Tips for implementing technology at your hospital
If you're thinking of purchasing health informatics technology, you have to do a lot of work on the front end before you seal the deal, says Grena Porto, RN, ARM, CPHRM, principal of QRS Healthcare Consulting Inc. in Hockessin, DE.
"You can't just rush and buy the latest wizbang thing and think it's going to work. There has to be a lot of preparation effort on the front end to be sure it's implemented correctly, that it's going to work in your system, that you've bought the right stuff," Porto says.
She says she has tons of examples of cases at hand where the technology doesn't meet the work flow process. For example, she cites insufficient EMR display screens as problems she sees quite often. Let's say an ER nurse is titrating a vasopressor drip and the dose is dependent on the current drip dose and the patient's blood pressure. With some EMR systems, those would be on two separate screens and the nurses would have to toggle back and forth between screens. So the nurses write down the blood pressure to view while they view the drip dose. "There's an example of poorly designed technology that just didn't work as well as the paper record," Porto says.
And don't try to cut corners to save a fraction of the millions you must spend to install a new system. She recalls a hospital that bought an EMR system for its ICU department, but the module had been designed not with the ICU in mind but a regular patient care floor. The vendor, she says, convinced the hospital to buy the module. Oftentimes she says this is done with a promise that when the appropriate technology is ready, the vendor will install that free of charge.
"The problems associated with that are huge. First of all, from the patient care perspective, the record didn't work for the nurses. Secondly, the nurses got so [upset] because they were being asked to change the entire way they do their work to accommodate this record that wasn't even designed for them." And this was all done because the hospital wanted to save about $40,000, even though they were spending millions on the technology as a whole, she says. The hospital ended up losing that money, paying nurses in overtime.
"And that's another thing I would say to people is do not underestimate the amount of time, effort, frustration, all of the things that are associated with implementing one of these changes. It is huge. So don't put your staff through more than you have to," Porto says.
She recalls the story of another client that wanted to implement a robotic dispensing system in its pharmacy. Knowing that the project normally took about 18 months, the hospital decided to do in six months. "And they decided to do this because The Joint Commission was coming and they wanted to have it place before their survey. I said to them, 'But The Joint Commission doesn't require a robotic dispensing system. They're not going to give you extra points for this. Why are you doing this?'"
The implementation went poorly and the hospital lost many staff members who were frustrated and spent.
"You've got staff that you've completely burnt out, you've got a lot of corners you cut, and now the system isn't working as well as it should and you're paying the price. Why did you do this? You didn't have to do this," Porto says.
She reiterates that if you're thinking of implementing technology, you can't cut corners because of budgetary or other concerns. "If you can't afford the whole thing, then don't get it," she says.
Another caution: "What I see happening too much is that hospitals want to retrofit the people to the technology. That will never work," Porto says.
She recommends every facility have a human factors engineer to help determine what technology is needed and how to best implement it. But Lydia Washington, MS, RHIA, CPHIMS, director, practice leadership for the American Health Informatics Management Association (AHIMA), says human factors engineers, beyond being expensive, are hard to find. "There's not a lot of people around that are trained in health informatics, and I think that's the real issue here," she says.
She says you can work around this if you get all the necessary people at the table when you're discussing technology implementation — clinicians, IT, nursing, "all the people who are in charge of looking at and monitoring safety."
She stresses the importance of a solid work flow analysis, "doing a sterile look at the work flow, involving all of the players, not leaving out anybody so that you totally understand what your process is and how it's going to change once you put the technology in, which can be hard to do and is very time-consuming, but it has to be done."
Validation crucial
She points to bar coding and the potential of entering the original data incorrectly. "One of the things you can do," she says, "is have a system that confirms that what you just entered is correct and what you wanted it to be. So that's a system of coming back and confirming and validating what you just did. Systems are real good with validation if they're put together properly."
Training and retraining also is essential and not taking the vendor at their word. Washington suggests due diligence including trial runs, talking with facilities that are using the technology you're considering. Vendors should be able to supply this. "The systems that I've put in in the past, we've done what we call 'proof-of-concept' testing, where you put it in for a limited period of time in a limited environment and you just play with it basically." Site visits are important, as is asking these facilities about how they're using the system and what issues they've had.
In your process analysis, "you really have got to be focused on what you're trying to accomplish, and again, not technology for technology's sake, but what are we trying to do here, how are we trying to impact patient safety and quality, and works backwards from that.
"I think if you do that," Washington says, "and you look at your current work flow and where there's gaps between the current work flow and where you need to be to get to the goals you want, then I'll think you'll be OK."
If you're thinking of purchasing health informatics technology, you have to do a lot of work on the front end before you seal the deal, says Grena Porto, RN, ARM, CPHRM, principal of QRS Healthcare Consulting Inc. in Hockessin, DE.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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