Managing and Leading Change: EHR Selection

Purdue Global University

HS450-01: Strategic Planning and Organizational Development

Managing and Leading Change: EHR Selection

In the healthcare industry, it is essential to adapt and adjust to new ways of thinking to deliver the best outcomes for our patients. Like many industries, technology has made improvements in healthcare that have allowed for increased productivity, better care coordination, and better quality of care. Electronic health records (EHR) is one tool that can be used to help achieve all of those measures and can be an asset to the clinic moving forward into the future. With any change, proper steps must be taken to ensure optimal success is achieved with implementing the new process. A collaborative approach is necessary for exploring priorities, processes, and obstacles that will need to be addressed during implementation.

Part 1  

The first step with implementing a new EHR system will be to establish two teams to help with planning and decision making. The first team that will be developed will be a clinician based team to give input on the clinical wants and needs from the EHR system. This team will consist of a physician, nurse practitioner, radiologist, pathologist, and pharmacists. These roles are chosen to represent the various departments that will be on the frontline of using the new EHR. Physicians and nurse practitioners provide patient care, and their input will be a valuable resource with ensuring that the system delivers quick and efficient ways to accomplish clinical tasks. The radiologist will represent the imaging department, and the pathologist will represent the laboratory department. Their input will ensure that the EHR provides functionality to improve workflow while allowing quick access to labs, pathology, imaging, and other clinical reports. The pharmacist will represent the pharmacy and will provide input on ways for the EHR to increase productivity and optimize medication delivery.

The next team that will be put together will consist of administrative staff that will include a medical biller/ coder, an office manager, an IT specialist, a patient account, and a patient service representative. The representative from billing and coding will help provide input on what is needed from the EHR to help improve workflow, reduce errors, and improve processes involving claims. The IT specialist will provide their expertise suggesting what equipment will need to be updated, security measures put in place, and network requirements for the project. As the office manager, there will be reports, tracking systems, and other managerial tools that will be desired options in the EHR. Finally, the representatives from account services and patient services will also provide input on scheduling, access to patient information, and desired options to improve productivity. 

Next, a leader must be established to help guide and steer the group in productive discussion. As the administrator tasked with this project, the leadership role will be my responsibility to develop an environment of creativity and collaboration. Disagreements are to be expected when bringing in different representatives from multiple departments with varying expectations on processes and what should take priority. Team building activities can be beneficial to help establish a cohesive team and demonstrate a functional way to achieve conflict resolution. These activities can help teams establish positive communication, self-development, encourage problem-solving, and foster teamwork, encouraging teams to work together (Fapohunda, 2013). 

The first team building activity that will be employed is called two truths one lie. This is performed by each person in the team, making two truthful statements about themselves and one lie. Each member of the group can ask two questions to each person to try and discover which statement is the lie. This is an ice breaker activity and encourages the team to get to know something about other members of the group. Ice breakers help spark conversation, increases the comfort level between group members, and helps to relieve inhibitions and tension (Chlup & Collins, 2010).

The second team building activity that will be done is called sneak a peak. To perform this, the leader will create a sculpture using building blocks or legos and hide it from plain sight. One person from the two groups will get a short time to view the sculpture and then go back and have a timed period to communicate with the team how to replicate it. Once someone has seen the sculpture, they are not allowed to provide any hands-on assistance on communicating verbally. Once the round is up, the person who viewed the sculpture will sit down and give no more aid to the team. This will continue until there are no more group members to build the sculpture, and in the end, their work will be compared to the original sculpture. This activity will encourage communication and problem solving amongst the teams.

The last activity will consist of a simulated scenario.  This will consist of a situation that doesn’t have any right or wrong answers but multiple options to choose from. This can be as simple as a medical dilemma such as a kidney being available for transplant, but the group must decide on which patient receives it. The patients will have different ages, backgrounds, and issues that will complicate the process for deciding. Each group must come up with a consensus pick that is agreed upon by each person in the group. This will encourage discussion, collaboration, conflict resolution, problem-solving, and will require that the team come up with a resolution supported by everyone. This will be key in future disagreements involving the implementation of the EHR.

Part 2

Implementing a new EHR will come with challenges that must be overcome to achieve success. Two of the most common barriers seen with EHR systems are buy-in from the staff and frustrations over decreased efficiency while the new system is being learned (Palabindala, Pamarthy, & Jonnalagadda, 2016). Buy-in from the staff can best be described as resistance to change. It is human nature to resist change, and when adding in new technology, the resistance can be even higher. Staff frustrations due to decreased efficiency will be caused by learning the new systems. Any time a new system is introduced, it will take time for the staff to be proficient with using it to improve workflow. To tackle these two issues change management theories will be applied to overcomes these barriers and help produce the best outcomes.

Exploring the first issue, buy-in from the staff, the ADKAR model of change management will be applied. ADKAR stands for awareness, desire, knowledge, ability, and reinforcement (Warrilow, 2009). The first step, awareness, is where the need for change will be conveyed to the staff. Talking points for this stage will include government mandates, improved reimbursement, increased productivity, and increased patient outcomes. The second step, desire, will be the stage that must encourage the staff to want to make the change happen. Talking points for this step will include explaining how the new EHR will help reduce errors, improving the overall accuracy of the medical records, make the information more accessible and available to the multidisciplinary team, and reduce delays in patient care between the different departments (CMS, 2012). The knowledge stage will lay out the timeline, plan for data migration, processes, and training procedures should be discussed, giving staff a clear picture of how the change is going to happen. The ability stage will include the training of staff, giving staff the skills to make the change. The last stage, reinforcement, is critical to the success of the change. This should include a support system for staff and any additional training or retraining that is needed.

Next, the issue of frustrations being felt by the team due to decreased efficiency during initial implementation will be addressed. This will be addressed with Lewin’s change model. Lewin’s model has three stages, unfreeze, change, and refreeze. The first stage, unfreeze, is where the right environment will be created (Warrilow, 2009). The need for change will be reinforced along with plans for training staff and the ultimate end result, which will be improved efficiency. The next phase will be change; this will including the training and setting up a good support system and mentors. The last stage will be refreeze; in this stage, additional training and support will be done to reinforce the competency of the new EHR system. Taking this approach will decrease frustrations and provide staff with a layer of support to help them during the transition. 

Part 3

In order to ensure the best EHR is chosen that align with the needs of the clinic, a strong procurement plan must be in place. The procurement plan will help with the selection of a vendor, establishing which vendor can meet the clinic’s needs, find options that meet the project budget, contract negotiations, and ultimately the implementation of the new system. To make the selection of the vendor as smooth as possible, a request for information (RFI), request for proposal(RFP), and request for quotation (RFQ) will be used. The first step that will be done in the procurement process is RFI. During this step is when the clinic will gather information from vendors. This will be sent out to a wide range of potential candidates to gain preliminary information on the EHRs each vendor has to offer (Mhay & Coburn, 2019). The information that is received back from the vendors will help with narrowing down the different vendors. 

The next step will be to send out an RFP. This will be a document that will be sent out to the shortlist of vendors that were selected after receiving the RFI.  The document will outline the vision and goals of the project. More detailed information will be included giving specifics to the vendor of what the options are being sought for the EHR system. This will also outline any interoperability issues that need to be considered with any current systems the clinic has in place. The document will detail all of the needs of the clinic to allow vendors to respond with their solutions for meeting them. This should also include specific information on training support and timelines for implementation (Mhay & Coburn, 2019). 

Finally, once all of the detailed information is obtained from the shortlist of vendors, an RFQ can be sent. The RFQ will specifically state all finalized options, functions, customizations, and requirements for the EHR. The purpose of the RFQ will be to receive quotes from the shortlist of vendors based on the finalized specifications for the project. This will allow the vendors to place bids on the project and allow the clinic to compare prices. This will be the step where the specific vendor is chosen based on clinic and budget needs. 

In healthcare, change is an inevitable part of the industry. Whether it is a change to the policy, regulation, technology, or reimbursement facilities who embrace change and adapt will set themselves apart. A new EHR system will help the clinic improve productivity and reduce errors. The impact on the patient will be felt by delivering better care coordination while improving outcomes. With the proper plan in place, the clinic will achieve the best results with implementing this new system. 

References

Chlup, D. T., & Collins, T. E. (2010). Breaking the ice: using ice-breakers and re-energizers with adult learners. Sage Journals, 21(3), 34–39. http://dx.doi.org/10.1177%2F104515951002100305

CMS. (2012). Electronic health records. Retrieved from http://www.cms.gov/Medicare/E-Health/EHealthRecords/index

Fapohunda, T. M. (2013). Towards effective team building in the workplace. International Journal of Education and Research, 1(4), 1–12. Retrieved from http://ijern.com/images/April-2013/23.pdf

Mhay, S., & Coburn, C. (2019). Meaning of RFQ RFI RFT RFP. Retrieved from http://www.negotiations.com/articles/procurement-terms/

Palabindala, V., Pamarthy, A., & Jonnalagadda, N. R. (2016). Adoption of electronic health records and barriers. J Community Hosp Intern Med Perspect, 6(5), 32643. http://dx.doi.org/10.3402%2Fjchimp.v6.32643

Warrilow, S. (2009). Change management theories. Retrieved from http://www.strategies-for-managing-change.com/change-management-theories.html