Field of Dreams? or… it could be just an empty ballpark! COACH May 2004

2 Agenda  the proposition  why this matters  case studies  what the stakeholders said  moving forward

3 The proposition  effective engagement and support of the end users is absolutely critical to the goal of getting information technology used to improve patient care, quality of professional life & health system management

4 Why this matters  Standish Report findings (1999)  investment in IT application development is HUGE  $250 billion US/year; 175,000 projects  failure rate unacceptable  31% of projects cancelled before they get completed  53% will cost 189% of their original estimates  Only 16.2% “on time, on budget”  three key overall success factors: end user involvement, clear statement of requirements, executive management support

5 Why this matters (cont.)  November 2001study* re: key factors in forecasting EMR/EHR implementation success  over 150 factors identified  only 2 identified consistently associated with successful implementations  top management support  clinician involvement *Sittig, D; The Importance of Leadership in the Clinical Information System Implementation Process

6 Why this matters (cont.)  spending ~ 2% of healthcare budget on IM/IT  too low anyway  if we screw up over 50% of these we’re really in trouble!  risk losing credibility with/support of senior policy makers, funders and end users  disenchanted users (once we lose them, they’re twice? 4X? harder to get back)

7 Case studies  Danish national system (MedCom)  grew from modest clinician-driven project  key success factor: getting opinions and ideas from general practitioners’ professional organization AND from practising GPs  New Zealand  extensive physician use of computers and EMRs in improving health status through HealthLink  strives to be responsive to physicians as primary obligation; many initiatives result from primary care physician demands  replaced alternate product (after millions of $) which failed when they tried to connect to GP computer systems  officials had little/no understanding of general practice environment

8 Case studies (cont.)  Cedars-Sinai 2003  Hospital believed it had sufficiently involved physicians in design/implementation process by working with 40-physician medical executive committee  turned off CPOE after complaints from hundreds of physicians – cumbersome, didn’t follow physician workflow  underestimated impact on ancillary departments, complexity of implementation and work involved in transitioning to CPOE

9 Case studies (cont.)  Upstate New York Veterans Healthcare Network*  in < 5 years, went from poor performer to a leading performer among VA 22 networks  conscious attempt to empower frontline employees by:  increasing patient outcomes focus  adopting a learning environment  increasing frontline autonomy  encouraging grass-roots innovation  developing esprit de corps among frontline workers *Timothy J. Hoff/IBM

10 Process used  interviews:  standardized interview template  interviewees  payers(i.e. CIOs), physicians/physician organizations, vendors, other – over 35 key players in the Canadian health infostructure scene  coast-to-coast coverage  synthesis and analysis of results

11 What the stakeholders said…  significant convergence among views of payers, vendors, end-users, CIOs  end-user engagement seen as “absolutely critical”, a “no brainer”, “essential”, “crucial”  agreement on critical success factors:  commitment to process - trust is earned  all parties need to be prepared to change their “going in” position – requires “active listening”  acknowledgement of interdependence  recognition and acceptance of different drivers  creating a climate of mutual respect

12 Stakeholders (cont.)  performance “spotty” across the country  generally poor reviews at the national level  balancing province-wide system needs with one-on-one medical care creates challenge  only two provinces have issued a strategic IT plan  vendors not generally involved/seen as the enemy  cultural differences (project managers vs end users) get in the way of effective end-user engagement  need to migrate from “create and direct” to “facilitate and empower  AB generally perceived to be engaging stakeholders  process slow and painful but making real progress  growing awareness, increased attention/$$

13 Moving forward  interest-based approach  start having the conversations, building the relationships now  allow adequate time for engagement  jointly define clear statements of requirements  engage end-user organizations on strategic and implementation issues;  work with informed end-users at the project level  at ALL stages of the process  engage skilled facilitators

14 Moving forward  the job’s not done with implementation  build in a “feedback loop” after implementation  ensure end-users aren’t “out of pocket” for their time  include those who are going to deliver the product….e.g., the vendors (VCUR)  use consistent processes  we need to talk about this….nationally, provincially and locally!

15 Recap  effective end-user engagement is critical if we want IT used to improve health outcomes  we need to ensure what we’re designing/building/implementing works for those who use the IT systems to deliver care  we need to do a better job of involving end- users….now!

16 Questions? Bill Pascal P. Eng., CMA CTO, Canadian Medical Association Mary Gibson CA Consultant