October 12, 2009

Get Buy-In Before Buying
By Selena Chavis
For The Record
Vol. 21 No. 19 P. 10

In an era of hefty technology investments, experts warn healthcare organizations to consider the bigger picture of physician adoption to ensure successful implementation of mobile devices.

There’s little argument that wireless technology and mobile communications have a place in healthcare’s future. Consider a 2008 study by New Jersey-based Insight Research Corporation that predicts $55 billion in telecommunications spending by the hospitals, physicians, pharmaceutical companies, and insurance providers that make up the $2.3 trillion U.S. healthcare system over the next five years.

The study, “Telecom, IT and Healthcare: Wireless, Wireline and Digital Healthcare, 2008-2013,” also suggests that spending will grow at a compounded rate of 8.4% over the forecast period, increasing from $7.5 billion in 2008 to $11.3 billion in 2013.

“The adoption of these devices … is inevitable,” notes Asher Kramer, FHFMA, ambulatory program architect at MaineHealth, who points to a new generation of technologically savvy physicians and clinicians entering the marketplace. “It’s absolutely a certainty that smaller, quicker devices are going to be the future of healthcare.”

From tablets and wireless carts to smartphones and PDAs, healthcare organizations and physicians are making the leap to increased mobility. And it seems logical to assume that if a hospital entity is going to make large technology investments, it would want physicians to use it.

With so much time and expense at stake, what steps can healthcare organizations take to ensure successful implementation and physician adoption of mobile applications? Many experts suggest that healthcare organizations resist getting caught up in the current industry fervor for immediate adoption of wireless and mobile technology. Instead, professionals advise hospitals to stop and take a deep breath before jumping into large investments in wireless technology that may or may not effectively integrate into a physician’s workflow.

“Technology for the sake of technology is silly,” says Reid Coleman, MD, FCAP, medical informatics officer at Lifespan, an integrated healthcare delivery system encompassing four hospitals in Rhode Island. “Our goal has never been to computerize the medical record. … It was always about improving workflow and patient care.”
While trends suggest that many providers are realizing the benefits of these types of implementations, experts suggest that there are just as many unsuccessful forays that have resulted in costly redirects and failures.

“Mobile devices certainly have a place, but they have a much more limited place than most IT professionals realize,” suggests Thomas Handler, MD, an analyst with Gartner research group, adding that in his experience, he cannot think of a hospital that effectively rolled out tablets to physicians in an inpatient setting. “All too often, hospitals focus on the industry pressure that they have to roll out the mobile devices to docs. They need to look at the bigger picture of workflow and see what’s appropriate for mobile.”

An Opportunity for Effective Collaboration
It’s no secret that private physicians have been behind the power curve as the nationwide push for HIT heightens. But the last couple of years have brought with them unique opportunities for healthcare organizations to help bring their physician stakeholders on board through the availability of new funding and the relaxation of Stark laws that would have prohibited this kind of help in previous years.

“Most physicians have been reticent to move toward mobile ambulatory technology. Now, hospitals are aggressively trying to work with medical staff to choose a system,” says Don Michaels, PhD, vice president of strategic and advisory services with Massachusetts-based Hayes Management Consulting, pointing to the need for hospitals to get as many clinicians on board with their technological systems out of the gate to avoid complexities down the road. “The goal is to try and minimize the number of disparate systems in a hospital setting.”

As pressure mounts in the rush to meet deadlines for stimulus dollars and keep up with the national HIT landscape, many experts suggest that healthcare organizations could make hasty decisions that will not benefit them in the long run.

“Some organizations may not be ready, but they will not want to miss opportunities to get stimulus dollars,” Michaels says. “The danger is that some organizations may not have the time to do effective planning and implementation.”

Kramer agrees, further explaining that “the use of mobile devices [across the social landscape] supposes the adoption rate would be great. I would be careful about introducing new tools until there is a positive foundation for adoption.”

Acknowledging that mobile devices will play an important role in healthcare going forward, Kramer emphasizes that workflow features were the most important consideration for the organization’s choice of the Epic EMR, a solution that he doesn’t necessarily view as being on the cutting edge with regard to wireless features. “There’s clearly an interest there, and it’s one aspect that Epic will have to look at going forward. [But] you can’t just look at the [bells and whistles]. … You have to also consider the change management.”

Handler points out that wireless technology will not always fit into the workflow of physicians in a hospital setting. “Everything has to be taken into context, and it really is different if you are talking about inpatient or outpatient,” he says, adding that some technology is just not conducive to a physician’s needs. “Do I want to review a radiology report on my smartphone?”

Coleman notes that at Lifespan, an organization that currently has a 100% computerized physician order entry (CPOE) platform, it was determined that some other clinician pieces would not work with wireless tools. “The most glaring place was with the critical care unit flow sheets. We found no advantage to using new technology,” he recalls, further explaining that the nurses use a complex form that works better on paper from a workflow perspective.

Best Practices for Adoption
Accurately gauging an organization’s readiness factor is the first step to success, according to experts. In the case of Lifespan—early adopters of mobile technology and wireless workflow—the organization judged its situation by the technology available. “We assessed our readiness by determining if there were technological tools that would make patient care better and safer,” Coleman says. “There is always resistance to change. … It’s not just with doctors. Doctors want to do the right thing.”

While that should seem an easy sell in most organizations, Michaels points out that the groundwork should be laid well in advance of introducing technology to ensure physician buy-in. “What you want to be able to do with physicians is give them as much information as possible and hope that the information convinces them of the benefits,” he explains.

Coleman says Lifespan conducted research prior to introducing wireless technology to physicians. “We demonstrated to them that the current system was fraught with errors. We conducted an in-depth study to show the magnitude of the errors,” he recalls, adding that the information was gathered and presented in a well-thought-out, organized fashion.

Handler adds that organizations will realize their biggest failures when they try to tell physicians what to believe. “If someone says, ‘You need this to do a particular function’ and the physician says, ‘It will not work for this particular activity,’ and then the hospital proceeds with implementation … then the physicians end up ignoring the technology,” he says, adding that physicians need to believe that the changes will improve workflow and patient care.

Organizations should identify a physician champion to lead the way, Michaels recommends. “Having multiple physician champions who can speak to the advantages of mobile technology is definitely a best practice,” he notes. “No matter how good a consulting company is, you really need local champions.”

Once physicians are on board with the effort, the next step is determining which technology works best in various workflow scenarios. Coleman says organizations should study a physician’s workflow as it is conducted on paper and try to match that process.

“Take everything good about what they are doing and put it in the device world. Then take everything bad about what they are doing and fix it,” he says, pointing out that the issue is much more about workflow than “bells and whistles.” “To get physicians to adopt technology, it just simply has to work well,” he says.

Michaels points out that Hayes Management Consulting typically provides a checklist to physicians—sometimes encompassing several hundred criteria—to determine what system elements are important to their daily workflow.

Narrow the choices down to a couple of vendor demos, and once a system is chosen, hospitals can leverage adoption of the system by providing funding. “If a physician wants ABC system and the hospital wants XYZ system, the hospital can say, ‘If you go with XYZ, we can help with financial support moving forward,” he explains, adding that most physicians will choose the system that will affect their pocketbook the least.

One Size Does Not Fit All
Most experts agree that there is not one type of wireless technology that is necessarily preferred over another. It often comes down to the type of work a physician is doing and the environment.

“I’m hearing a lot of physicians say that they want smartphones,” Handler says, adding that while that may be the case, they want them for specific functions. “They want smartphones because they want to check lab results and do single-order entries.”

However, certain types of activities are not going to be suited for smartphones, Handler notes. “What I tend to say is, ‘Let’s look at the task at hand,’” he says. “If I’m going to review a chart for the first time, there’s not a mobile device that’s appropriate for that activity. If I’m in a hospital, what do I need as I go around to see patients? I need to see what’s happened the last 24 hours and do some charting. That’s not always easy to do on tablet.”

At Lifespan, physicians prefer the wireless cart due to the nature of CPOE, Coleman points out. “CPOE requires some typing. Most are happier using keyboards,” he says.

Along the same lines, Coleman notes that Lifespan physicians tend to like bigger screens for viewing graphics, making laptops on wireless carts the technology of choice. “Our clinical information system is accessible on smartphones … but the real estate on a smartphone makes it difficult to view graphic images and make entries,” he explains.

Handler suggests that tablets work better in an ambulatory environment as opposed to an inpatient setting. “Always consider what format, under what task, under what concept,” he says. “There’s not one size fits all. … Tablets may be bulky for 15% of what [a physician] is doing, but it may address the other 85% just fine.”

The Breaking Point
Handler advises healthcare organizations to continually monitor the success of a rollout and predetermine the metrics for when an unsuccessful implementation needs to be killed.

“A project is all about an end point,” he says. “We want to get to the point where we are providing better care. … No one wants to pull the plug on that. But an organization may need to change the process if it’s not moving in the right direction.”

Pointing to a number of disastrous rollouts of wireless technology at hospitals across the nation, he suggests that sometimes it’s better to discontinue a bad implementation—despite the lost dollars—than to continue moving forward with a technology that will ultimately not be used. “If something is not working, stop,” he says. “If you fail, you then have to win physicians back.”

Handler points out that once a contract is signed, money will have to be paid. The price for an unsuccessful implementation can be much greater in the long run, though. He recalls that one healthcare organization had to scrap a project and then wait four years to try again. Physician trust had been lost, and the hospital had to wait until many of the residents had moved on and new physicians were on board for a second try.
“It was not a technology failure, … it was a political failure,” he says.

— Selena Chavis is a Florida-based freelance journalist whose writing appears regularly in various trade and consumer publications covering everything from corporate and managerial topics to healthcare and travel.