Field of Dreams? or… it could be just an empty ballpark!

1. Field of Dreams? or…it could be just an empty ballpark! COACH May 2004

2. Agenda • the proposition • why this matters • case studies • what the stakeholders said • moving forward

3. The proposition • effective engagement and support of the end users is absolutely critical to the goal of getting information technology used to improve patient care, quality of professional life & health system management

4. Why this matters • Standish Report findings (1999) • investment in IT application development is HUGE • $250 billion US/year; 175,000 projects • failure rate unacceptable • 31% of projects cancelled before they get completed • 53% will cost 189% of their original estimates • Only 16.2% “on time, on budget” • three key overall success factors: end user involvement, clear statement of requirements, executive management support

5. Why this matters (cont.) • November 2001study* re: key factors in forecasting EMR/EHR implementation success • over 150 factors identified • only 2 identified consistently associated with successful implementations • top management support • clinician involvement *Sittig, D; The Importance of Leadership in the Clinical Information System Implementation Process

6. Why this matters (cont.) • spending ~ 2% of healthcare budget on IM/IT • too low anyway • if we screw up over 50% of these we’re really in trouble! • risk losing credibility with/support of senior policy makers, funders and end users • disenchanted users (once we lose them, they’re twice? 4X? harder to get back)

7. Case studies • Danish national system (MedCom) • grew from modest clinician-driven project • key success factor: getting opinions and ideas from general practitioners’ professional organization AND from practising GPs • New Zealand • extensive physician use of computers and EMRs in improving health status through HealthLink • strives to be responsive to physicians as primary obligation; many initiatives result from primary care physician demands • replaced alternate product (after millions of $) which failed when they tried to connect to GP computer systems • officials had little/no understanding of general practice environment

8. Case studies (cont.) • Cedars-Sinai 2003 • Hospital believed it had sufficiently involved physicians in design/implementation process by working with 40-physician medical executive committee • turned off CPOE after complaints from hundreds of physicians – cumbersome, didn’t follow physician workflow • underestimated impact on ancillary departments, complexity of implementation and work involved in transitioning to CPOE

9. Case studies (cont.) • Upstate New York Veterans Healthcare Network* • in < 5 years, went from poor performer to a leading performer among VA 22 networks • conscious attempt to empower frontline employees by: • increasing patient outcomes focus • adopting a learning environment • increasing frontline autonomy • encouraging grass-roots innovation • developing esprit de corps among frontline workers *Timothy J. Hoff/IBM

10. Process used • interviews: • standardized interview template • interviewees • payers(i.e. CIOs), physicians/physician organizations, vendors, other – over 35 key players in the Canadian health infostructure scene • coast-to-coast coverage • synthesis and analysis of results

11. What the stakeholders said… • significant convergence among views of payers, vendors, end-users, CIOs • end-user engagement seen as “absolutely critical”, a “no brainer”, “essential”, “crucial” • agreement on critical success factors: • commitment to process - trust is earned • all parties need to be prepared to change their “going in” position – requires “active listening” • acknowledgement of interdependence • recognition and acceptance of different drivers • creating a climate of mutual respect

12. Stakeholders (cont.) • performance “spotty” across the country • generally poor reviews at the national level • balancing province-wide system needs with one-on-one medical care creates challenge • only two provinces have issued a strategic IT plan • vendors not generally involved/seen as the enemy • cultural differences (project managers vs end users) get in the way of effective end-user engagement • need to migrate from “create and direct” to “facilitate and empower • AB generally perceived to be engaging stakeholders • process slow and painful but making real progress • growing awareness, increased attention/$$

13. Moving forward • interest-based approach • start having the conversations, building the relationships now • allow adequate time for engagement • jointly define clear statements of requirements • engage end-user organizations on strategic and implementation issues; • work with informed end-users at the project level • at ALL stages of the process • engage skilled facilitators

14. Moving forward • the job’s not done with implementation • build in a “feedback loop” after implementation • ensure end-users aren’t “out of pocket” for their time • include those who are going to deliver the product….e.g., the vendors (VCUR) • use consistent processes • we need to talk about this….nationally, provincially and locally!

15. Recap • effective end-user engagement is critical if we want IT used to improve health outcomes • we need to ensure what we’re designing/building/implementing works for those who use the IT systems to deliver care • we need to do a better job of involving end-users….now!

16. Questions?Bill Pascal P. Eng., CMACTO, Canadian Medical Associationbill.pascal@cma.caMary Gibson CAConsultantmarygibson@shaw.ca