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Sutter Health Ready To Deploy HIE, But Can It Succeed?

Posted on June 30, 2014 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Sutter Health doesn’t have a great reputation when it comes to EMR implementation. Late last year, when we reported that Sutter’s Epic EMR crashed for an entire day, comments came pouring in about the company’s questionable approach to training its staff on using the system.

According to Epic consultants who’d been involved in the project, Sutter leaders decided that Epic experts were there to “facilitate” training done by inexperienced in-house teams, rather than actually teach key users what they need to know. The result was strife, disorder and anxiety, according to several consultants who’d been involved. Since then, Sutter has connected its EMR to five medical foundations and 17 hospital campuses; by next year, it expects the EMR to connect to information on 3 million patients. But there’s no reason to think it’s changed its training strategy, which could cast a bit of a pall over the new project.

Now, Sutter Health is building out a health information exchange, working with Orion Health, which will tie together hospitals and doctors both inside and outside of its network across northern California. Sutter plans to begin deploying the HIE in phases this summer, starting with data integration with the Epic EMR and extending to testing exchange of inbound and outbound data. If the project works out, it seems likely that it will be a plus for every provider that does business with Sutter.

The question is, will Sutter do a better job of managing this process than it did in rolling out its EMR? While it’s easy to boast that your plans are going to be a “gamechanger” for the market, it’s hard to take that claim at face value when your EMR implementation hasn’t gone so splendidly.

Certainly, Orion is a reputable HIE vendor which has been praised for having strong products and service. And Sutter certainly has the financial wherewithal to see such an effort through. The thing is, if Sutter leaders (seemingly) took a wrongheaded approach to the all-important issue of EMR training, who knows what curveballs they might throw into the process of rolling out an HIE? Even if its EMR has stabilized and Sutter has somehow gotten past its training hurdles, its past missteps don’t inspire confidence.

If I were with Orion, I’d draw a firm line where training was concerned, as Sutter’s past strategy only seems to have cast its last major HIT vendor in a bad light. If not, I’d make sure the contract had a workable bailout clause…or be prepared for some serious headaches.

Lessons Learned from Sutter’s EHR Implementation Challenges

Posted on September 25, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of our more popular recent posts was published on EMR and HIPAA and was titled, “Adding Insult To Injury, Sutter’s Epic EMR Crashes For A Day.” When the post was shared on LinkedIn, it prompted a really insightful discussion on EMR training and Sutter’s approach to EHR implementation. A few of the comments were so good that I wanted to share them for more people to read and learn.

The first comment is from Scott Kennedy, an Epic Stork Trainer:

I was an Epic training consultant on the E. Bay Sutter EHR implementation and I can tell you first hand that Sutter Admin, and the Nurses are at odds. This unfortunate relationship made it difficult to train the staff. Epic itself is not to blame. Those who are using the Epic EHR are not as trained as they should be.

Sutter used an “in house” training team rather than bringing on a full consulting team with much more experience in training and educating end users. The “in house’ trainers included some nurses, RTs, and the like as well as a host of newly graduated college students who had less to no experience with conducting a formal training presentation on a multidisciplinary EHR.

Hiring and training “in house” is a great addition to bringing on an experienced, skilled, professional team of Epic credentialed trainers, like myself who do this as a profession all over the country.

We were also directed by Sutter EHR implementation Administration to “facilitate” rather than “train.” “Facilitate included passing out exercise booklets to the clinical end users and having them work on their own, rather than conducing concise, lectured, guided practice prior to each exercise. Hands on exercises are an essential part of the training, but should not be the complete focus of training.

The learner is left on their own to figure out the system, which is counter productive. That approach only builds anxiety, confusion and eventual resentment for the system and the administration who have chosen the EHR they are fumbling through.

I empathize with the clinical end users. There training experience could have been much more instrumental in getting them off on the right foot with their new EHR, had the training approach been more adult learning theory based rather than self-learning based.

I only wish I could come back to Sutter and retrain the nurses and other clinicians from the proven, consistent, progressive, successful adult learning approach, which enables and empowers the end user to grasp, comprehend and assimilate the EHR system into their daily shift work flow. That is not to say that there are not implementation bumps and optimization needs that have to be addressed, but they are far less impactful when the clinician is properly trained.

I am so sorry Sutter nurses and staff that I trained, but I was firmly told to “facilitate” your learning rather than “train” you. I tried to implement adult learning methodology, but was told by your EHR administration to “stop talking and let them do it on their own.”

Epic EHR is not to blame here. Epic is a sound, EHR system that is serving the needs of millions of patients and their care providers around the world, without incidents such as those being experienced at Sutter.

There is a right way to implement and train and a wrong way. Sorry Sutter EHR implementation administration, but “I told you so!”

I asked Scott Kennedy if he’d thought of leaving the project since it was being done the wrong way and he offered the following response:

@ John, yes I did come very close to leaving the project. As a matter of fact after I was verbally “scolded” for lecturing to much I phoned my recruiter and asked to be placed on another project, but then, after careful thought, I decided to stay on the project and attempt to train and support as much as I could. But it seems that my individual efforts were not enough to counter the original training “facilitation” focus.

To add insult to injury those of us trainers who were there for the Sutter E. Bay implementation were told not to return for the W. Bay implementation. The EHR administration wanted an entirely new outside consulting team.

I got a fellow colleague on the project, hoping that the E. Bay administration would have learned from and the current W. Bay implementation would be better. The training colleague I got on the W. Bay project shared with me that it was worse than the E. Bay implementation. They kept the experienced Epic trainers as support and utilized them as little as possible for actual front end training. So sad, really.

The EHR administration at Sutter tried to cut every financial corner possible and lost sight of the long run implications of improper front end training. Now they are paying the price.

Michael A. P., an EMR consultant offered this insight as well:

I’ve also had the misfortune of working with Sutter for a (thankfully) brief period. In their long history of attempting to implement Epic, they could be counted on to make the wrong decision in almost every situation. Their internal politics trump the advice they receive from vendors and highly experienced consultants. The result is an implementation that serves neither the patient or the users best interests.

Then, Ryan Thousand, an IT Architect at Athens Regional Medical Center, offered a broader view of what’s happening in health IT and EHR:

I hate to say it but most large healthcare organizations are getting like this as well…. There are WAY too many layers in these organizations and sometimes to get work done can mean 4 weeks of executive meetings and in the end no decision or 100% opposite of the recommended direction given. That being said, with the rapid change in healthcare and the mergers and acquisitions occurring right now, I fear the worries for Healthcare in general over the next couple of years. We cannot continue to try to meet mandates the government is making while still ensuring 100% utmost patient care; and in the end that is really all I care about.. the patient in the bed who is BENEFITING from my implementation. Change is always tough but done the right way with the right people (as you all stated above was not done correctly) we will continue to see great things happen on the HIT side. But unless Epic/Cerner all the big players in the markets as well as the local clinician and providers work together and decide the best outcomes for our patients, we will all one day suffer, as we will all one day be patients.

In all the years I’ve been writing about EMR and EHR, the biggest problem with most EMR implementations is lack of EHR training or poor EHR training. It’s really amazing the impact quality EHR training can have on an implementation. However, many organizations use that as a way to save money. If they could only see the long term costs of that choice.

Personality Traits Predict Nurse Acceptance of Mobile EMRs

Posted on August 27, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As HIT leaders know well, clinical personnel have a wide range of responses to EMRs, ranging from enthusiastic adoption to outright panic. In most cases, hospitals can’t predict which doctors and nurses will need extra support and which will be power users until they roll out their EMR.

However, a new study suggests that by examining nurse attitudes, the HIT team can get some idea ahead of time which will jump on board with mobile EMRs and which will hang back.

Key personality traits can predict which nurses are more likely to accept and adopt EMRs, according to a new study appearing in a FierceEMR piece.

The study, which appeared in BMC Medical Informatics & Decision Making, analyzed a questionnaire filled out by 665 nurses to compute a “Technology Readiness Index.”  In so doing the researchers broke out a series of personality traits that impact on whether nurses see mobile EMRs as easy to use and useful.

Researchers concluded that four traits in particular — optimistic, innovative, secure and uncomfortable with technology — had a meaningful impact on their acceptance of technology, according to Fierce EMR:

* Optimistic nurses were more likely to see mobile EMRs as useful and easy to use
* Innovative nurses saw EMRs as being easy to use, but not necessarily useful
* Those who were insecure or technology-challenged saw the EMR negatively

According to the study write-up, researchers concluded that continuous educational programs aimed at increasing IT literacy should be provided for nurses. It also recommends that hospitals recruit, either internally or externally, more optimistic nurses as product champions for the mobile EMR.

Of course, figuring out the personality types of  nurses en masse isn’t practical in most situation. After all, most hospital IT administrators don’t have the time to do a scientific study prior to their launch, especially if they’re doing a multi-layered mobile launch using new tools and introducing new requirements. But it doesn’t hurt to know, informally at least, which types of nurses are likely to be able to lead the mobile EMR charge.

Real-Time Responses To EMR Training

Posted on February 28, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Teaching hospital staffers and clinicians to use your EMR is a hard enough job. Figurng out just what they didn’t learn during training is even harder. But here’s a trick some hospital administrators and IT leaders are using to do just that.

A report in the HealthTechZone blog notes that at St. Joseph Hospital in Chicago, they’ve already seen some success with a technology that allows audiences to respond to quizzes embedded in EMR training materials.

The hospital’s training sessions use a polling software application called TurningPoint which allows audience members to respond to questions in real time, using either their smart phones or “ResponseCard” keypads. The technology also allows presenters to bring in audience members not in the room at presentation time and collect their responses to polls remotely.

At St. Joseph, administrators use this technology to structure their EMR training sessions more effectively and focus in on areas where the audience seems not to have understood what was presented.  It’s as simple as sending the training group on a break, reviewing the quiz and reorganizing PowerPoint slides to re-emphasize any points that the audience missed.

But the response technology’s use doesn’t end there, the blog reports. Once the formal training is over, administrators hand audience polling results to the IT team. IT administrators then use the data to address employee concerns as they proceed with the EMR rollout.

I think this is a great approach, not only for training but for gauging employee (and clinician) support for the EMR rollout, gathering input on the effectiveness of the EMR in users’ daily work lives, and generally fostering EMR acceptance by having a finger on the pulse of user sentiment.  Readers, have you tried anything like this?

Video: The Horrors Of Generic HIT Training

Posted on November 20, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Everyone knows training is a big burden, and tricky to pull off under the best of circumstances. Let’s hope things don’t go as badly for you as they do for the doctor and trainer in the following video.

The video, brought to us by HIT training vendor OptimizeHIT, offers a wry take on what happens when EMR training isn’t relevant for the doctor who’s getting the training. In this case, we witness the plight of a heart surgeon who’s forced through a discussion on primary care functions that she neither wants nor needs.

I recommend you give it a look. I think some of you will find this quite amusing. If the dialogue sounds familiar, my sympathies.