Quick Observation - In addition to 1) outstanding leadership, 2) high quality technology, 3) standards and 4) policy it is critical that we recognize the 5) fundamental role that stakeholder engagement and 6) communication will play in the success of this type of project. That includes not only the people (providers, staff) who will use health IT and those who will benefit from these systems (patients, consumers), but the broader community as well. It also takes into account the unque needs that different types of consumers and providers have from mental health to surgeons and not assume that physical location is what defines a "population"
Individual EMR implementations are a microcosm of what we are about to do on the National stage and those of us who have done this for years know how that this has little to do with technology and everything to do with change management.
One unique difference is that unlike large hospital based systems we are essentially about to embark on a media campaign to engage people where many of them don't believe that Government should be in the business of health care. Twice in the last week for example, I was on conference calls in which providers ask what would happen if they simply stopped treating medicare and medicaid patients instead of implementing now.
In England it was consumer lack of trust and providers hesitancy to disclose PHI that stopped the projects not technology. We also need to address the business case as much as define what "outcomes matter" but like all young IT companties we are top heavy on the IT and Medicine side of the house and have more opprotunity for growth on the marketing and communication side.
Although there isn't a great deal of academic researching into the success factors for successful EMR's there is a lots of research from other complex system implementations. We know for example that they often hinge on a couple of key factors for success.
- Strong project sponsorship - ie engagement of both those directly impacted by the technology (providers, staff) as well as those that receive services from them (consumers, patients, community)
- Communication Strategy that precedes the technology implementation - People can adapt to and support big changes if they understand the importance and the big picture. It is critical to develop a collaborative team approach to bring about organizational change.
- Clear goals that take into account both the current state and expected outcome. It is critical that there is a strong connection and two way communication between the end users and the external implementation team.
I believe our our National HIT agenda needs to have a pro-active community engagement strategy, a clear communication plan and measurable goals in these areas right from the start to be successful. We are essentially about to engage in a massive consumer marketing campaign in which we are going to ask people to buy a government mandated product and implement it in their private business between them and their patients.
In England they have struggled for years not only because of technical problems but because consumers and providers didn't see the value to them, don't trust the government's role in it and don't feel like they were asked to participate in the design and implementation process.
The new ONC policy and standards committees include a broad range of stakeholders but they questions they are asking are provider centric. The entire discussion of meaningful use has revolved around their needs vs the outcomes that consumers want. If we are to have develop a transformative health care system with patients in partnership with providers then they need to have an equal voice in the design and even funding of this endeavor.
Meaningful use to a consumer includes things like email contact, real time lab results, health care anywhere vs a medical home, customized information that is relevant to their conditions and takes into account their language and education. It includes high quality care for their encounter not by clinic and it ensures that their health care history is kept in the highest confidence.
We really need a bi-partisian, non political body to spread head a massaive grass roots community engagement and communication plan. Clearly we need someone (the NeHC perhaps) that people trust who isn't a vednor or consultating firm to step into this role as national convenor for this project.