My primary care physician, the last time I was in for a checkup, had not adopted ePrescribing or started using an electronic health record (EHR). My understanding is that the medical group to which he belongs had not rolled out these capabilities to him yet but was planning to do so. Hopefully, this summer when I see him again he will be plugged into the electronic health record that the group is adopting. Although he may not be happy about having to adapt to this new way of working, I will be happy because it provides another layer of safety for me as a patient. For instance, the risks of miscommunication between my doctor and my pharmacy will be greatly reduced. From my experience as a quality and productivity expert, I know that there will be many benefits for his practice group. As the American Medical Association has shown in a white paper my physician may not be spending much less time handling prescriptions, but his office staff surely will. Overall, there will be a significant gain in productivity and safety for the office.
After examining this example of the adoption of technology at my physician’s office group I recognize several challenges that the group faces, many of which are common to any enterprise adopting new technology faces, including not just healthcare providers but also small businesses and nonprofit organizations:
· Will the new technology increase productivity?
· Will there be a positive return on investment?
· Will the new technology improve patient safety?
· If the technology is adopted, how should it be rolled out or implemented?
These challenges and questions should not be faced by just one person. Rather, a team with effective leadership should undertake the responsibility. The team should use a formal problem solving approach such as Plan-Do-Check-Act to insure success. One of the first things that the team should do is determine why the technology should be adopted. That is, it should clearly state the goals for the adoption. Perhaps the technology is mandated by an accrediting body or government body. This is the case for ePrescribing as CMS has mandated its adoption by the beginning of this year or physicians will be penalized. Another example is the case of my auto mechanic, Arie Nol Auto Center; his business is adopting new technological tools so that he can repair newer autoes that have many complex computer-based electronic components, thus remaining competitive.
The technology should not be adopted if a good case cannot be made for doing so. This is the approach of Toyota Motor Systems, which first maximizes the effectiveness of any of its manufacturing processes that use human labor before adopting any robotic machinery on the floor. Using this approach it has stayed atop of quality when compared to other auto manufacturers. This year Consumers Reports placed Toyota first in 6 or 10 of categories of autoes.
If a team decides to adopt a piece of technology or software it should next set up a detailed plan for adoption. One of the elements of the plan is the identification of measures of success. In the opening illustration I identified two measures: will the technology increase productivity and will it increase patient safety? The AMA stated that it would but each site should go beyond the research reports and measure its own success in implementation. Another measure that a team may want to examine is patient or customer satisfaction. Physicians implementing an EHR should see how it affects patient satisfaction.
Next the team should create a detailed plan for implementing the technology. The plan should include collecting baseline data for the measures of success that it has identified, a detailed listing of steps in the implementation and the identification of a leader of the implementation. For larger businesses or medical groups the steps of implementation should focus on first having a limited rollout of the technology to a group that is eager to try it; this way, if the rollout cannot reach the goals that it has set the failure will be much less costly. Imagine the cost to a business if it does not experiment first and the supplier of the technology mislead the group on the capacity of the technology!
During the implementation of the technology the leader should continuously collect data on the measures that the team has identified. This way adjustments can be made to the implementation if necessary or the project can be terminated if it can be seen that it will end poorly.
If the implementation goes well, the team should celebrate its success and then plan how it can make better use of the technology that it has adopted while it rolls it out to the rest of the business or site. Most new technology is complex and fully implementing its features takes time. In fact, a business or healthcare provider may never use all of the capabilities of a product. For example, I purchased an iPad2 several months ago and I am still learning about some of it capabilities for my business. I anticipate learning much more so as to increase my own productivity.
Before I close, I would like to mention a couple of sites that review medical apps for physicians, not for patients. One that I recently found and recommend is imedicalapps.com. It reviews apps not just for Apple products but also for Android systems and Blackberry. One feature that I found at this site was that the newest iPad will record dictation and add it to documents. This may be very handy for physicians who do not want to enter data into an EHR during a patient encounter. Apple in its App Store for iPad and iPhone has identified what it considers the top 50 apps for medical professionals.