Application of Project Management Concepts to Mitigate Time and Change Process Barriers to EHR Adoption
Application of Project Management Concepts to Mitigate Time and Change Process Barriers to EHR Adoption
The implementation of electronic medical record (EMR) or electronic health record (EHR) systems is perceived to bring quality, efficiency, and safety benefits to healthcare organizations. Despite this, the overall adoption rate of EHRs is low.[1] Based on a systematic review of the literature of EHR adoption, eight main categories of barriers to adoption were found.[2] These barriers include:
• Financial
• Technical
• Time
• Psychological
• Social
• Legal
• Organizational
• Change Process
This post will explore the application of project management concepts to the issues of Time and Change Process barriers. The use of project management methodologies, templates, and an experienced project manager will increase the likelihood of success of the EHR implementation project.
The Time Barrier
The Time barrier describes the negative impact EHR implementation will have on the physician, for training and for increased time to perform data entry. This increases workload and reduces productivity. It can be argued that the time required learning the system may be of benefit in the end in terms of improved efficiencies. Further study to demonstrate the benefits of learning and mastering an EHR may be convincing to improve adoption rates. Many physicians report that the use of EHRs increases the time required for each patient encounter. This is caused by the need to slow down the workflow for data entry or for changes to the usual routine of a patient visit, eg, stopping in the middle of an office visit to enter a medication or lab order. Due to slow typing or other data entry issues, some physicians report spending more time outside of the patient encounter to document the visit. Another barrier associated with Time, is the conversion of paper-based medical records to the electronic system. Some physicians are only comfortable with their own interpretation of their handwritten notes and see the conversion as their responsibility. The time burden of this conversion may outweigh the EHR benefits, and will be seen as a barrier to the adoption in their respective medical practices.
The Change Process Barrier
The implementation of an EHR is often viewed as forcing major changes in the longtime work practices of physicians and other healthcare personnel. The Change Process may mitigate many of the other seven main categories of barriers listed above. However, the change process itself is a major initiative that will impact the workload of EHR users. The change process should address changes to organizational culture, resistance, leadership participation, and provision of incentives. The cultural change goal must be to achieve an environment in full support of an electronic health record system. Provision of incentives is needed in order for EHR users to understand that benefits of the system outweigh its early adoption issues such as the learning curve and decreased productivity. Project champions, senior management, and project leaders will play a pivotal role in the acceptance of an EHR. Each will play a part in the cultural changes that need to occur at the management level, which need to in turn, trickle down to the end users by way of strong and effective communication. As the provision of incentives may drive adoption, so too does motivation provided by leadership.
The Project Management Process
The Project Management Body of Knowledge (PMBOK)® outlines five process groups that should be followed for a project: initiating, planning, executing, monitoring and controlling, and closing.[3] These process groups form a matrix with nine knowledge areas of a project: integration, scope, time, cost, quality, human resource, communications, risk, and procurement management. The Project Integration Management knowledge area is of particular interest in the application of project management to address barriers to EHR adoption because it influences all other areas.[4]
Time Management
Important to a project manager, senior management and other stakeholders is the time allocated to the various tasks of EHR implementation. As it relates to the Time barrier, the Project Manager must ensure appropriate time is planned for participation of end users to increase adoption of the end product. The applicable Process groups are outlined below with bullet lists of Actions to Mitigate Barriers to Adoption.
- PM Knowledge Areas: Project Integration, Time, Cost, Quality, Human Resource, Communications, and Risk Management
- PM Process Groups: Planning, Executing, Monitoring & Controlling
- Planning:
- • Interview stakeholders to determine appropriate amount of time to allocate to various tasks of EHR implementation: user requirements gathering, record conversion, training, creation of help desk support, workflow redesign.
- Planning:
- • Plan appropriate processes and time for conversion of paper-based to electronic records.
- • Map current and to-be workflow processes.
- • Develop Project Plan
- Executing:
- • Communicate with senior management to ensure appropriate human resources are available and utilized for implementation tasks.
- Executing:
- • Ensure system design supports to-be workflow.
- • Provide appropriate level and functional training for the various end user groups.
- • Ensure data entry skills training is available as needed.
- Monitoring & Controlling:
- • Formulate metrics to determine adoption rates.
- Monitoring & Controlling:
- • Utilize failure analysis to determine adoption barriers.
Change Management
The Project Manager must act as a central hub for communications across the project team and up and down the management chain to link management vision to the end users of the EHR system. The Project Manager must identify a project champion from whom much of the influencing will be communicated. The Project Manager and Project Champion must communicate benefits of the EHR to the clinical staff and to patients, and must offer incentives to improve adoption. The applicable Process groups are outlined below with bullet lists of Actions to Mitigate Barriers to Adoption.
- PM Knowledge Areas: Project Integration, Scope, Human Resource, Communications, and Risk Management
- PM Process Groups: Initiating, Planning, Executing, Monitoring & Controlling
- Initiating:
- • Identify project champion(s).
- • Develop Communications Plan for stakeholders.
- Planning:
- • Assess organizational EHR readiness.
- • Identify benefits of EHR adoption.
- • Educate the organization on EHR implementation.
- • Interview stakeholders to determine impact of EHR system adoption on current workflow practices.
- Executing:
- • Communicate system benefits.
- • Provide adoption incentives.
- Monitoring & Controlling:
- • Formulate metrics to determine adoption rates.
- Monitoring & Controlling:
- • Utilize failure analysis to determine adoption barriers.
There are examples of literature to be found that suggests key factors to optimizing EMR implementation success, such a paper is “Best Practices in EMR Implementation: A Systematic Review”
References:
1. Davidson E, Heslinga D. Bridging the IT adoption gap for small physician practices: an action research study on electronic health records. Inf Syst Manag 2007;24(1):15–28.
2. Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res. Published online 2010 Aug 6;10:231.
3. Project Management Institute. A guide to the project management body of knowledge (PMBOK® guide). 4th ed. Newtown Square, PA: PMI Publications; 2008.
4. Houston S. The project manager’s guide to health information technology implementation. Chicago: HIMSS; 2011. p. 27-39. Available from: [1]
Submitted by Dianne Laumann