I recently had an interesting discussion with some people who had been involved with selling and implementing Electronic Medical Records at various hospitals. Everyone agreed that a successful deployment of EMR technologies required many different things to be aligned—process changes, training, physician engagement, system design and configuration that would support the desired benefits, data integration, well-suited reporting and analysis tools and more. When these and other things are well aligned, the EMR software deployments can yield significant benefits. When they are not aligned, the benefits can be minimal at best.
The salesperson, who had sold Healthcare IT for most of his career, made the case that the software vendor certainly cannot take responsibility for all those factors. The software vendor needs to be able to deliver a solid product with valuable capabilities and competent consultants who can assist with the implementation. Yet, he lamented, it was somewhat disheartening to know that in a significant number of cases, the hospitals would not achieve the benefits he had emphasized during the sales process. The software was not at fault, he explained. They could show many success stories that demonstrated that the software was fully capable of delivering those benefits. If the client didn’t address the success factors that we out of his control, it was not his fault that they did not succeed. And as a salesperson, he didn’t feel his job was to focus on all the potential obstacles that might get in the way of a successful deployment. That was neither his expertise nor what he was paid to do.
The consultant agreed with him. It would not be reasonable to expect the software vendor (or the person selling the software) to own the process of aligning all the factors that need to be aligned to achieve the potential benefits of Electronic Medical Records (or Electronic Health Records). The consultants were typically engaged to address specific elements of the deployment—ranging from technical details of configuration and customization to training or process mapping. The scope of their engagement (and their power in the organization) limited their ability to influence and align the many different factors that would likely impact the long-term project success. The projects are often led by the IT departments, and they usually bring in consultants to do relatively well-focused tasks. As they work on those tasks, the consultants may see red flags that would negatively affect the overall effort, but addressing those risks are typically not in their work scope.
A CIO who had been involved with multiple EMR deployments shared that “Too often the original goals are forgotten, and our project management tools and methodologies get too focused on a successful ‘go live’…while achieving the benefits of the system becomes secondary.” While it is fully appropriate for the IT department to play a lead role in the acquisition and deployment of an EMR system, the alignment of key success factors are often outside the control, influence and expertise of the people in that department.
Finally, a person responding to one of my earlier blog entries noted that a major alignment complication with managing EMR deployments is that healthcare systems are a conglomeration of small businesses rather than being a single organization managed by an executive team that has the authority and finances to drive the execution of a company strategy.
Given these challenges, I suggest that healthcare leaders (or those who want to be a part of successful EMR/EHR deployments) should look to the emerging field of community collaboration and cutting edge techniques that allow a variety of stakeholders to come together to achieve benefits that they cannot accomplish individually. Deploying EMR/EHR is not a zero-sum game where one stakeholder needs to lose for another to win. Instead, it is one where the biggest benefits come when the stakeholders work together and jointly recognize the need for collective alignment. Not every change is a plus-sum change for every stakeholder. Success will require nearly every stakeholder to embrace some change that, by itself, would not be their choice, but I believe there is enough WIIFM (What’s In It for Me?) upside to using electronic medical/health records to allow all the stakeholders to gain. The key is to align their interests with a collective good and then pro-actively manage the progress of each of the stakeholders in a jointly-crafted strategy. I would suggest that doing that type of collective strategy development, alignment and execution requires more advanced strategic management tools than most organizations typically use today. But, the stakes are high enough that I think it is worth it.