Short Link: http://j.mp/6wKM66
Last Wednesday I attended a conference on “The Economic Stimulus Package and Healthcare Technology: How Will the Stimulus Money Flow and How Can You Prepare?” at Georgia State University. (Details at the end of this post.) There were over 300 attendees. Many of the people that I met were new to healthcare, but drawn to it by news of the pending federal stimulus monies for HIT. I agreed with and greatly appreciated *almost* everything that I heard.
My only quibble was the shared sentiment (expressed at the conference and frequently elsewhere) that getting physicians to change their workflow is one of the biggest barriers to EHR adoption.
Michael Hammer’s 1990 “Reengineering Work: Don’t Automate, Obliterate” Harvard Business Review article popularized the analogy that automating existing processes is akin to paving a meandering cow path instead of what should be done, which is to create a road that proceeds straight from point A to point B. When successful, the results can be substantial increases in effectiveness and efficiency. However, business process reengineering failure rates have been reported to be 50 to 70 percent (or higher, given natural human reluctance to admit or publicize failure). User resistance is often blamed. Similar levels of failure have been reported for EMRs (this 2006 study is representative). The basic problem is that implementing *most* EHRs is an act of reengineering, and reengineering is a high risk endeavor.
A good way to explain this success rate is through use of the classic Thesis-Antithesis-Synthesis method of using a contradiction to motivate conceptual innovation:
- Thesis: “Instead of embedding outdated processes in silicon and software, we should obliterate them and start over.” (Hammer, 1990)
- Antithesis: There are many, many reasons people resist change, and not all of them are bad.
- Synthesis: Automate the cow paths (so as to minimize the psychological shock of automating previously manual processes) and then systematically but gradually straighten and widen these paths until a straight and wide digital superhighway is attained.
How is it possible to “systematically but gradually” improve automated workflows? First implement workflow management system process definitions that fit the way workflow is already being accomplished. Second let users get used to the new technology. And third, only then gradually change the process definitions that determine EHR behavior at a rate that is no faster than can be tolerated. The workflow management system foundation, with its workflow engine that executes easily changed process definitions provides the means to accomplish process changes that do not require rewriting and recompiling software code. The business process management layer provides the means to systematically optimize process effectiveness, efficiency, and flexibility. (More on EMR BPM in this previous post.)
To summarize my main point:
Using EHRs that are easily molded to existing physician workflows, which can then be systematically improved while respecting normal human tolerance for change, is the key to EHR adoption.
Here is a bit more info about the excellent conference that provoked this post:
“The Economic Stimulus Package and Healthcare Technology:
How Will the Stimulus Money Flow and How Can You Prepare?”
Technology Association of Georgia,
Georgia Health Information Exchange, and
Georgia Chapter of the
Health Information and Management Systems Society
May 14, 2009,
Georgia State University