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Communication Skills in Health IT, Building Strong Teams for Successful Health IT Outcomes

Elizabeth (Liz) Johnson / Karen M. Marhefka

INTRODUCTION

In America’s 21^st century healthcare system, landmark federal reform legislation enacted since 2009 continues to modernize care-delivery organizations with health information technologies (health IT) that began with the adoption of electronic health records (EHRs). Most notable of these laws was the American Recovery and Reinvestment Act (ARRA) and its Health Information Technology and Economic and Clinical Health (HITECH) Act provision, which established the Centers for Medicare and Medicaid’s (CMS) Meaningful Use of EHRs Incentive Programs (Blumenthal & Tavenner, 2010). These programs earmarked more than $22 billion in incentive payments for eligible physicians and healthcare providers who successfully met increasingly stringent requirements for EHR implementation. Ten years later, as part of a February 2019 CMS Notice of Proposed Rule Making, it was recognized that $35 billion had been paid, which resulted in 96% of hospitals and 78% of physicians now using certified EHR technology (Medicare and Medicaid Programs; Patient Protection and Affordable Care Act, 2019).

Although the long journey to successful integration of health IT by providers industrywide continues, there are challenges that must be addressed. Tremendous complexities exist throughout healthcare organizations working on expanding and optimizing health IT initiatives, highlighting a critical need for effective communication campaigns throughout the lifecycles of acquiring, implementing, adopting, and optimizing the use of EHRs in both inpatient and ambulatory settings. Efforts such as these, with effective communication programs in place as a core strategy, support the goal of achieving the Institute of Medicine’s (IOM, now the National Academy of Medicine), six aims for improvement in care-delivery quality, making it safe, equitable, effective, patient-centered, timely, and efficient (Institute of Medicine [IOM], 2001).

As America’s healthcare system strives to be a “continuously learning” system, healthcare leaders and providers realize that communication and improved patient engagement are central to improving the value of healthcare (IOM, Best Care at Lower Cost, 2013). Clinicians, clinical informaticists, health organizations, and health IT policymakers serve as agents of change in the effort to involve patients not only in decision-making, but in providing key pieces of health data. To enhance these efforts, in 2013 the IOM introduced the Evidence Communication Innovation Collaborative, which explored obstacles, solutions, and strategies to enhance patient involvement in healthcare (IOM, 2013). Two projects resultant from that collaborative are “shared decision-making strategies for best care” and “patients’ attitudes on data sharing,” which served to provide ways to encourage provider–patient communication and transparency in healthcare.

Studies continue to show that good physician–patient communication leads to improved patient satisfaction as well as increased willingness of patients to share pertinent data, adhere to medical treatment, and follow advice. Under these circumstances, patients also are less likely to lodge formal complaints or initiate malpractice suits (Ha & Longnecker, 2010).

These findings support the need for a robust EHR communication campaign continuing long after the EHR implementation period. The introduction of enhanced information technology tools requires clinicians to adapt to using systems that typically do not conform to longstanding personalized workflows, may produce tedious documentation efforts, and may lead to widespread EHR user resistance. Workflows that were once autonomous are now rule-bound and standardization has replaced personalization. Without such communication strategies, EHR user acceptance and enhanced optimization in a postimplementation era is far less likely. Ashley Barrett writes that heavy investment in the implementation of computerized provider order entry (CPOE) may well encounter significant physician resistance. In large part, the clinician revolt occurs because physicians had been insufficiently informed about and inadequately trained in the use of the clinical decision support (CDS) tool being implemented (Barrett, 2017). According to David Bates, MD, in a 2006 Baylor University Medical Center Proceedings paper, failure to achieve leadership support or clinical buy-in from the large number of providers using the system resulted in strong resistance from an overwhelming majority of physicians effectively derailing the entire initiative (Bates, 2006).

Taking into consideration the lessons learned by provider organizations that encountered challenges with health IT implementations over the past decade (Kaplan & HarrisSalamone, 2009), such costly, high-risk experiences— especially in an increasingly patient-centric healthcare industry—have underscored the importance of effective, cross-enterprise, patient-focused communication plans and strategies. The communication must include physicians and clinicians, administrators, clinical informaticists, IT professionals, and the C-Suite—all of whom play critical roles as new technologies are continuously introduced. Effective communication programs continue to be a high priority for hospitals and physician practices that have implemented and are optimizing EHR technology throughout the industry. The “continuously learning” healthcare system in America depends on the involvement of all stakeholders— from patients to providers to management to vendors—to manage communications effectively and share them openly within the entire healthcare community. The purpose of this chapter is to provide an overview of communication strategies that have proven effective in driving the implementation and optimization of EHRs to support needs of patients, physicians, and the caregiver workforce. Sections in the chapter include (a) the importance of communications in health IT initiatives; (b) a focus on patient-centered, transparent care; (c) components of the communication plan; (d) industry considerations (roles of federal agencies, federal regulations, and the burgeoning role of mobile applications, social media, and health information exchange); and (e) chapter review.

IMPORTANCE OF COMMUNICATIONS IN HEALTH IT INITIATIVES

As stated so eloquently by George Bernard Shaw, “The single biggest problem in communication is the illusion that it has taken place.” Nowhere is that more true than in today’s healthcare organizations. In an article published in 2008, Georgia Tech Professor William Rouse states that “healthcare organizations exist as complex adaptive systems with non-linear relationships, independent and intelligent agents, and system fragmentation (Rouse 2008, p. 18). While variation among them is gradually diminishing through increasing standardization of practices and systems, many provider cultures still struggle with decentralization and reliance on disparate legacy systems. This is changing as health information exchange (HIE) technology improves along with the national transition to a valuebased care delivery model. The goals of HIEs are primarily to capture and share information with building pressure to transform the information into actionable intelligence (Van Gilder, 2014). As we have stated, the majority of healthcare organizations across the nation have implemented EHRs, and providers are continuously working to optimize the use and data output of their health IT applications, enhancing the need for effective and tactical communication plans. As the IOM’s (now National Academy of Medicine) Evidence Communication Innovation Collaboration notes, “Communication is central to transforming how evidence is generated and used to improve the effectiveness and value of health care” (IOM, 2012). The rapid changes in diagnostic and treatment options and the increased number of patients, with varying degrees of health literacy, turning to the Internet for health information only serve to underscore the importance of clear and consistent communication. The following section provides insight into the importance of communications in health IT implementation and optimization programs: in governance, the structure of a governance model, and rules for governance efforts.

The Complexity of Healthcare Communications

Healthcare systems face unique challenges in communications. Unlike corporations or other organizations, healthcare involves a variety of stakeholders, often with competing goals and definitions of quality, in what is called a complex adaptive system (Rouse, 2008, p. 18). Complex adaptive systems are described by William B. Rouse as follows:

•   “They are nonlinear and dynamic and do not inherently reach fixed-equilibrium points. As a result, system behaviors may appear to be random or chaotic.” For example, healthcare in America is not governed by a single entity. The federal government has provided incentives to providers to implement and adopt the use of EHRs which have financial impact, while the level and timing of compliance remains within the providers’ prerogative. Within a community, care providers have different owners and financial structures, i.e., for profit, notfor-profit, single-owned entity, multiprovider organization, etc., which affect how frequently enhanced EHR technology fits into their yearly business plans. Communication approaches should be adaptable to environments which will not remain constant.

•   “They are composed of independent agents whose behavior is based on physical, psychological, or social rules rather than the demands of system dynamics.” The physician population best fits this characterization. Physicians have varying preferences and have typically adopted a workflow that is honed over a lengthy period of time and is based on personal preferences. The organization’s influence over the compliance of these physicians to use the EHR as implemented is limited to the physician-perceived benefits of treating patients while using it. Clear delineation and dissemination of benefits for all stakeholders is an effective approach for affecting independent agents in terms of user adoption and in curbing user resistance.

•   “Because agents’ needs or desires, reflected in their rules, are not homogeneous, their goals and behaviors are likely to conflict. In response to these conflicts or competitions, agents tend to adapt to each other’s behaviors.” Again, physicians provide a good example of this scenario. Take the case where two competing physician cardiology practice groups are serving in a hospital that has implemented an EHR system that has built-in standardized decision support rules that reflect leading clinical practices to reduce variation in care. However, the two practice groups cannot agree on the standard of care or do not want to share their practices with the other competing group. Being cognizant of this expected behavior should lead to the inclusion of collaboration opportunities as a part of the communication plan.

•   “Agents are intelligent. As they experiment and gain experience, agents learn and change their behaviors accordingly. Thus, overall system behavior inherently changes over time.” Physicians, other clinicians, clinical informaticists, and administrators are highly degreed professionals who are required to comply with continuous education requirements in order to maintain their certification. This provides a mechanism for sharing leading practices among their colleagues and changing their knowledge, skill level, and attitudes. The challenge is that the rate of change varies across these groups where we find that the impact of technological change is affected by the varying levels of experience with the use of that technology (Weinberg, 2004).

•   “Adaptation and learning tend to result in selforganization. Behavior patterns emerge; they are not designed into the system. The nature of emergent behaviors may range from valuable innovations to unfortunate accidents.” When implementing and optimizing an EHR, we are not just enhancing the use of the technology; we are also enforcing standardized workflows. Although many system users adopt these standardized workflows, there are also those who strive to maintain inappropriate “workarounds” to avoid changing their old behaviors. This requires that clinical and operational leadership be consistent in their use of clear messaging in order to hold their department members accountable for using the EHR technology in the appropriate manner.

•   “There is no single point of control. System behaviors are often unpredictable and uncontrollable, and no one is ‘in charge.’ Consequently, the behaviors of complex adaptive systems can usually be more easily influenced than controlled.” U.S. providers of care reflect a wide spectrum of structures—from small single proprietorships to limited partnerships to large multientity corporations. Some are privately owned; others are government owned and operated, such as the Veterans’ Administration healthcare system. Within healthcare systems, decision-making is rarely a simple, single-threaded event. Creating successful campaigns for ongoing change require understanding the influence structure and leveraging formal and informal communication approaches.

Healthcare is, indeed, a complex adaptive system that cannot be directly controlled. Providers of care must be continuously influenced to do the right thing and to aspire to a common goal. Communications that are planned, strategic, broad-based, and compelling are our best tool for effecting positive changes in our healthcare environment.

Leadership and Governance

The use of EHRs in healthcare organizations continues to drive transformational change in clinical and administrative workflows; organizational structure, i.e., the workflows which exist among physicians, nurses, and administrators; and relationships between the frontline workers, physicians, administrators, and patients (Campbell, Sittig, Ash, Guappone, & Dykstra, 2006; Bartos, Butler, Penrod, Fridsma, & Crowley, 2006). Understanding the risks posed by the disruptive facets of organizational and process change is critical to ensuring the effective implementation and in optimizing the use of EHRs and mitigating risks of failure (Ash et al., 2000) An essential part of risk mitigation in care-delivery reform through health IT is the planning, implementing, and continuous refinement of organizational communication initiatives that help to achieve the aims of an enterprise-wide governance team.

To succeed, responsibilities for such communications initiatives should be shared between health system leaders, champions, informaticists, and those charged with oversight of the implementation and ongoing support of health IT systems, all of whom should have a role to play in governance structures whose processes are grounded in a strong communications strategy. A 2012 Hospital & Health Network magazine cover story entitled “iGovernance” summarized the importance of such an approach for transforming healthcare organizations as, “This IT governance function, guided from the top but carried out by sometimes hundreds of clinical and operations representatives, will be evermore crucial to managing the escalation of IT in healthcare delivery….” In fact, without such an informed governance process, the article states, “IT at many hospitals and health care systems is a haphazard endeavor that typically results in late, over-budget projects and, ultimately, many disparate systems that don’t function well together” (Morrissey, 2012). Accountability begins at the hospital level and rises through the enterprise level. Messaging through electronic, in-person, or video media options from chief executive officers and board members of governance groups solidifies the importance of enterprise-level health IT projects (CHIME, 2010, chap. 9). However, both governance structures and the communications that support them require tailoring depending on the nature of every health system. Communication leaders from the organization should be involved in developing the governance and communication plan to align with or to evolve the culture of the organization.

Governance models in healthcare organizations provide a structure that engages stakeholders to work through critical decisions and ensure that risks associated with changes in policy, technology, and workflow are mitigated to maintain or improve the quality of patient care. A strong example of a working model is provided by the author’s own health system—Tenet Healthcare Corporation. Figure 22.1 illustrates the governance structure used for the Tenet Healthcare IMPACT Program (IMPACT: Improving Patient Care through Technology) and the importance of communications that has been built into all layers. Although this structure was built specifically for the EHR implementation effort, it continues to function well in a postimplementing arena where the focus is on optimization—improving usability and enhancing feature/functionality.

• FIGURE 22.1. EHR Implementation and Oversight Governance

As shown here, a key to the success of this governance structure is a three-tiered organizational structure that engages the corporation, regional operations, and the hospitals themselves in a coordinated effort. Another key success factor was early commitment to key roles, including clinical informaticists, physician champions, training and communications leads, and health IT leads. Binding the program together with unified, shared, and consistent messaging continues to be a foundational strategy that supported all aspects of IMPACT’s execution and continues to guide EHR optimization efforts (Johnson, 2012).

“Governance should be comprised of senior leadership representatives, from all major departments in your organization, who not only understand the technology needs of their respective departments, but are also able to holistically consider IT on behalf of your entire organization.” When determining the leadership of the committee, consider that a clinical operations executive can provide both clinical knowledge and present known impacts of past decisions around workflows and technology selections. Evaluate the value of a “clinical technology subcommittee, to ensure that IT decision-making is thoroughly aligned with everyday clinical practices” (Nine best practices in healthcare IT governance, 2016).

Rules for Governance

Enabling governance committees requires a solid set of rules, since hospitals are matrixed organizations comprising multidisciplinary staff and leaders from across a healthcare organization. A set of “rules to live by” in “iGovernance” is identified in Table 22.1 (Morrissey, 2012).

The following describes each role:

1.   Hardwire the committees: Ensure that the chairs of lower-level committees are participants on the next level of committees. Their role is to bring forward recommendations and issues needing higher-level engagement for resolution.

2.   Set clear levels of successive authority: Committee responsibilities should be well defined so members know issues they can address and issues beyond their level of authority.

3.   Do real work every time: Focus meetings on important issues in need of clinician engagement. If there are no critical items, cancel the meeting and send out status reports electronically.

4.   Form no governance before its time: Recognize that different organizations will not be prepared to embrace a governance structure at the same time or to the same degree as others.

5.   Put someone in charge that can take a stand: The leader of the top committee must be someone that commands respect and possesses operational authority to enact recommendations.

More specifically for health information technology, the Office of the National Coordinator for Health Information Technology (ONC), knowing that this area requires consensus among many stakeholders, lays out milestones and expected outcomes for governance. In their governance framework, ONC presented milestones and expected outcomes, rather than specific steps, for governance. These goals include organizational transparency and trust for all stakeholders (Office of the National Coordinator for Health Information Technology, 2013).

Focus on Customers and Players

Those who are engaged in EHR implementation and EHR enhancement initiatives should also be involved in communications associated with these ongoing programs. Figure 22.2 illustrates the spectrum of customers and players.

• FIGURE 22.2. Focus of Communications

In the provider setting, each of these groups has a different type of communications engagement. The media and vehicles used may be different, but the strategic focus is the same: improving the quality of patient care through strategic adoption and continuous optimization of health IT that is in turn enabled by smart communications.

Patients and Communities. In its 2001 report, Crossing the Quality Chasm: A New Health System for the 21^st Century, the IOM (now known as the National Academy of Medicine) established the need for patient-centered communications and support as part of the six aims for improving healthcare, as noted in the introduction (IOM, 2001). Since then, patientcentric healthcare and the emergence of care-delivery models such as the Patient-Centered Medical Home (PCMH) continue to be central to health reform. Integral to the PCMH concept are seven joint principles established in 2007, one of which calls for a “whole-person orientation.” This means each personal physician is expected to provide for all of a patient’s lifetime health service needs. Lifetime engagement related to health drives the requirement for comprehensive physicianto-patient communications and shared decision-making (Patient-Centered Primary Care Collaborative, 2007).

Such communications are also required to support healthcare reform at the community level, as demonstrated in CMS’s 2011 establishment of the Three Part Aim for the Medicare Shared Savings Program, e.g., the Medicare ACO, with its focus on “better care for individuals and better health for populations” (Federal Register I(C), 2011). In its final rule for the Medicare ACO, CMS mandated the requirement for advancing patient-centered care through accountable care organizations (ACOs), stating “an ACO shall adopt a focus on patient-centeredness that is promoted by the governing body and integrated into practice by leadership and management working with the organization’s health care teams” (Federal Register II(B)(5), 2011).

Physicians. As discussed in the introduction, adoption of EHRs by health systems or practices will not continue to succeed without the endorsement and ownership of the physician community, whose working environment must continue to adapt to changes to long-established workflows. Furthermore, when included from the outset of any health IT transformation initiative, the deployment of “physician champions” are powerful and effective communicators, assisting colleagues through various facets of health IT adoption.

In fact, a Government Health IT story reported that ONC itself, through its regional extension centers, recruited “physician champions” who were well on their way to becoming meaningful users of EHRs to help others in their area get over the hurdles of digitizing their medical records (Mosquera, 2011). Therefore, communications that support not only training initiatives and the management of continuously changing procedural requirements, but also an understanding of the dynamics of legislated healthcare reform itself are important from the earliest stages of health IT adoption.

However, such needs are often unmet. An April 2012 iHealthBeat article reported, for example, that the results of a recent survey of more than 250 hospitals and healthcare systems demonstrated that significant percentages of respondent physicians had inadequate understanding of Stage 1 meaningful use requirements; others cited a lack of training and change-management issues (Providers Make Progress in EHR Adoption, Challenges Remain, 2012). As a result of improved programs and communications in organizations such as regional extension centers, 72% of office-based physicians had used an EHR by the end of 2012, and 66% were planning to or had applied for meaningful use (Bendix, 2013). Today, 78% of physicians own EHRs. These statistics spotlight the continued need to directly engage physicians in health IT implementations through comprehensive communications initiatives that recognize the issues of inadequate training and and ideal end user usability remain.

Developing and supporting physician champions who communicate effectively is essential to long-term adoption and use of the EHR.

Nursing Workforce. For patients in both inpatient and ambulatory settings, nurses constitute the frontline of patient care. But for health systems everywhere, they are also on the frontline of health IT optimization. As Joyce Hahn, Executive Director of the Nursing Alliance for Quality Care, said, “Nurses represent the largest potential users of electronic health records” (Hahn, 2011). “Barriers to EHR adoption included cumbersome system functionalities, lack of interoperability, and hardware issues in a study examining the use of EHR in community settings in the U.S.” (Sockolow, Liao, Chittams, & Bowles, 2012).

The communication and governance approaches require reflection of the potential effect on nurses’ workflow, satisfaction, efficiency, and adoption of the EHR, as well as the importance of considering the interaction between system functionality, usability, and clinician workflow. As with their physician colleagues, therefore, the role of communications is not limited to training nurses in the ongoing use of EHR systems and continuous enhancements, but rather preparing them to engage fully in the design, testing, implementation, and optimization of EHRs to support improved care coordination and continuity of care. Throughout the healthcare industry, health systems’ CIOs are finding that “the success of large IT initiatives depend not only on the willingness of floor nurses to accept enhanced technology, but also on the strength of the IS-nursing management connection” (Mitchell, 2012). Therefore, engaging nurses through communications as both champions and heavy users of health IT is a strategic necessity.

The clinical nurse informaticist has become a key role in ensuring the adoption of EHR technology and the sustainment of benefits. The role is to be a key change agent and communicator to all clinical disciplines by facilitating interdisciplinary workflows and using metrics to drive improvements in patient care.

Nursing Advisory Teams (NAT) can function as decision-making bodies—and NAT’s decisions become the standard for the implementation and optimization of core clinical EHR applications. The consistent way that these leaders communicate their decisions has proved to be integral to promoting safe, quality patient care and improving outcomes for patients and families while supporting the clinical quality initiatives (Johnson, 2012). Nurses and nursing informaticists are key in the communication approach with physicians. Using their established relationships, nurses are perfectly positioned to support the removal of the barriers and concerns physicians typically express in using EHRs, particularly computerized physician order entry. Provision of key talking points and documented benefits should be formally incorporated into the communication plan.

IT Departments and Multidisciplinary Project Teams. IT departments and project teams are responsible for meeting the challenges of new-system introductions as well as managing the continuous upgrades to existing ones. To support this work, the teams’ roles in communication efforts involve engaging clinicians in staff positions, confirming commitments, managing change, and setting EHR deployment and enhancement strategies (CHIME, 2010).

Organizational newsletters are also effective communication vehicles for sharing best practices, success stories, and fostering team cohesiveness in managing health IT initiatives across the healthcare organization. For example, The IMPACT Insider was Tenet’s weekly cross-enterprise e-newsletter for IMPACT program news, which features stories from successful hospital EHR implementations and enhanced functionality go-lives so that hospitals scheduled for these activities can take advantage of the lessons learned (Tenet Healthcare Corporation, 2013). This resulted in improved training processes and enabled hospitals to be better prepared across the board for changes in the system’s EHR applications. The success stories also fostered healthy competition across the health system to surpass previous EHR adoption and quality metrics results. Newsletters should be distributed on a consistent basis, have a recognizable template of content that is always included and are distributed in a variety of communications mediums such as email, print, and internal company Web site.

Patients and Consumers. One imperative in the Patient Protection and Affordable Care Act (ACA) is that providers must encourage patients to engage in their own care and communicate electronically with providers. This is seen as an important step in reducing hospital readmissions for patients who have certain medical conditions, such as diabetes. However, hospitals face some resistance from patients, who would rather speak directly with their physicians or do not understand the benefits of reviewing and maintaining their own health records.

To combat such challenges, hospitals are implementing and refining patient-portals where patients can check their appointments, see their lab results, pay bills, and send secure messages to their physicians. Some hospitals also are interacting directly with private physician offices to ensure follow-up care, which often reduces the need for readmission, and are using telehealth services for high-risk patients. In addition, organizations, such as home nursing agencies, are text messaging to check in on pregnant women and new mothers (Versel, 2013). It should be noted that to ensure success, the language and content of patient communication will be different for that used among clinicians. All of the components of health literacy such as reading level, language preference, and local naming conventions for health conditions are critical considerations when crafting communications for the patients and consumers.

Historically, ONC-sponsored Regional Extension Centers (RECs) served as a communication and support resource for providers as they select, implement, and use EHRs (ONC, Regional Extension Centers, n.d.). These centers assisted in workflow analysis and helped providers connect with their patients using tools like patient portals, intended to be used as a window to their information in their EHR. In taking a look back, in July 2013, more than 147,000 providers were enrolled with a regional extension center. Of these, more than 124,000 had implemented an EHR and more than 70,000 had demonstrated meaningful use. Some 85% of REC-enrolled providers were working with an implemented EHR versus 62% working with an implemented EHR in the general provider population (Office for the National Coordinator of Health Information Technology [ONC], 2013). Clearly the RECs were able to assist provider in meeting early requirements and today that function must be replaced with private industry solutions.

Healthcare System Leadership. As noted in the section on governance, communications led by an executive-level steering committee, often chaired by a health system’s chief executive, operating officer, or chief clinician, represent the beginning and the end of successful health IT implementation processes and continue as a vital component of health IT continuous improvement. The top of the organization not only establishes the size of the investments the organization makes, but also communicates “the broad strategies for IT in advancing business goals and, ultimately, acting on the result of a consistently applied proposal and prioritization regimen” per the 2012 “iGovernance” article cited earlier (Morrissey, 2012).

BUILDING A COMMUNICATIONS PLAN

Communication plans can make significant improvements in our ability to deliver better results in care and outcomes, as evidenced by the following achievement. VCU in Richmond, Virginia was recognized with a 2018 HIMSS Davies Award for working with a throughput and capacity team on several initiatives aimed at improving communication among providers, patients, and families (HIMSS Davies Awards, 2018). As part of their communications plans, they included a checklist to ensure that a plan was in place 20 hours before anticipated discharge, team meetings to discuss each patient, and communication tactics with patients and staff. The enhanced communications plan at VCU resulted in a significant increase in discharges by noon which allowed 1500 new admissions each year. Other health systems also employ email updates, end-user training, superusers who function as subject matter experts, and champions to secure buy-in for continuous system adoption.

To be effective in building communication plans, knowledge of change management is required. By incorporating John Kotter’s model of change, the following steps can be taken to successfully undergo change including using a variety of communication channels (Change Management in EHR Implementation, 2016).

•   Develop a clear vision for what you want the practice to look like in the future: Clearly state what your practice will look like for patients, you, and your staff after a successful EHR implementation.

•   Ensure that staff understand they own the practice’s Future State: Let staff know that each of them will have a role and will be responsible for achieving success.

•   Establish urgency: Communicate to staff WHY change is occurring, the implications for NOT changing, and why it needs to happen as quickly as possible.

•   Build a credible guiding team: Identify practice staff who are credible with their peers and other staff, can engage staff, build and maintain staff commitment, and sustain momentum.

•   Educate all practice staff: Staff must have full knowledge of the CEHRT and understand how using the technology will affect them, their work, and the entire practice. Accurate, timely information will help you control the rumor mill that is inherent in any change initiative. Remember—education and training will be required throughout your change initiative journey.

•   If you are the practice leader, recognize your role to persuade others to adopt a change initiative: Practice leaders must communicate and educate other practice staff on the vision for the Future State and how the practice will achieve that vision through the use of technology and other practice transformation strategies.

•   Help practice staff reach a positive decision to adopt and maintain the change: Promote the use of the guiding team to help staff with day-to-day problems and to provide timely technical assistance. As the practice leader, establish a culture where it is OK for staff to identify problems and concerns while encouraging them to help find practical solutions.

•   Promote confidence and confirmation to sustain the change: Practice leadership must continue to assess, communicate, and intervene, as needed, to promote continued acceptance of the EHR system and other practice transformation initiatives.

•   Create short-term wins: Although goals and objectives are generally considered long-term, acknowledging short-term success is necessary to maintain momentum.

•   Create a culture of continuous quality improvement by evaluating, adjusting, and rewarding staff: Practice leaders must constantly listen to staff, respond to staff needs, evaluate progress, and intervene to help fix things that are not going as planned. This support helps shape both the practice and its evolution toward the Future State.

In addition to managing change, simple tactics are required. A 2009 article by Chad Eckes, CIO and Edgar Staren, MD, entitled, “Communication management’s role in EHR success,” offers other ideas, such as (Eckes & Staren, 2009):

•   Fact Sheets, newsletters, and posters: Collateral tailored to clinician audiences.

•   Road shows: Health IT educational demos of forthcoming system capabilities.

•   Town hall meetings: Opportunities for senior leaders to hold question-and-answer sessions.

•   Standard meeting reports: Detailed status notes of schedules, budget, risks, and progress.

An e-newsletter can be used to communicate success stories from hospitals that are further down the road and have successfully implemented health IT initiatives. Such a vehicle is especially effective for integrated health systems whose hospitals are spread geographically across the country.

Recognition and inclusion of critical stakeholders has withstood the test of time, as described in the 2005 JHIM article by Detlev Smaltz, PhD, FHIMSS, and colleagues, in which they discuss the importance of project communication plans focused on stakeholder groups and meeting their needs. Table 22.2 provides a sample of this plan for three stakeholder groups (Smaltz et al., 2005, p. 53).

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