not going to have the buy in, it doesnít matter if
itís providers, it doesnít matter nursing staff, administrative staff, or even our patients.
And it also has to be equitable. We canít build these models just to put a shift to
move workflow. We have a change versus a transformation, and Iím going to get into that in just a
moment. But as leaders, we tend to look at why people do what it is they do. And as we
get to this Iím going to be going back to the teams, as other people have said, and
talk about culture. And Terry and Joe really keyed on this, is when youíre doing health
information technology you really have to have a culture change. This is not your paper
records merely on electronic, it takes transformation. With motivation people do things, theyíre
motivated differently. Do they want to do it in the first place? And then also, how
do we continue maintaining it with our discipline. These are all very important things that a
leader has to look at, and more so keep in mind weíre talking project manager.
We see it all over the place here in the news and everywhere else how we need to engage
our patients. How our patients are want us to engage them. And I think thatís really
interesting as we go through and look that a lot of the focus on the EMRís have been
the providers. How easy is it for the provider to use? How easy for it is the nurse to use?
Often times we leave out one of the most important customer groups, which would be our external
customers, which would be our patients. I want to make sure that we engage our patients.
We do the right things that it is that we need to do and I think everything will come
together.
So, having said all of this and having looked at this, what do leaders really do? Well at
our care weíre a federally qualified health care center and weíve got quite a few locations
that we deal with in multiple states. One of the things that weíve started and I will
add that Iím going to get to this later; we are in the process of changing out our
electronic health record system to another system. Now is it going to be easy to do?
No. What were our drivers behind it? Well, we kind of looked at things and looked at,
you know when we start talking about not making a hill of beans, we found that all we ended
up in our EMR doing was counting beans. We werenít really looking at patient management.
So we really had to make a shift as, once again a part of our strategic plan to move
around and work with this culture change, to create great teams that function. It was
pointed out that maybe your most technical person or the person thatís been here the
longest is not the best people on the teams. I have to tell you this will be about my fifth
deployment of an electronic medical record system in some various place or another, and
Iíve got to tell you that from my experience, the people who are the best or that function
the best in the teams, are often times the ones who are the most, or I should say the
least technologically savvy. And also the ones that you wouldnít think that would be
there, such as people who are not in leadership roles. One of the things we found out in our
first go around in 2006 was the fact that we thought, well, we needed leaders in there,
we needed the managers, and we really hit it heavy with middle management. And we really
found out that the truth is middle management didnít know what was going on often times.
So what we did was we reached back and we looked at what would be better. So we started
pulling the people from the field; the people whose feet were on the ground. And I agree
with Joe to do the rounding and stuff, and we still consistently do that right now, but
itís more at the lower level, itís the people that are working and the people that are going
to actually use the system that are helping us make the decisions. So we created great
teams that function. We found people that can work well together, not necessarily people
that are flown together. Because we found of course if youíre hostage to a project,
youíre not going to really give it your all for the project.
One of the things in leadership, and also the team when you look at the team approach
as well, is be prepared to stand your governance ground. When you start looking at leading
projects as an EHR, itís a huge - - thereís a huge amount of responsibility that has to
rest on the project leader, the project manager. If thatís the CIO, thatís great, if thatís
the CMIO, thatís great too, wherever that falls into, but youíve got to be prepared
as a team to stand your governance ground because really what youíve got to do is get
the system running. And it was an interesting concept that we saw going from one EMR to
now working on the setup of the other one. We typically as people and in healthcare,
have a propensity to want to automatically engage the process on the frontend and figure
out how weíre going to do something before weíve even set up the information on what
weíre going to do. Now let me say that, take that a little step further. Often times weíre
more worried about the end result as far as the process, than getting it set up right
in the first place. So one of the things that we found was, and we didnít think we did,
we actually duplicated our paper processes in our first EMR. That was our mistake. That
was our bad luck. That was our looking at things and hoping that we can duplicate the
same process or utilize the same process through electronic means and that absolutely positively
has not worked. And I would submit to anybody that if youíre merely looking for an EMR
or you have people that are going to view this EMR to say well this is how we do it
now, you have to stop right there and be prepared to stand your governance ground and say no.
Thereís a difference between change and transformation, and for our care we chose transformation because
change is merely trying to fix something that already exists. Transformation is doing something
totally new, and if we do that, weíve got to have all new processes and donít even
think that the existing paper process is going to work. Donít ever be afraid to redirect
your team toward the goal.
Often times we get into situations to where you get the double talk and you get in the
(inaudible) meetings and the team meetings and you hear the what ifís and you hear how
people say, ìWell this is the way we do it now and I really like doing it this way.î
Once again itís going back to the governance with your other users, but with your team
members you have - - donít be afraid to redirect them and say, ìI understand what youíre
saying, but weíre not here to visit our (inaudible) process, weíre actually here to develop new
ones.î But I think thatís just a human thing to do. People do it. I do it all the time.
Weíre here to achieve results. One of the things or several of the things that weíve
done in our care is we eliminated our IT department. And when you look at that and people look
and you think, oh, wow, what do you now? We have Knowledge Management Systems now, we
donít have information technology. It goes back to Joeís talk about IT cannot lead a
project like this. There are very few things that IT can do, but Iíll tell you, most people
are afraid of technology, especially when thereís a lot of (inaudible) involved of
getting them to use it in the first place. So our idea behind this was, well letís just
donít have an IT department, letís call it Knowledge Management Systems, and letís
really manage knowledge and information and use that to deploy out to our physicians and
our nurses and our other users as opposed to technology. So if we took the emphasis
off the technology and put it on putting information and knowledge into the userís hands, we found
that that really is a nice approach. Does it work? For our care it has, because once
again technology often times doesnít work, or if thereís a problem, people tend to blame
technology. But if you take technology out of the focus, then we found it works better.
We also created subject matter experts. We donít have anybody thatís the keeper of
the knowledge at our care. We have even our changed management teams, everythingís a
team approach. Greg Wolverton gets to lead a lot of things. Greg Wolverton gets to make
a lot of decisions. At the same time, at the end of the day, itís because of the input
and the information and knowledge that the subject matter of experts have gone out in
the field and researched and brought back to the whole team. So once again, put that
focus on the information and knowledge.
Our first foray in 2005 was strictly EMR. We were ready to go electronic. We had a lot
of places to go. One of the things that we really looked at was we were starting to grow
faster than we could put paper charts out there and we can get our information out there
and work our billing systems. So the truth is our first foray in 2005 was more about
practice management and less about electronic health record system. Automatically folded
over into this patient management, thatís where we are now. So we took our emphasis
off of an EMR and now we prefer to view it as electronic patient management because weíre
doing a whole lot more with our medical records. Our care is the Part B, where Iím a provider
for the whole state of Arkansas. You can imagine all the medical case management and everything
else thatís going on there. Thatís not specific to an EMR or an EHR, thatís patient management.
Weíre trying to manage gold, such as diabetes self-management education. As we move towards
patient management, the patients like it better, and so far our providers have liked it better.
We continue to push lean, and Terry and Joe talked about this as well, youíve got to
be lean. Do not think, and at our care we donít think that anytime weíre faced with
a problem we automatically eliminate it by adding people, you canít do that. Often times
people are the problem and the solution to what youíre dealing with, whether thatís
eliminating, and in some cases you have to add them, but itís also redesigning theyíre
workflow in their own mind, and once again, going back to that culture change. One of
the things that weíve done at our care with our knowledge management systems is push our
subject matter experts who do other jobs. So weíre able to have people that want to
help other people, and at the same time theyíre already working and we donít have them a
part of the ìITî department, so thatís worked a whole lot better for us.
Leaders need to lead and not manage. That is very, very important. Typically we find
that people working on EMR, and donít get me wrong, I work late hours, but when you
typically find that everybody gets overwhelmed because youíre working Saturdayís or you
find yourself working at night. If you are the leader, please, please, please lead the
teams, donít manage their output. Because if youíre going to manage their output, you
donít need them and youíre just putting way more on yourself than you will ever, ever
even come up to be able to even manage. Youíre going to go into a tailspin rather easily.
So make sure you continue to lead the group. And once again that goes back to the previous
slides. Make sure that you create these team approaches, let your subject matter experts
come to you, and all youíre doing is governing at that point.
Meaningful Use results: Some of the things that weíve been able to do through our knowledge
management systems and also our quality departments as well, work hand-and-hand. We are Meaningful
Users. Weíve got, I think itís 98, roughly 99% of our providers right now are certified
Meaningful Users. We are at milestone three, so weíve already achieved our second year
of funding as well for our providers. But by using quality and knowledge in this team
leadership, weíve enrolled and certified 34 providers as Meaningful Users, and got
the money for it I think. So when you start talking about it, your finance people and
your CEOís and CIOís say show me the money. Well weíve developed quality and knowledge
based scorecards for all staff, not just providers, not just nursing staff, but everybody. We
also educated all of our Ark care and Kentucky care staff on Meaningful Use and what it means
to our patients. We found that the important thing about that was a lot of our staff really
honestly didnít know what Meaningful Use was, they just felt it was some mechanism
that administration put out there to get them to do more work. And our patients didnít
understand it because they donít understand how far we need to go and what it means to
them. So these mechanisms are put in place once we get the staff to understand, and we
kind of work internal outward. So as we pushed internally and we educated internally, all
of the staff were able to branch out like a tree from the trunk outward with our patients
and were able to push it out. In the meantime, a lot of that and you can see in the results
obviously thereís places some things were moving, some things were not, and this is
probably not very large for you to see. But weíve seen an increase in compliance, and
I think compliance goes both ways. You know you expect compliance out of your patients,
but I would suggest to everyone that your staff should have some compliance as well
in making sure that the patient understands everything that they need to do. So that kind
of gives you an idea. We get more into our Balanced Scorecard as we go back to them;
we combined our Meaningful Use results with our patients in their medical home. We now
have 26 sites that are NCQA level three medical homes. We aligned both patient-centered medical
home and Meaningful Use measures and created a ìTOPSî report. Itís Total Organizational
Performance System Report. And weíve got five pillars of organizational excellence;
people, service, quality, stewardship, and growth. And this gives you an idea here of
where we look at preventative care measures, other required measures, and this is reported
monthly to absolutely, positively everyone in our organization. And also weíve got quality
champions who actually have a physical meeting 30 minutes once a month in every one of our
facilities that itís required that everybody attend so everybody can be brought up to speed
on where our organizational excellence and our quality pillars are heating and tying
it back into our strategic plan, Meaningful Use, and patient-centered medical home.
So, in kind of closing, thereís a lot to look at this. You know we want to think itís
hard, and it is hard, but with the right team and the right approaches, and working as a
team, and utilize the resources that are on hand, the RAC Online, everything is excellent
resources. But I think the key thing is donít be afraid to reach out to those that maybe
you need to reach out to because itís like itís really itís a circus out there. It
smells good and it looks good, but at the end of the day it really gets expensive. So
make sure you take your time, you build your good teams, and get good information. And
I want to thank everybody for bearing with me and listening to me, and I would like to
go ahead and turn it over to Doug Smith.
Doug Smith: Good afternoon everybody. Iím going to tell you first a little bit about
Greene County Health Careís Community Health Center. We serve over 31,000 patients a year
with integrated primary care, so it has medical, dental, behavioral health, enabling services.
Weíre level three NCQA accredited or recognized at our four main sites. Looking at Community
Partners Network HealthNet, which is the health center controlled network that provides the
IT from CPHís point of view, weíre trying to create an integrated health management
system that incorporates practice management, electronic health records, dental electronic
management, data warehousing, all of those tools into one integrated system that will
support that integrated care system. Community Partners HealthNet was created back in 1999.
Greene County Health Care has been using electronic health records and other things for over 12
years now. Community Partners HealthNet was created to help spread that to other health
centers. This picture is a sort of basic schema of the integrated system with the practice
management, dental, tie-into state registries, tie-into the lab companies; LabCorp, Spectrum,
Quest, the different ones. Tie-into HIE, tie-into prescriptions, Sure Scripts-RX Hub. Our own
data warehouse, which is used for our reporting we take from all 18 of our members. Virtually
all of the data thatís in the electronic health record system and drop it into a data
warehouse every night and we have a report writer that generates reports for all the
centers. And weíve actually developed some remote ways that the centers can generate
those reports themselves for their QI and other management purposes.
To me, healthcare homes, which is what most of us who are CHCís are really trying to
create. And we can meet these medical home criteria, but also do some other things provided
integrated culturally appropriate services, including more oral and mental health; meet
the Meaningful Use criteria. So weíre like level four patient-centered medical homes
because of what we do. To do this it requires a lot of resources. We know about these health
care homes and the requirements, patients under medical home requirements that we have
to coordinate care as comprehensive. Weíre trying to expand accesses, community health
centers. Weíre trying to do it as culturally competently as we can with all the different
populations that we serve. Doing that requires a lot of resources, and many of those require
partnerships with other entities in the local community. The focus on this is on quality,
as my co-presenters have pointed out. All of this is not an IT project. IT simply provides
some tools that can do portions of it. On the other hand, there are actually tools that
are very, very powerful in terms of tracking different things, from the Meaningful Use
measures to profit measures, all kind of outcome measures. One of the things that are going
on is much more of the integration of the behavioral health and measures related that
thatís coming into the system now. When you look at NCQA standards, theyíre pretty well
known at this point in time. Theyíre around access communication, patient tracking, care
management, self-management support, electronic prescribing, tracking of all the different
tests done, it could be lab tracks, lab tests, and referral tracking, transition of care
types of things. Thereís a substantial amount of performance reporting and improvement,
advanced electronic communications between the practice, whether itís the providers
or other clinical staff on the practice, and the patient trying to get more timely and
more open communications with the patients. One of the things thatís really important
to recognize in terms of doing all of this, I think Greg mentioned before, is that a number
of the patient-centered medical home requirements and a number of the Meaningful Use requirements
overlap, itís important to understand which ones overlap and how you can focus resources
and then not duplicate effort in doing things that would actually meet both if you do them
properly. Iíve provided you some information here about those. Iím not going to read all
of the slides, thatís there for your information and also there are I think links that I have
created here for you that have a number of much more detailed crosswalks between the
patient-centered medical home and the NCQA standards. CHCANYS in New York has a good
one, NCQA has their own. Itís important to look at those, understand them, and then combine
the things up that youíre doing.
The principle barriers to implementation are very similar to what people talked about before.
Weíve been doing this for a long time and we say the same things that youíve already
heard. You know this is not an IT project, youíve got to get total organizational commitment,
you have to do all this planning to get it done, and we get a lot of head nodding, but
then people donít really allocate the resources to get that done because theyíre used to
being in this crisis mode and it makes it very hard and stretches implementation out
over a long time. It really needs to be addressed upfront and people need to allocate the resources
to get that planning and all done beforehand. It makes things much smoother. Youíre going
to spend the time one way or another. You can do it in an organized fashion or you will
do it at some point in time. But youíre talking about a total cultural change in the organization.
There may be a lot of procedure and policy running. Working in groups like networks is
good because we can share a lot of those things so that weíre not reinventing the wheel.
NCQA itself still has a number of issues which theyíre working on. Their sites are not user
friendly when you do multiple sites. If youíre a community health center that has 10 sites,
to get each one accredited youíre going to have to upload some 300 pieces of information
and itís going to be the same to each one, but itís going to have to be uploaded separately.
In many cases there are manual audits required when some of those could be computer done.
So I mean thatís something that needs to be streamlined and made a lot more user friendly.
There should be a place where you can put things up and indicate that theyíre for all
10 of your sites, not have to put them up each time. Itís a very labor intensive process
at the moment.
Organizational readiness: One thing as a network we try and access the organizational readiness
to do these things and the level of commitment. There has to be a very strong commitment on
the part of management there to allocate the resources and to get things done. They have
to really be willing to spend time to redesign all of the clinical processes. And the lessons
learned that we have learned through 12 years of doing this, is that really that buy in
of the staff involvement in the planning process and the leadership commitment really drives
how these types of implementations go. If you have those things, then that implementation
will move along in a reasonably timely fashion. Without them it can stretch out over years
and years. Training is another thing besides people have to allocate enough time to train
people to use tools. Youíre talking about very complex tools and weíve shown up at
sites where weíve had training set up for a particular day, theyíve chosen the day,
but on that day we go there and train the providers and they havenít blocked off their
schedule, theyíre not available. These are complex systems. I mean you cannot learn them
in an hour, and youíre certainly not going to change workflow and do all of that kind
of thing on the fly. I mean itís impossible. Workflow design to incorporate and take advantage
of any set of complex tools or toolkits really has to occur. I mean youíre not trying to
use technology to just do things in the same bad fashion theyíve always been done. Youíre
trying to take a systems approach and adjust workflows in ways that are more efficient
both for the staff and the patient. One of the things that weíve found is that QI committees
at the network level and also in the individual health centers are really critical. They can
share very critical information, they can share templates, and they can create templates
that do many of these things easily for people. And that doesnít have to be done over and
over again; it can be created by working together.
Leadership: Leadership is one of those funky things. You can go all kinds of places and
everyone will tell you all kinds of things about leadership and what must happen. Weíve
heard a couple times already about lean collaborative, and thatís the particular thing that we have
used at Greene County Health Care. It was actually NC State that provided those. They
had a number of community health centers that enrolled in them and they went out and taught
them the different processes and techniques involved in lean work. They went to each of
the different centers and implemented a project jointly with people from all the other centers
so that they could see how those worked. So there were five or six centers that teamed
up together to do those types of things, so they learned how to do (inaudible) events
and other change processes. They can use their PDCA, which a lot of health centers use, Plan
Do Change Act, but youíve got to have a structure to be able to make the changes, to change
the processes. All of this type of stuff, as has been mentioned before, occurs in an
environment that is very stressful on a normal day of no changes occurring, based on complex
patients coming in. And the world is changing extremely rapidly and more rapidly each time
we turn around; that adds an additional layer of stress on top of things. And then you of
course have management who is trying to change everything to try and make the world a better
place hopefully. That creates another layer of stress on it. Itís very, very important
that you do different things that can reduce those stress levels. Healthy workplace, communication
is one of the most important things that can be done in that arena. So one of the things
that Greene County Health Care does is we use true colors training, which is a particular
technique, and that associates peopleís personality with different colors so people are - - you
know can understand the personalities of other people, what sort of personality groups they
fall in, how they look at the world versus how you look at the world, and can see how
those different types of individuals can relate to each other better. So weíve gone through
a number of those trainings in all of our centers and they start off with all of the
basic things and then there are more advanced levels of training. But the purpose of all
of that is to encourage better communication between the different teams, which is an important
kind of thing that has to occur in any organization to be successful and to reduce stress, but
its particular easier trying to change things it becomes of the change management as to
how you do that. Leadership itself has to be able to work with all of the staff, the
board of directors, and external influences to create the purposes, build the commitment
of all of the individuals, be able to include the diverse points of view coming in from
those individuals, and then develop the process orientation in the team thatís going to create
the synergy which is going to transform the actual practice. And you know you have actual
tools that can be used as a transformation, but youíve got to create an environment to
be able to do that, and you also have to be able to manage the stress levels in a complex
practice and hopefully you can be able to reduce those doing a number of different things.
Those I think are some of the critical points, some of them we had, you know my co-presenters
had very artfully presented earlier on. My function has been to sort of have cleanup
here and reiterate a number of things and to try to do that very quickly so that there
is time left for you all to submit questions. And I hope Iíve done that.
Dr. Alana Knudson: Excellent. Well thank you so much, Doug and Greg and Terry and Joe,
you have been providing us some excellent food for thought and we do have a number of
questions already in the queue. So with that, why I donít turn the first question over
to Terry and Joe, and one of our participants today would like to know: At what point is
it appropriate to evaluate current skills of staff who will use the system or will assist
in the implementation of the systems?
Terry Hill: Yeah, great question. There are a couple of different areas where you need
to really access the computer skills, if weíre just talking about that. And that - - as early
on as possible to get the basic computer knowledge is good to access their basic computer skills.
They know how to use a mouse, they know how to resize a window, all of that sort of stuff,
and you know to get that as early as possible because it takes quite a bit of time to train
people on that. And sometimes if Iím - - Iíll be in a room and people will say, ìYou know
our staff really doesnít have very good computer knowledge.î And Iíll ask the question, ìHow
many of you have a Facebook page?î And when half the hands go up, that usually means theyíre
not too bad, that thereís some hope there. And then as the project moves forward, there
are other points where youíll need to access of using the EHR and understanding some of
that. But right away as early as possible to understand their basic computer knowledge
is a good time.
Dr. Alana Knudson: Thank you so much. Also we are getting a number of questions regarding
how to access the slides. If you would please send your request for the slides to Healthit@hrsa.gov,
you will get a copy of todayís slides.
So letís move on to some additional questions. Greg, one of our participants today would
like to have your perspectives on, it appears that thereís some grey areas where a leader
must manage, at least temporarily at times, hence the need for our leaders to have experience
in what they are leading. How does that work in the implementation of EHR systems when
some of our leaders have limited experience with those systems themselves?
Greg Wolverton: Sure, you know weíre - - and thatís a very good question and right to
the point, and thatís where we are in our organization right now with the change of
EMRs, because none of us know really the new one as far as the overall the process and
everything. What I really believe is if everything operates in terms of project management, if
youíve got people that can lead a project, no matter the project, whether itís an EMR
or itís an IT project or no matter the project, if itís building the vehicle, if youíve
got the proper things in place and the proper mechanisms in place and the proper plan in
place, then anybodyís going to be able to drop in. Weíve got a chair and a co-chair
and things like that that everybodyís going to be able to do. But I would just encourage
an overall leadership in systems approach to think that just not one person could do
it. It may take, as (inaudible) it may take a village to raise this child.
Dr. Alana Knudson: Great response, thank you so much. Would you please provide the website
for the crosswalk between the Meaningful Use and the PCMH?
Doug Smith: Yes, those are actually in the slide presentation, I believe, so when you
get those sent to them youíll get the links. One is that CHCANYS, which is Community Health
Center Organization of New York. Thatís http://www.chcanys.org and then NCQA I donít know the actual link,
but itís in there set of 2011 standards, its appendixes two and four.
Dr. Alana Knudson: Excellent. Thank you so much. Going back to Terry and Joe, do you
have any tips for implementing the transition for a state correctional setting in general?
Also, do you have any specific recommendations for connecting with different state agencies?
Joe Wivoda: I really donít have anything on, that I can share, on correctional facilities,
I donít know about Terry?
Terry Hill: No, we donít have anything specifically, but I think weíre really going to have to
put that on a fast track here. I donít know if anybody mentioned long-term care, but the
transitions between hospitals and long-term care organizations are gaining new importance.
But then youíre right, I mean we have a prison population, we have these other pieces as
well and probably way too little thought has been put into how weíre going to make this
all work. And if anybody has that, we certainly as a resource center would be interested in
anything you might suggest on that as well.
Dr. Alana Knudson: Excellent. Thank you. We had another question that came in about where
to get the slides, and if you would please email HRSA IT, or rather Healthit@hrsa.gov,
and itís on this last slide that was shown. If you just request the slides they will be
sent to you.
And this is a question for all of you: What do you think is the most important lesson
learned that you have observed in your experiences implementing EHRs from a leadership perspective?
Maybe we can start with Greg first with that question.
Greg Wolverton: Yeah, sure, and thatís a good question right there. I think you have
to look at it once again is just the previous experience. And depending on what youíre
looking at and how youíre doing it, I think the biggest takeaway and the biggest lessons
learned was take your time and understand that everybody does have their own view. Take
your time, try to extract everyoneís views, and try to put something together as a team
that everybody can work with.
Dr. Alana Knudson: How about you, Doug, whatís your perspective on this question?
Doug Smith: Could you repeat the question again?
Dr. Alana Knudson: What is the greatest lesson learned for, in your experience, working with
leaders who are implementing EHR systems?
Doug Smith: Well I think the thing that Iíve noticed the most is something weíve talked
about several times is that people, no matter how much we tell them, that itís really complicated,
they tend to compare it in their minds depending on practice management for this event. Which
is a complex process, but you know itís sort of confined and in a lot of ways relatively
simple to do. Doing an EHR or hopefully not just an EHR but a whole integrated system,
really is a system redesign whole organization project, and that involves the - - it needs
to involve a lot of people in an organization, itís not just the IT people or itís not
just the clinical staff. It needs to have everybody, including the leadership of the
organization. And they have to know how to put together effective teams. As a network,
we provide some of the project management expertise because weíve done it over and
over again so we can say what needs to happen here. Help and develop a plan, work with the
teams to do that. That said, we canít do all of it, thereís got to be leadership at
the individual centers or the implementations lag.
Dr. Alana Knudson: Excellent, thank you. And how about you, Terry and Joe, what has been
your experience and observation of leaders?
Terry Hill: This is Terry. I would agree with everything that was said. Itís interesting
because when you get people who have really studied this or done this, thereís not a
lot of disagreement on this concept. In essence it really starts with leaderships sitting;
you know coming together and forming those teams. Itís almost like an orchestra it strikes
me, that the leader is helping to orchestrate a kind of complex number of processes and
with a common goal of reaching not just Meaningful Use, but as I think has been mentioned already,
safer care, better care, really making the electronic health records come alive as some
that is consistent with the mission of healthcare providers in general. That if itís sold as
that, I really like Gregís suggestion that we even take IT out and call it Knowledge
Management Systems because it is basically something thatís going to require everybody
to be on board and weíre going to have to have a goal thatís larger than just the technology
piece of it. And I think that starts with leadership. Joe?
Joe Wivoda: And this is Joe. I guess I would probably echo a lot of what Terry is saying,
but Iíd put it this way, that these projects have less to do with what vendor you have,
how good your project manager is from the vendor, how good your IT staff is, how engaged
your physicians are, than it does with having leadership really involved and engaged in
the project. That is by far the most critical piece to - - Iíve never seen an EHR project
going well that didnít have a lot of involvement from the hospital or clinic leadership.
Dr. Alana Knudson: Excellent. And we have another great question for all three of you
regarding when do you consider moving people from a team when theyíre causing the team
to become dysfunctional? And how about, Greg, why donít you start off with the response
to that question?
Greg Wolverton: Well Iím not sure, thatís a little bit of a loaded question, but Iíll
give it a go. No, I mean I think we all have to work with people that have some form of
dysfunction. But when it comes to creating the whole team or the whole team causing dysfunction
within the whole team, and Iíve had some experience with this, you have to replace
them immediately. I mean first you have to have the talk to understand what the role
is, and if thatís not understood that goes back to stand your governance ground. Youíre
responsible for the whole team, not the individual, and everybody has to know on the front end
that thatís what your responsibility is and thatís what you need to do. And Iíve already
had to do that. So my answer is immediately.
Dr. Alana Knudson: How about you, Terry and Joe?
Terry Hill: What I would say is that I would agree with what Greg says, but I donít think
you want to put the teams only the people who are gung-ho on there as well. That you
want to put some of those people who are a little bit of doubters but may give it a fair
shot. And then I agree because if theyíre going to be the resisters in the organization,
if you can get them to buy into this. If you can get them to see what - - that the outcomes
can be something very important, et cetera, itís better to have them in the team than
to have them sniping at you from the outside. But if they cause the team to be dysfunctional,
then you really got to cut the cord and get them out of there. Joe?
Joe Wivoda: Yeah, I mean like Terry said, thereís a purpose to having folks that are
not engaged or disengaged in the project to be involved in it and let them go through
those stages of grief. And if they wonít go, you know get all the way to acceptance
and support and theyíre still actively disengaged, youíve got to make that decision quickly,
like Greg said, heís right on.
Dr. Alana Knudson: How about you, Doug?
Doug Smith: Well you know I agree. I mean the purpose of creating a team is to have
diverse points of view, and youíre always going to have naysayers and the leadership
and the team hopefully can deal with that in a general sense. But if people are going
past that to other levels of endeavor, let us say, sabotage, and things that are destructive,
and the other things you have going on, the other training, workplace communication, training
and other things that are not successful in changing that behavior, then they have to
be removed from that team and conceivably from the organization, depending on what their
particular issues are.
Greg Wolverton: Let me add to that if I could, this is Greg. Just one last thing on that.
You know often times we find that when youíre in the middle of transformation, often times
people that donít get on board will automatically fall off on their own; we have seen that as
well too.
Doug Smith: It happens.
Dr. Alana Knudson: Absolutely. Well, another participant today, and this is an open question
to all of the presenters today. Another question asks: From an IT project management perspective
and not solely specific to EMRs, what is your experience and opinion on agile methods for
implementation?
Greg Wolverton: Well, this is Greg, Iíll be glad to tackle that if you want me to.
Dr. Alana Knudson: Certainly, please.
Greg Wolverton: Iím all about agile methods. I am, I have to tell you, I am the post-it
note king and Iím all for very high-touch and low-tech approaches like agile would put
it up there even with a white board and different colored sticky notes to move around.
Terry Hill: Iím not particularly familiar with agile itself, but many of these process
management things like lean, use a lot of the same basic techniques with post-it notes,
white boards, and thereís a lot of overlap, whether you call it process reengineering,
a lot of the techniques are the same. Itís probably not really critical which one of
these vehicles you hop on. Youíll have to choose one of them as the way to do it. Knowledge
of some of the other ones is useful, but each of them has a lot of the same things.
Dr. Alana Knudson: And we have about two minutes left before we need to wrap up. Iím going
to just ask you one last question. If you would just depart with one pearl of wisdom,
if you will. Why donít we start with Doug?
Doug Smith: I think the most important thing is really that what youíre trying to manage
is not IT. I mean what youíre trying to do is improve the quality of the care and manage
knowledge and information. And you have to keep focused on those things and how youíre
going to do that.
Dr. Alana Knudson: Excellent. How about you, Greg?
Greg Wolverton: One of the things that I tell everybody every time, and just about every
time we meet, we have to consistently and constantly remember itís about the information
and knowledge and not about the technology.
Dr. Alana Knudson: Excellent. How about you, Terry and Joe?
Terry Hill: One of the things that I say, and I tried to point it out in my presentation,
there are tools and resources out there. I mentioned Balanced Scorecard, Baldridge, lean
process improvement, thereís a lot of technology thatís business technology or management
technology that can be used very effectively here. Joe?
Joe Wivoda: This is Joe. I would reiterate one of our themes of our presentation, and
that is this is not an IT project, itís an organizational project.
Dr. Alana Knudson: Great. Well I canít thank you all enough for joining our webinar today.
A special thanks to our presenters who shared their wisdom with us. And again, if anybody
is interested in getting a copy of the slides, please email Healthit@hrsa, H-R-S-A, .gov,
and those slides will be sent to you. And again, thank you so much and have a wonderful
weekend.