When a hospital implements a new electronic health record system, there's no shortage of challenges to grapple with as the years wear on and the costs pile up.
Chief among them is the fact that, as the new system is being rolled out piece by piece, existing applications still have to keep in working order to maintain operational support and care delivery. That juggling act demands smart staffing strategies – not just for the IT teams getting the new infrastructure up and running, but for those professionals dedicated to supporting and maintaining the older core systems.
Houston Methodist took several years to replace its best-of-breed clinical applications with an integrated EHR. At HIMSS17, leaders from the health system will explain how they managed the challenge, offering their perspectives on the staffing pitfalls for a project of such size and scope, suggesting principles for maintaining employee satisfaction, giving tips on leadership strategies and on balancing the needs of employees and contractors alike.
As an academic medical center with seven hospitals, a large physician practice, a research institute and a comprehensive residency program, Houston Methodist has a "fairly large" IT staff of 540 employees, said Penny Black, director, EHR & perioperative at Houston Methodist Hospital.
All those employees had to be considered when, three years ago, the system decided to replace most of its best-of-breed apps with an integrated clinical system.
"We had independent periop, anesthesia, pharmacy, EHR radiology – many of them have been consolidated by the integrated model," said Black. "Cardiology also, to some extent. One application we did not integrate would be the lab, but that pretty much covers the clinical systems."
Right away, it was apparent that openness from leadership would be a lodestar for the duration of the multiyear project, she said: "Communication, transparency, managing employee resources and our consulting colleagues is really important, no matter what the project."
Alan Perkins, associate principal with the Chartis Group, brought his expertise in organizational change management and process design to bear on the initiative, and now also serves as associate VP for clinical informatics at Houston Methodist.
"There are really three key risks that this organization – or any organization that's undertaking a large-scale, enterprise IT-enabled project – needs to take into account," said Perkins.
"The first is that if the majority of the existing IT resources are going to be dedicated to the new initiative, as they often are, the risk is that the quality of the legacy operating environment – and we're calling that core clinical – could decline," he said. "That could negatively affect adherence to regulatory requirements and key operational performance initiatives. That's one risk we sought to mitigate here."
The second risk," said Perkins, is that if staffers assigned to the new implementation retain their operational responsibilities but then are also periodically pulled in to address operational issues, progress on the rollout could be adversely affected.
"The third risk is to the IT leadership team," said Perkins. "If they're being asked to do both, that could significantly increase their workload. Trying to attend to both a large-scale implementation and existing operational responsibility could cause issues."
Black says a key part of the rollout planning was recruiting the tech professionals who would serve on the implementation team: "That was a combination of folks both from IT and from operations," she said, and once the team was put together, its members were single-minded in their new task, working apart from their "old operations, jobs, positions and colleagues."
At HIMSS17, Black and Perkins will share some of those org charts and explain how they managed the challenges and opportunities of the new staffing situation. "At one time we had more than 60 team members on the EHR team, and then one day, just five days after an upgrade, it shrunk down to 28 members," said Black. "We supplemented the existing legacy teams with consultant colleagues to help keep things running smoothly."
Perkins recommends that hospitals make use of two dedicated but symbiotic deployment support teams: "One team that's primarily or exclusively focused on the new initiative, another that's primarily or exclusively focused on existing operational support," he said. "These teams (should) operate in a manner that is both independent and interdependent."
Adding new leadership, contract workers to the mix
"Another example of what was unique about our project is that we not only supplemented our analyst level resources, we supplemented leadership," said Black. "One of the risks of trying to manage a large-scale implementation and manage existing applications would be over-stretching those resources. So we brought in consulting managers, directors and even up to the vice president level to supplement our legacy team."
Hospitals should look at these supplemental leaders not merely caretakers, but as people actively entrusted with advancing the strategic goals of the organization, said Perkins. "They may be in their roles for a year, maybe two years, even three years. And so it's important that they be able to hit the ground running – that they be experienced leaders, that they have a proven track record of success. And when you're bringing them in, you're bringing them in specifically to carry forward the strategic goals of the organization, not just keep the lights on."
That can be easier said than done, of course: "When you bring in interim leadership, as in this case, there are several key decisions that need to be made," said Perkins. "One is you have to define how HR related responsibilities are going to be divided between your permanent staff and your interim leadership, you have to clearly define who retains financial authority – how are you going to handle things such as approval of invoices or budgeting.
"And then you need to talk about how your interim leaders are going to function really seamlessly as part of the team," he added. "Because again, if you're bringing them in not merely as caretakers but as key leaders in the organization for a period of years, you need to make sure they are able to function effectively in their roles."
Given that projects such as these demand the use of both employees and contractors, Black also has some simple advice for building them into a cohesive unit: "Include them."
For the 18 months or so of the implementation, "our consultants were on-site," she explained. "We included them in our operations meetings, in our team events, in our dinners and outings. We treated them like they were part of the team. And in fact many of them – this started in 2014 – are still with us today."
An overarching principle, of course, must be sound change management principle, said Black: "People adapt differently to change. Some of the folks who went over to the implementation team suddenly had new offices, new applications, new managers, new colleagues. Everything changed for them.
"Not everyone handles change equally," she added. "We worked to be transparent and provide good communication for the legacy team. In fact, we stayed away from words like 'legacy.' We called the home team the core" clinical team, and actually engaged them and made sure they understood there would be a place for them."
Perkins echoed the sentiment that communication is key.
"It enhances transparency and trust. So it's important to develop a communication plan, cross-team communication mechanisms – employee meetings, newsletters, special events – and that these communication venues emphasize the inclusiveness of the entire IT team," Perkins said. "And especially the significance of the support team's role in the organization. When that's done well and consistently, that communication will help to build trust and reduce any anxiety that might be felt by the team."
Perkins added that Houston Methodist had an entire team dedicated to change management, another focused on program management, a third dedicated to communication, and a specialty testing team.
"Part of that was being very transparent, specifically with regard to the staffing roadmap," said Perkins. "We're explicit from the very beginning about where we're going with staffing, we're communicating the process and the end state, so people have a very clear goal and a very clear view of where they are now, where they're going to be at the end, and what the process is going to be to get from here to there."
Penny Black and Alan Perkins will present "Managing a Legacy Team in an EHR Transition" at HIMSS17, Feb. 21 from 8:30-09:30 a.m. in Tangerine Ballroom, F3 at the Orange County Convention Center in Orlando.
HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.
This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.