• Patient record keeping (EMR, PACS, ADT, CPOE, etc.)
• Billing & Payment
• Bed management
• VOIP and data communication
• Temperature monitoring
• CPOE
• Internet/Intranet
• Employee time keeping
• Nurse call
• Some biotelemetry and other patient monitoring devices
• Web-based networking, browser-based programs
• Kiosks
• Patient education and entertainment
• Community outreach
• Marketing

This list is by no means intended to be exhaustive; I’m sure there are systems and devices that I haven’t listed. The point is to consider our dependence on the broadband / wireless networks in our hospitals and understand that investment in these systems (to expand, upgrade, stabilize) has greater impact than we at first might imagine. Healthcare needs demand high speed and redundancy from the source to the target.

I remember when I was CCIO at Adventist Health. The dependence on our electronic systems, especially the EMR, was tremendous to provide, chart and bill for care.  Our wireless systems had to be scalable and handle a growing amount of wireless traffic.  Patients and staff should never have to “wait” on a system response and resort to paper because the system is “slow.”  This interrupts the clinical thinking that is necessary to practice quality care. 

Not too long ago, when I was working with a client providing systems evaluation by rounding on units, clinicians demonstrated dropped connections and other wireless issues that were preventing them from carrying out daily clinical responsibilities on time.  It is only through detailed planning, implementation, testing and meticulous collaborative issue resolution that these supporting infrastructure components can be realized.

1. Input from multiple stakeholders. Before any project gets off the ground, it is important to know who it will affect and to examine what possible effect changes may have—positive or negative. There’s sure to be concern, even among those who might want change. Moreover, these folks will have diverse interests, different goals and different expectations of the project’s outcomes. Maybe most importantly, they’ll have different ideas on how to achieve the desired outcomes. After examining the impact the project may have on various groups and individuals, it is in this area that input from multiple stakeholders is most valuable.  
2. Communication. We hear this over and over again: Keep the communication lines open, Clear lines of communication, Communication is key…And it’s so true! There’s no value in seeking input from others and attempting to understand another’s needs if you’re not going to a.) provide a mechanism for them to communicate their needs, wants and concerns, and b.) listen. The other idea we often hear is: Communication is a two-way street. This is true also! So as much as you may expect to receive input, you have to be willing to make clear project goals and direction. Let others know what you are thinking so that they can provide feedback. Also, encourage your team to play “Devil’s Advocate” – it can help provide a new perspective.
3. Leadership. This is the tie that binds it all together. As much as there must be input and clear lines of communication, there must be decision-makers. Consensus is wonderful and an obvious hope for any team project, but with multiple stakeholders it is often difficult to achieve. Without competent leadership, projects often fall victim to stalemate or indecision. It is necessary to have someone who can recognize ideas that the group shouldn’t move forward on – someone with the power to flip the “kill switch.” It is just as necessary to have effective leadership to help guide discussion and generate ideas.

The care plan is an essential element of patient care. It lets each nurse, physician, lab tech, resident—all those responsible for providing care—know what steps need to be taken to help improve each patient’s condition. The care plan is also a bane to nearly every nurse; the task of documenting the stages of care usually falls to nursing staff. This means that the nurse not only documents the work he does with patients, but is also supposed to keep up with what the physician and other care providers do for patients. The end result is all too often total dissolution of the care plan.

As a nurse, I understand the pains that go along with documenting patient care. As an expert in informatics, I understand that we could make the tasks of documenting much easier for our nurses and other providers. One solution is to remove the burden of documentation from nursing staff and automate the plan of care. This may not be as easy as it sounds.  Healthcare IT providers in many cases do not automate the process in a streamlined manner that addresses the information needs of the clinician.

Some ideas for automating the care plan:

1. Make sure caregivers never have to chase down information that has already been documented elsewhere
   • Manage patient status from the point of care
2. Don’t force staff to enter information that’s already been documented elsewhere
   • Integrate existing systems such as EMR, dietary services, pharmacy, imaging, nurse call and bed management
3. Eliminate delays in the information sharing process
   • This may mean going paperless, using wireless phones or implementing a real-time workflow automation solution
4.  Understand clearly the business need and workflows
   • Address this need during the contracting phase of your negotiations. Be sure that the vendor can meet the workflow needs and see the solution in use.

The results of an automated care plan are astounding, and have a tremendous impact on satisfaction, especially among nurses. Ultimately, automating the care plan cuts down on wasted time, and improves patient safety and satisfaction.

You’re forced to wonder, what’s the next hospital over doing? And when you hear that one of the other hospitals in your purchasing group just chose the EMR you’ve already crossed of your list, you feel the need to go back and reassess.

It’s time to stop wondering—stop worrying! The right solution for Medical Center X is probably not the right solution for Medical Center Y. This is not to say that discovering the right solution is easy. It involves a great deal of analysis. This analysis is best orchestrated by a team that isn’t prejudiced to certain systems or functionality. An objective perspective from a team that has experienced a variety of solutions in a number of settings can offer important insights.

Having helped hundreds of people through transitional IT periods, I can tell you: each facet of the planning and implementation process is made more efficient with strategic advisement. Without a strategy in place, it’s easy for an organization to become frayed. Irreparable divides arise because no one is there to wrap their arms around the conversation. An expert in these situations helps address needs and concerns, identifies commonality among committee members and steers all in an agreeable direction. Buy-in from key stakeholders is essential, but that won’t happen without solidarity and accord.

Making the right decisions the first time around provides organizational stability and ultimately helps reduce costs.

The reality is: if you’re conscientious enough to seek out information on CPOE and EMR implementation, you’re unlikely to fall into the rabbit hole of doom. However, if you don’t assess where you are currently and involve your staff in the decision-making that will get you to where you want and need to be…well, then you are headed for trouble.

We call it Change Management or Crossover Management. We do it so that we don’t drag an entire staff kicking and screaming into an unrecognizable environment. This is particularly important when it comes to implementing new processes and new IT because, aside from introducing something new, you have to eliminate the “old way” and years of habitual practices. Any change—even those that make the job easier or patient safer—can be hard to accept. Involving staff in the analysis and making them agents of change helps create “buy-in” and ownership on the level necessary to make change successful.

Outside of the literal IT investment, Change Management creates a structure that allows hospital to invest the time and resources required to support widespread acceptance and adoption of change. Some keys are to:

• Allow for input to ensure that selected systems and processes meet most needs
• Address training and education for staff
• Ensure efficient workflows (Obstacles should be removed, not introduced!)
• Provide resources and support for widespread acceptance and adoption

The worst thing you can bring to Crossover Management is a “Do it or Die – Take the Bull by the Horns”-type mentality. Successful Crossover Management engages staff and addresses their concerns. Don’t forget, as caregivers, we’re natural problem solvers. When presented with the issues, we solve problems—we don’t fight the answers!

We’re interested! Tell us what Changeovers you have been or are currently involved in? What issues cropped up and how are you solving them?