HIMSS16: Meaningful Use and the ‘culture of innovation’

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Realizing the value of your healthcare facility’s EHR system is harder than it might seem, says Elizabeth Regan, PhD, associate HIT professor and chair of South Carolina University’s Department of Integrated Information Technology.

Regan, who presented a session entitled “EHR Optimization: Why Is Meaningful Use So Difficult?” at HIMSS16 in Las Vegas, spoke with CMIO.net about getting the most out of HIT, 10 keys to successfully implementing new ideas and technologies, and creating a “culture of innovation” within healthcare organizations.

Can you give an overview of your presentation at HIMSS16?

The focus of my presentation was on the challenges of achieving meaningful use or meaningful outcomes—which is really about innovation. This topic is especially timely with the growing concern that many healthcare organizations are not realizing the expected value from their investments in information technology. This concern was underscored the past few weeks as CMS and ONC responded by announcing changes to the Meaningful Use incentive program.

What strikes me most about the transition to electronic health information, however, has been the wide disparity in results, which raises critical questions:  What differentiates initiatives that are successful in achieving meaningful use (improved outcomes) from those that fall short or fail? What do successful innovators do differently?

What are some ways healthcare can leverage technology to solve clinical problems?

First, if the goal is to solve clinical problems—i.e., to improve outcomes—that needs to be the starting point. As Steven Covey likes to say, “Start with the end in mind.” Begin with agreeing on the desired outcome, and then figure out the technology, process, people, and policies from there. Successful EMR use depends on integrating the system into often complex organizational settings. The value that seems to bring the various medical professional groups together for integration is a broad consensus about the importance of effective and efficient care.

Leveraging technology is not just about patient satisfaction, clinical process, data privacy and security, patient engagement, population management, or cost savings: It’s about all of them at the same time! Realizing value is a systemic challenge. You can’t change one component of the system without affecting other components of the system. And as we discussed in the presentation, innovations—even very costly ones—have little chance of success or sustainability when implemented in silos. How things are done can make or break initiatives and have a tremendous impact on achieving value. And it’s essential to focus not just on the technology, but equally on people, process, organization and other dynamics.

What sets apart those innovators who are able to achieve positive healthcare outcomes?

My research revealed a number of themes that consistently emerged among innovative organizations reporting significant improvement in quality of care and patient outcomes. I’ve summarized them into ten critical success factors.

  • Active CEO commitment (with a focus on mission, vision, building buy-in, and creating a compelling need for change)
  • Patient-centered care and patient engagement
  • Quality focus with clinical benchmarks for monitoring success
  • Workflow (process) integration
  • Strong leadership of clinical professionals (physicians and nurses)
  • Engagement, training, ongoing support
  • Supportive organizational climate for innovation
  • Collaboration culture (teamness)
  • Systems perspective on change (holistic view) 
  • Technology reliability, responsiveness, interoperability

However, there are overlaps and different perspectives on categorizing them, which suggests interdependencies among them. These interdependencies also underscore about the importance of approaching innovation from a holistic or systemic perspective—you can’t change one factor without impacting others as well.

What is necessary to create a 'culture of innovation' within a healthcare facility/organization?

Evidence suggests that participation and engagement are vital for the success of new technologies. Successful organizations tend to create a cooperative dynamic where end users solve technical problems, write templates, and teach each other about software features. Teamwork is a major pillar.  Collaboration is a clear expectation. The value that seems to bring the various medical professional groups together for integration is a broad consensus about the importance of effective and efficient care.

It all starts, however, with the CEO at the top. Visible leadership from the top was one of the most dominant factors associated with successful implementation of EMRs. Successful innovators effectively tied change initiatives to achievement of clinical improvement goals of improved care, greater access and lower cost. They encouraged risk taking, saw their role as reducing barriers, and were realistic about expectations, realizing that not all efforts would succeed, and focused on learning from mistakes. It’s about recognizing that innovation is an iterative process and viewing it as an organizational learning process.