The journey to a paperless hospital – The importance of having a proven rollout methodology

When it comes to supporting healthcare with IT, having a great product is just one quarter of the puzzle. There are several reasons why vendors and care providers struggle when it comes to implementing and achieving a really good adoption of healthcare IT.

Then there is also the challenge of what to do with a patient’s existing clinical data. And, since you are buying new software, this typically means you want to improve patient outcomes and realise other specific benefits, all of which you have hopefully defined in your case for implementing a new IT solution in the first place. Finally, you have to find the right product and, maybe even more importantly, the right vendor. Then, the moment you start changing things, or even talking about making a change, there will be some people involved who will fight to prevent any changes from taking place at all. And this is all before you actually begin to roll out anything.

In order to be successful with your IT endeavours you will have to address four key areas which will ultimately represent your key pillars of transformation:

1. Communication: collaboration, management support, and a good internal communication strategy.
2. The Product: choosing the right product.
3. Equipment: a reliable and powerful IT infrastructure; a sufficient amount of available equipment (PCs, smart phones, tablets, computers on wheels, etc.); effective training to ensure proper use.
4. Actionable reports: analytics, KPIs to monitor execution of set strategy, useful and fully accessible information.

Pillar 1: Communication

It is crucial that you first work with (and listen to) your team to define the communication strategy which will help your organisation transform and create a positive vibe. Since each care provider, and even each department, can vary, one approach will not work in every case. You need to set up a methodology which will allow for diversity, help you identify any specifics, and allow you to adapt as you roll out your IT solutions.

Also, do not underestimate the importance of executive support, because when it comes to difficult decisions you will need their approval to move forward. Of course, to really make it, you will need your foot soldiers – your power users on different wards. After all, they are the ones who understand the benefits, know why the transformation is necessary, and will be the ones who understand the product(s) inside and out. And what’s more – they need to understand how to use these products in the correct way, and must be willing to help other colleagues immediately, whenever they get stuck. You will quickly see that these power users are also the ones who constantly provide feedback to the vendor on what is still missing, and what could be improved upon in order to make the product even better.

Pillar 2: The Product

Now that you have a positive vibe, an established method of communication, and good attitude towards the journey you are about to embark on, it is important that you choose the right product. Unfortunately, in healthcare there are still too many awkward and obsolete solutions. There are also some large, so-called monolith solutions, which may seem attractive at first, but tend to be very expensive, inflexible, and might not even cover all of your requirements. So, do some research before you decide on your product, and make sure it is “future proof”, flexible, and that it will allow you to expand your IT capabilities based on your needs and financial means. Also, don’t be afraid to do things differently, since, in general, the most obvious and existing approaches and IT solutions have not yet provided the expected results on a larger scale.

But, and possibly most importantly, don’t let any one vendor lock you in, and don’t underestimate the importance of setting up a life-long and vendor-neutral EHR. Lately, there has been more and more buzz around health data platforms and the development of an ecosystem of apps. And, the common concept here is that clinical data should not be bound to the applications that created it.

Still, one good thing that can be said about large vendors with monolith solutions is how they approach rollout. They demand close collaboration with the care provider and usually have a well-defined rollout methodology. So, no matter which product you select in the end, make sure that the vendor understands the role and importance of a good rollout methodology, and that the vendor will offer you appropriate guidance during this phase. Or, if they are new to the market, they should at least be willing to work closely with you to define and develop a rollout methodology.

You have now selected the right product; your core team of power users is ready, but before you actually go live, there are still a couple of things you need to sort out:

• As soon as possible in the process, decide on the first ward where you will deploy the new app, and include some of the team members from this ward in your core team of power users. But, do make sure that your core power user team covers other wards as well. Find the ward that will take on the project with a positive attitude, and will help improve the rollout methodology, so that once you scale it up to other departments, you will have a smoother ride.
• Do some modelling of the processes. Figure out how things are currently done, how processes will change once you implement your new solution. This way, you will catch any potential conflicts and resolve them upfront, thus eliminating, or at least reducing, the number of complaints once you go live with the product.
• Conduct knowledge transfers to your power users and run workshops for everyone on the ward, so that once you go live, everyone will already be familiar with the system.
• Make sure that once you go live you can switch from your existing way of doing things to your new approach in as short a time as possible, because having two systems in place at the same time means extra work, added frustration, and an increased risk of making mistakes. Doing a “big bang” approach on just one ward is usually not too difficult if you have done your preparation properly beforehand.
• Offer adequate support to the ward that goes live, so that any potential conflicts are resolved immediately. This means that having representatives of the vendor present is usually good advice.

Pillar 3: Equipment

All can fail if you don’t make sure that your IT infrastructure and equipment is adequate and available at every step – whenever and wherever users need them. It is quite easy to overlook the fact that paper forms and charts are not only used for writing clinical details, but also work in another important way – they serve as “triggers” in paper-based processes. Basically, once the doctor writes a lab order on a paper, she puts the order on a dedicated shelf where a nurse will see it, and take samples. And, once the results are back, the nurse puts a paper with results on another dedicated shelf which doctors constantly check to see if there are any new results.

Once you take away the papers, you also break these processes. You need to make sure that you replace these triggers with some new ones (smart phones, task lists, etc.), otherwise you may be in for a surprise. Since now there will be no more paper around to write orders, put down observations, or check results, medical teams will need to use computers to do everything. No matter how well you might have optimised login procedures, and no matter how good the rollout or the product itself is, if there are not enough computers, smart phones, tablets, carts, etc. to use the system whenever someone needs it, rollout will struggle and eventually fail.

Pillar 4: Actionable reports

Now that you have gone live and everything is running smoothly, you should be able to tell whether you have achieved any of those benefits and improved patient outcomes, right? This is where the analytics and KPIs come into play. But, to really achieve the best results, you really shouldn’t wait for KPIs and analytics until you go live. You need to set up your KPIs upfront, and start monitoring them the moment you start with the project! This is the only way you will know whether you are on track, and what your outcomes are. By having actionable KPIs and/or dashboards/reports, you can also make any necessary corrective actions proactively, which in turn makes you more efficient.

Rolling out new IT in healthcare is challenging, and setting up an agile rollout methodology that takes into account all four pillars can really help you improve your chances of making the successful transformation to paperless. Keep in mind that no two departments are exactly the same, so plan for some agility, and no matter how experienced you are, always start out small with one ward where you can test and adapt your methodology, the product, and the equipment.

Then, roll out – big bang or step by step, whichever will best work for you.