Transitioning healthcare companies from paper to electronic records presents huge consulting opportunities. To dig deeper into a client's perspective, Consulting 's One-on-One sat down with Kate Surman, the administrative director of patient care services at Stanford Hospital and Clinics.
Consulting: Why did you decide to embark on an EMR transformation? What were the initial and long-term goals?
Surman: Stanford Hospital and Clinics (SHC) decided to embark on a transformational review of the current state prior to starting the EMR design and build process. The organization-wide implementation of an EMR created a strong platform for shared investment in the design of workflows across roles, venues and departmental boundaries. Siloed functional groups that had previously relied on their own unique IT systems or handwritten documentation with limited capability to share information real time would now be incorporated into an organization-wide system with the ability to share information real time. SHC embraced this as an opportunity to take a fresh look at existing processes from the patient perspective and implement process redesign instead of simply hard-wiring the current state. The transformational goal was to design the patient, family and staff experience prior to building the clinical information system. The team completed the following:
- Selected five patient journeys
- Mapped the current state (what "is")
- Identified "pain-points" & "workarounds"
- Developed future state (what "can be")
- Researched experiences of other hospitals
- Considered IT, and non-IT improvements
- Validated IT improvements with EMR vendor
- Educated SHC & EMR teams
- Organized clear deliverables for future use
The success of this effort was measured based on the large number of ideas that were implemented in the system build as well as the creation of a framework for continued system and workflow optimization.
Consulting: At what point in the process did you hire a consultant?
Surman: Stanford Hospital and Clinics is fortunate to have an internal consulting team, Process Excellence, made up of Program Managers who partner with leadership throughout the organization to drive large cross-functional initiatives. SHC also has a strong IT PMO organization. Given the short time frame and tremendous breadth and scope of this organizational-wide transformation endeavor, SHC decided to augment these internal teams by hiring a consulting group. The selection process was rigorous and allowed SHC to select a team with experience in IT implementations within hospital settings, clinical personnel, project management expertise and a willingness to roll up their sleeves to conduct process mapping sessions, facilitate large sessions and document findings. The consulting team lead was partnered with a Process Excellence Program Manager to drive the work. The team included 30 individuals, half from the consulting firm and half from SHC, with representation from diverse areas such as the Emergency Department, Nursing, Attending Physicians, Pharmacy etc. The team was engaged for a period of five months. The effort benefited from strong executive level sponsorship from the VP of Process Excellence, CMIO and CIO and included report outs to the CEO and Board of Directors.
Consulting: What were some of the initial challenges you faced? How did you overcome them?
Surman: SHC determined that it would be critical to pull talented front-line staff out of operations to focus full time on the transformation initiative. It was difficult to make the case to operational managers to allow some of their best and brightest to leave operations and dedicate their efforts to a project – the benefits of which wouldn't be realized for over a year. Project leadership was ultimately able to make the case and leverage a fantastic team. The next challenge was to provide project management and IT skills to those individuals who made the transition from a clinical role to the project team. Their energy and enthusiasm made this possible as they proceeded through workshops on process mapping, facilitation and change management in addition to an introduction to the EMR.
Consulting: Knowing what you know now, if you were to embark on this transformation again what would you do differently?
Surman: SHC was one of the first to invest time in an early transformation effort prior to the design and build of this particular EMR system. Therefore, there was some duplication of effort when the design and build team arrived and needed to go back to key stakeholders to understand the current state at a much more granular level. This resulted in duplication of interviews for busy clinicians that might have been avoided if the teams could have combined the current state assessments and captured the necessary granular level detail during the initial interviews.
Consulting: What advice would you have for other hospital administrators considering embarking on their own EMR transformation?
Surman: One of SHC's biggest keys to success was leveraging fantastic clinical staff and transitioning them from operations to implementation design and build and then on to their current roles in Informatics. They have been able to keep the transformational process change ideas alive throughout the life cycle of the project and into the optimization phase. The investment that was made in this team has paid off many times over. They are a fantastic resource for the hospital and clinics.
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