I had the opportunity to talk about lessons learned from EHR implementations as part of the faculty for the “Leadership Strategies for Information Technology in Health Care” course at the Harvard School of Public Health (HSPH) last week. And yes, I was fortunate to make it in and out of Boston between snowstorms for the one day I was there.
The course is part of Executive and Continuing Professional Education at HSPH. It is a two week course with 4 modules. The first week covers Module 1 on IT Strategy and Governance and Module 2 on the EHR.
The faculty lineup for the first week is impressive. John Glaser, CEO Health Services at Siemens Healthcare and former CIO at Partners HealthCare System, lectured on “IT Strategy Considerations.” John Halamka, CIO at Beth Israel Deaconess Medical Center in Boston covered “The National Perspective and IT in the Era of Health Care Reform.” Vi Shaffer, Research Vice President and Global Industry Services Director at Gartner, provided an “Overview of the IT Industry.” Meg Aranow, Senior Research Director and Health Care IT Advisor at The Advisory Board Company, discussed analytics. New care models including telehealth, retail clinics, and accountable care organizations were also covered by various faculty members. Mary Finlay, Professor Simmons School of Management and former Deputy CIO at Partners, discussed IT Governance. Mary is the program director for the course and does a terrific job.
Students come from various roles in health care. The course has also become well known internationally at this point – with about 30% from other countries. For this session some students came from as far away as Australia and India.
I was happy to be part of the faculty and get a chance to hear a few other lectures that day as well as interact with the students over lunch. Here are some of the EHR implementation lessons I shared in my talk:
- The CIO and executive leadership in health care organizations have many priority initiatives at any given time. The EHR implementation will become a primary focus, especially as it gets closer to the go live date. As the CIO, you need to know where and when to be deeply involved vs. maintaining an overall awareness of the project’s progress, being ready to address issues as they are escalated.
- Engaged executive sponsors are needed throughout the life of the project. If the CIO is the only one worrying about the project, there’s something wrong. At the same time, the CIO should avoid saying “it is not an IT project”. To be successful, it has to be a true partnership between clinicians, operations, and IT.
- An EHR implementation has a significant impact on your entire organization and all staff members. A robust change management program is critical given the multi-disciplinary effort that EHRs require.
- Many decisions get made through the life of the project. Establish early on very clear decision rights. Know which group makes what decisions and define the escalation path when issues can’t get resolved at lower levels of the project governance structure.
- Your plan should include a “Go Live Readiness Assessment” at 120, 90, 60 and 30 days prior to go live. All teams are expected to report out their progress and open issues in detail. Project leadership then creates a readiness scorecard. This allows leadership to focus on the areas that are behind schedule and address issues to ensure an on-time, successful go live.
- Contingency planning needs to be part of the overall plan. Any major system implementation needs a back-out plan if something goes wrong. But you also need to account for the operational impact. You can’t stop the flow of patients into the emergency room but do you reduce your surgical or clinic schedules? Each organization has to determine what’s right for them. And then there’s the unrelated and unanticipated crisis that you have no control over – it could be a major facility issue like a power outage, a weather incident like the snowstorms we’ve seen the past few weeks, or a mass casualty incident in your area. Be sure to include your organization’s emergency management team in your activation and contingency planning.
- At go live, it’s all hands on deck in the command center and throughout the organization. Everyone has their specific roles. Leaders need to be present. The CIO may not be running the project but maintains a very visible presence in and around the command center. It’s a 24/7 operation for the first few weeks after go live. And be sure to round – find out how things are going for front-line staff and thank them for their work.
- Once the system is up and running, you have to recognize that optimization is ongoing. Don’t minimize the requests. Listen carefully to your users. At the same time, manage expectations about how much will get done and by when. Help shape the message. Multiple communications channels are important. Structured processes for intake of requests and a formal prioritization process with agreed upon criteria are critical. While optimization for your organization and the unique workflows is needed, don’t get stuck there. Learn from others how they have leveraged the product. Reach out to your colleagues and learn from them. Many have gone before you at this point.
And when you’re ready, be sure to share your own lessons with others.
Harvard School of Public Health’s Executive and Continuing Professional Education program, “Leadership Strategies for Information Technology in Health Care”
Three Days and Counting. . .
Values in action. . .
MiChart summer interns – a win-win!
We’ve all had those bad customer experiences: rudeness, “not my problem” attitude, bounced from person to person, being left on hold too long, not hearing back from someone as promised. You know what I’m talking about.
And we’ve all had those excellent customer service experiences: think about the difference. Was it the smile, the caring attitude, the problem solving focus, the level of ownership, the offer to help before you could even ask for help? These are just some of the attributes of good customer service.
If you provide a product or service to anyone in the work you do, it’s a good idea to look at your own customer service and how you stack up. And,who doesn’t provide some kind of product or service to others? You may have both internal or external customers.
When I started this position in late 2012, I laid out my core principles and values to my staff. Customer Service was one of them – as I said then, “while we don’t touch patients directly, we are all part of the extended care team; clinicians and caregivers rely on the systems we provide and support to care for patients in a safe manner. Excellent customer service in all our interactions is critical.” Continue reading
“Hansei” is the Japanese word for reflection. One of my UMHS colleagues, Dr. Jack Billi, told me he’s impressed that I am writing a blog and sees it as an example of Hansei. He says as leaders we don’t take enough time to reflect. I agree.
A typical day for me is running from one meeting to the next, driving back and forth from my office to the hospital campus, and squeezing in email when and where I can. Evenings are more email and prepping for the next day’s meetings.
The practice of writing a blog has indeed caused me to be more thoughtful about a range of topics. I find myself observing things differently. I reached out to one of my industry colleagues, Anthony Guerra, Editor-in-Chief of healthsystemCIO.com, for advice when I first considered writing a blog earlier this year. He encouraged me to do so. He told me that through the practice of writing a blog I’d start looking at things differently, observing things in new ways. He was right. Continue reading
Spoiler alert! I don’t have the answer either and want to learn from others.
I remember the old days before email: we relied on talking to each other and on written communications that came on paper. On the day before a vacation I would finalize reports, make copies, and stuff them into inter-office envelopes after I’d taken care of all my follow-up phone calls. Now on the day before vacation I have to get through all the email that can’t wait another week and generate new ones as I work through my to-do list.
It seems endless. Everyone complains about too much email. Can’t we just shut it off? No, it’s the way we work now and there’s no going back.
Here are some of my tips:
Triage – I quickly scan for priority emails by subject, who it’s from and importance (some people actually use those flags as intended). Deal with what you have to in as timely a manner as possible. Continue reading
You start in a new leadership position and you want to make changes. Should be easy, right? After all, you’re the boss. You call the shots.
You inherit a history and a culture, ways of working and thinking and behaving. You inherit a leadership team and a staff. You inherit a department that works within a broader organization and its culture. Still, you are the leader; you can make some changes, but it will take more time.
When I started at UMHS, there had been a 6 month gap with an internal interim CIO. She had kept things going but was happy to handoff to me. Continue reading
I’m heading to the CHIME Fall Forum for a few days. Many of my health care CIO colleagues will be there. I look forward to the chance to network and learn from them in track sessions, and hear from keynote speakers. I’m even being pressed into service on a panel called “Leadership Stories Worth Telling” as there was a last minute cancellation.
I have been active in professional organizations for many years. Anyone who doesn’t take the opportunity to get involved in such organizations is limiting their own professional development and, in turn, limiting what they can offer to their employer.
I remember many years ago when I attended my first professional conference. Continue reading
Operation Baby Blanket? What’s that? Is that the code name for a new software implementation?
This CIO is the grandma of Hannah, an adorable two year old; two more grandbabies are on the way. While I’ve done various crafts in my adult life, I don’t do it enough to call it a hobby. And my crochet experience is limited. I did make a baby blanket for one of my daughters 30 years ago.
So I surprised my family two years ago when I told them that I would make a baby blanket for Hannah, and I actually did it. Now, a second grandchild is due in December. Could I make a baby blanket for her in time? Would I be able to squeeze enough time out of my evening email work session to get one done?
I needed to design and create a baby blanket in time for the baby shower.
I am happy to announce that I presented a finished crocheted baby blanket to my daughter, Katie, at the shower last weekend.
How did I meet this goal? Basic Project Management! Continue reading
How often have you heard an IT leader say they want a position that’s “more strategic” and “less operational?”
The reality is that there is always a balance of both, depending on the level you work at in your organization. Sometimes, it’s not the balance you’d like to see.
As the CIO, my typical day is back to back meetings. Plus, I squeeze in email and phone calls on a range of additional issues. I read and answer email well into the evening after I get home.
In the past week, I’ve reviewed presentations and read articles on health care in the future and how technology enables innovation: reflective thinking and planning. Continue reading
Last November, I started the practice of hosting monthly breakfasts for up to 20 of my department staff at a time. We skipped two months around the time of our major inpatient go live in June. That means I’ve spent time with at least 160 staff getting to know them, listening to their concerns and answering questions in a small, informal setting. There’s a small group of “frequent flyers” who have come to more than one so far. I tease them that it must be the food but I know it’s them wanting to have a voice which I’m happy to listen to. “Make your voice heard” is a theme I’ve been encouraging all year.
At the most recent breakfast, there was a lull in the conversation. I called upon one of my frequent flyers whom I have come to know is willing to tell it like it is. Continue reading
Last week, I wrote about the value of site visits as a way to learn from others. Fresh off the annual Epic User Group Meeting (UGM), I’ll call it a site visit on steroids. There are over 10,000 attendees, 100’s of educational sessions presented by users, direct access to Epic staff, and plenty of networking time; you see what I mean?
This was the first year it made sense to invite my executive colleagues from UMHS to attend. Our core Electronic Health Record is now in place, our executives need to look to the future: what else is possible with the product we already have, what new functionality is planned for future upgrades, and what other Epic users are doing.
Three UMHS executives answered my call and they were glad they did: the Hospitals and Health Centers CEO, and the executive directors of the children and women’s hospital and the adult hospital. We will debrief as a group soon about what they saw and heard, and to explore what functionality we should prioritize next. Continue reading