Implementing IT Solutions: Getting Physicians Onboard

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In the drive towards increased efficiencies, either implementing or upgrading automated physician reporting systems is a major goal for many imaging facilities. From computerized provider order entry (CPOE) to cardiovascular information systems practices and clinical departments are bringing new technology online designed to automate as much as possible of the physician reporting process. But to make it work, you’ve got to get your physicians on board.

Gaining physician mind share and participation on may be easier said than done. In fact, training physicians in using the technology you’ve installed to automate reporting is the last step in the process. Unless you want the process to drag into the next decade, you’ve got to lay your groundwork very carefully, inviting administrative, physician and clinical leaders and staff into the process at a very early stage. Otherwise, your stakeholders, particularly physicians, may become extremely resistant to the idea, slowing the progress to a crawl as you work through the resistance at the back end rather than the front end.

Take for example LifeBridge Health in Baltimore, Md., a health system with two major hospitals. The training process was the culmination of a long-term effort that began years before the Cerner Millennium CPOE system was brought online, according to Ev Amaral, vice president of operations improvement. “The first thing we did was to hire a consulting group to help us with our thinking in terms of a readiness assessment—how ready our facilities were to adopt CPOE,” she says.

“Also, we wanted to find out where we were in terms of the business case for CPOE with our resources, management and project skills,” she continues. Only after a management retreat and conversations with important administrative and physician stakeholders did LifeBridge even start to put together a strategic plan to implement the technology. Her take-aways from the experience? Involve key physicians and administrators early, realize the process is going to take a long time and have a lot of hands-on help available when implementation starts.

Jon Pavlicek, project manager for cardiology at Banner Health, agrees that any type of automated physician reporting system, especially when installed in conjunction with other technology upgrades, is going to take several years to implement and require a major commitment from administration and physician leaders to gain mindshare. Banner Health, a healthcare system with 3,065 acute-care hospital beds in facilities in seven Western states, uses Agfa HealthCare IMPAX CV cardiovascular image and information management system.

For Steve Cameron, program director for St. Peter’s Cardiac and Vascular Center in Albany, N.Y., the implementation of a Lumedx cardiovascular clinical information system required an intensive training effort, including a training disk that walked physicians through the process as well as the installation of flat-panel television screens in reading areas which continuously walked physicians through the login and search process, he says.


The preparation process



Identifying physician and administrative champions of the automated reporting process early on is vital, says LifeBridge Health’s Amaral. Communicating early and often was also key to the eventual success of the CPOE system. Both LifeBridge and St. Peter’s took time at every physician gathering—from grand rounds to staff meetings—to update physicians on the process and needs of installing and implementing the new systems. “Breakfasts and lunches didn’t work too well in this situation,” says Cameron. “Breakfasts were semi-successful, lunches not really, as physicians tended to leave early either before or in the middle of our presentation.”

Sending out training materials in advance of or at actual training sessions helped at both Lifebridge and St. Peter’s to reinforce the message being communicated. St. Peter’s mailed physicians CD-ROMs that demonstrated the process, while LifeBridge mailed letters to each physician detailing the upcoming transition and noting the expectation that doctors would participate in the CPOE system once it was online. LifeBridge gave out CDs to each doctor at the training sessions, which were held in a classroom setting.

For doctors who wouldn’t participate in the classroom setting, trainers went out to their offices to get the job done, Amaral says. At St. Peter’s, Darvan Durr, cardiac department systems administrator, did a lot of individual and ad hoc training. It helped, he says, that the physicians were familiar with him in his previous role as an audiovisual and pharmaceutical technologist. At Banner Health, super-users were trained at each facility and given the responsibility of getting any new users up to speed.


The results


Despite the headaches involved, Pavlicek says the rewards are well worth the effort. At Banner Health, it used to take anywhere from 24 to 48 hours to get a patient record into the electronic medical record system. Now, he says, “The physician can walk in, read a study, create the record, electronically sign it, review it and print it out. The staff scans it into the EMR immediately and it is part of the medical record.”

At St. Peter’s, the Lumedx system has been rolled out in the catheterization lab and has helped to eliminate all transcriptions related to cardiac caths, saving both time and money. The upgrade to a cardiovascular clinical information system that supports PACS involved a transition to a paperless system, which also generated economic gains. Overall, cardiology volume grew 7.7 percent in 2006 in a competitive environment.

For LifeBridge, the carefully thought-out planning and implementation process involved in bringing CPOE to the group’s two hospitals was richly rewarding. “We have seen compliance increase dramatically—at Sinai, compliance is at 88 percent and at Northwest it’s 82 percent,” says Amaral. “The doctors are seeing the power of the system and how it complements our evidence-based medical approach. In practical terms, compliance can’t get much better as some very complex orders will always have to be written out, so I don’t expect it to ever reach 100 percent.”

In LifeBridge’s pharmacies, results have been equally dramatic: pharmacist verification times for orders have fallen 90 percent at Northwest and 80 percent at Sinai. Radiology turn-around times have dropped from 71 minutes to 35 minutes at Northwest and from 109 minutes to 77 minutes at Sinai, Amaral notes. It’s just what the doctor ordered.

 

IT Training: Physician Training Done Right
 When implementing a health IT system or CPOE, a well thought-out training program is essential. Administrators, system administrators and physicians recommend the following steps:
  • Aggressively sign physicians up for training. Don’t passively wait for doctors to sign up for training classes. Assign staff to follow up via phone and get every physician signed up for a training class. If some doctors don’t show up, call them again and get them to participate.
  • Provide plenty of opportunities for retraining. Even if a physician has attended a training session, it doesn’t mean that he or she necessarily “gets” how the system works. If a doctor is clearly flummoxed, keep working with him or her until the training sticks. At LifeBridge, one physician needed eight separate training sessions to become fluent in the technology.
  • Go to satellite and physicians’ offices. In addition to or in place of bringing physicians together for a training session in a classroom, you can send the trainers to the physicians. Whether physicians are in their offices, in a reading area or on the floors, taking the training to where they are rather than expecting them to come to you can boost training and ultimate compliance.
  • Experiment with interim steps. Going cold turkey from an entirely paper reporting system to an automated system is a big leap—placing an interim step in the process can lessen resistance. St. Peter’s starts physicians with a checklist of the options available on the structured reporting form so they can get used to using and checking options off on the pick list, then transitions them to the computer system once they are comfortable with that in-between step.
  • Beef up support staff. In the days before the system goes live, make sure to have adequate vendor trainers and well-trained, in-house super-users on hand. If necessary, pull regular staff off other duties, train them and place them in visible locations throughout the areas where the physicians will be working.
  • Clearly identify support staff. When going live, identify vendor and internal support staff clearly by having them wear bright lab coats or with some other identifying mark, so doctors who need help have no doubt of where to get it. LifeBridge brought Cerner coaches in and also assigned internal staff to be available, clearly identifying them in bright blue vests on the floors.
  • Bugs are inevitable. Regardless of how much testing and preparation you’ve one, bugs will pop up in the system once it goes live. LifeBridge implemented a version of emergency response during the days that the system went live, meeting with key personnel three times a day and putting out memos hospital wide detailing any problems.
  • Keep the directions posted and available. Just because you’ve given out zillions of copies of the directions on how to log in and use the system doesn’t mean that physicians will necessarily have them on hand when they go to log in. So keep the directions that walk through the process clearly visible and on-hand on every floor and reading area where a physician might access the system. St. Peter’s Healthcare makes sure that trained techs are available for on-the-spot help in places where doctors are doing procedures, such as in the cath lab.